Appraisal of medical students' diagnostic ability in relation to their learning achievement and self-confidence as a learner

What kind of factors may influence medical students' development of the dia gnostic reasoning process.' This retrospective study is based on a 6-year h istorical series of consecutive classes. It comprised two phases, one befor e and another after some changes in course processes. Diagnostic reasoning was assessed with the diagnostic-thinking inventory (DTT) that measures two aspects: degree of flexibility in thinking and degree of knowledge structu re in memory. This instrument was applied in the sih-th semester to a total of 362 students of both sexes, by consecutive sampling over the 6-year ser ies. Learner's descriptors and measures of academic achievement were also o btained The results revealed average DTI scores equivalent to 68% of the ma ximum sum, without significant gender differences in the group. Two Indicat ors were more significantly associated with the total score: the level of t he learner's self-confidence and the mark obtained in a problem-solving cli nical test. Students belonging to the course renewal phase (last biennium) showed significantly higher scores when compared with the students in the p revious phase. A multiple regression analysis identified three predicting f actors that independently explained 16% of the variation of the total DTI s core: level of self-confidence, problem-solving mark, and study phase. The findings confirm the usefulness of the inventory for a quick appraisal of d iagnostic reasoning. They also suggest that learner's characteristics and c ontextual factors in learning contribute to the score of diagnostic ability with that instrument.