From Cases to Constructs: What Real-World Clinical Reasoning Reveals About Gaps in Medical Assessment

• In Event: Advancing Professional Competency and Learning

Abstract

As part of a larger project to develop new assessment formats that measure clinical reasoning for pediatric certification, this qualitative study explores how pediatricians and pediatric residents describe their clinical reasoning in real-world practice. Through 22 semi-structured interviews, we identified five critical dimensions related to clinical reasoning that are essential to competent practice but underrepresented in current multiple-choice–based assessments: diagnostic flexibility, managing uncertainty, collaborative reasoning, contextual judgment, and self-correction. These interviews were conducted to ground early-stage innovation in authentic practitioner experiences and uncover gaps in how clinical reasoning is currently assessed. Framed by situativity theory, the study illustrates the value of practitioner-informed data in guiding assessment reform and supports the shift toward more authentic, context-sensitive evaluations of professional competence.

Author

• Kelly Edwards, American Board of Pediatrics