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Registrar clinical reasoning project outcomes

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In 2018 the GP Synergy Research and Evaluation Unit undertook to measure clinical reasoning skills among GP registrars in their first GP term. We used the Diagnostic Thinking Inventory (DTI), a validated instrument developed in the UK, and planned to observe development of these skills over time.  Registrars who completed the DTI in Term 1 were asked to complete it again at the end of Term 2.

The 41-item DTI was completed online. It results in two domain scores: ‘Flexibility in Thinking’ and ‘Structure of Memory’ (see also the news item about the 2019 clinical reasoning project).  Registrars were offered a report at both time points to help focus their learning around clinical reasoning.

The DTI was completed by 249 (61%) Term 1 registrars. Of these registrars, 105 (42%) completed the follow-up DTI in Term 2. The initial mean scores on both domains for NSW/ACT registrars were comparable with those of UK trainees. Domain scores at Time 1 and Time 2 were compared using paired t-test analysis. Term 2 scores showed significant mean improvement compared to Term 1 on both domains – Flexibility in Thinking (p = 0.002) and Structure of Memory (p<0.001).

The study provides the first available data for Australian GP registrars measuring clinical reasoning using the DTI. These findings suggest the DTI is useful for tracking development of clinical reasoning skills among registrars. Future research will include assessing the validity of DTI in relation to registrar exam performance.