Clinical reasoning of Indonesian medical students as measured by diagnostic thinking inventory

Introduction: Clinical reasoning skill is one of the most important skills for a good physician. A number of instruments have been developed to measure this skill, including the Diagnostic Thinking Inventory (DTI). Several studies have been carried out to measure its reliability and validity; however, evidence of its construct validity is still limited. This study aims to explore the construct validity of the DTI and to measure the clinical reasoning skills of Indonesian medical students.

Method: The subjects were 1135 medical students and 60 general practitioners. They were asked to complete the Indonesia version of DTI.

Results: Overall reliability of the DTI was .74 and .50 for the flexibility in thinking scale and .70 for the evidence of knowledge structure scale. A one way unrelated ANOVA showed that there were significant differences in the DTI score (F = 7.097, p = .000), flexibility of thinking subscale (F = 6.111, p = .000), and the evidence of knowledge structure subscale (F = 5.306, p = .000) with the scores increasing over the period of medical training and practical experiences. The biggest proportion of subjects in all groups reached the highest level (scored between 171-246/level 5).

Conclusion: This study has shown the construct validity of DTI in a different linguistic context. It also has shown the level of clinical reasoning skills of Indonesian medical students varied with year of study.