Development, validation and evaluation of key feature questions : For assessing clinical resoning skills of final year medical students in medicine at bahria university of helath sceicnes

Date of Award

10-2025

Degree Type

Thesis

Degree Name

Master of Health Professions Education

First Advisor

Dr Sadia Masood

Second Advisor

Dr Sara Shakil

Third Advisor

Dr Syeda Kausar Ali

Department

Educational Development

Abstract

Clinical reasoning (CR) is a core competency in medical education and a key factor in determining competent clinical practice. Traditional formats at Bahria tend to emphasize lower level cognitive skills and often do not explicitly target clinical reasoning or real-world problem solving. Examinations based on key features utilizing three different formats with a clinical reasoning focus were created to fill this gap. Key features questions, such as extended matching questions (EMQs), short answer questions (SAQS), and MCQs with a CR focus created to fill this gap. They were tested for validity and reliability among final-year medical students.
Objective: The study aimed to develop. validate. and evaluate a Key Feature Based Examination (KFQ) to measure the CR skills of final year medical students in medicine. emphasizing content validity. reliability. and item performance.
Methods: A validation study was conducted after Ethical approval at Bahria University Health Sciences. involving 108 final-year MBBS students after purposive sampling. KFQ were constructed around key,decision-making points in common medial scenarios. Six subject experts evaluated the items for relevance and clarity using the Content Validity Index (CVI) and Content Validity Ratio (CVR). The validation of the tools guided by the unified framework of validity by Messick's. Reliabiliy was assessed through Cronbach's alpha and Inter-rater Reliability (IRR). Student perceptions were gathered through a structured feedback survey.
Results: The CVI values indicated strong expert agreement with most items scoring above the acceptable threshold of 0.78. The overall reliabilit,v of the KFQ assessment. as measured by Cronbach's alpha (α = 0.760), demonstrated good intemal consistency, whhile the IRR (lCC = 0.726) reflected satisfactory inter-rater agreement. In terms of internal analysis the KFQ showed an overall balanced distribution of difficulty and discrimination indices. This process helped enhance both the reliability and construct validitly of the test. The SAQ format demonstrated slightly higher mean scores compared to EMQs and MCQs. suggesting that SAQs amy have better captured students, ability' to apply CR across multiple clinical items. Finally, student feedback analysis indicated overall positive perceptions toward the KFQ-based assessment.
Conclusion: The Key Feature-based assessment was found to be valid and reliable in evaluating CR skills among final-year medical students. Examination based on Key Features provided a comprehensive assessmentt of applied clinical knowledge. supporting the integration of KFQ into undergraduate medical assessmentt. The integration of multiple item formats provided an opportunity, to assess in depth different domains of CR skills. making the KIQ tools promising approach for evaluating higher-order cognitive skills in undergraduate medical education.

First Page

1

Last Page

123

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