Case Study: The Clinical Problem Question
Many interviews for Basic Training positions include one or more questions which ask candidates to respond to a clinical scenario and in so doing demonstrate their clinical knowledge or lack of clinical knowledge. On the surface it is a reasonably valid approach to take. After all, the candidate’s core role will probably be assessing and dealing with clinical problems daily.
There are some problems, however, with using a clinical problem as the basis for an interview question.
Firstly, the extent of required medical and clinical knowledge for training positions is broad and there are better assessments (such as a Multiple-Choice Examination or Clinical Problem-Solving Test) for gaining a more valid assessment of the extent of a candidate’s clinical knowledge.
Secondly, designing clinical problems for interview questions may risk development of a scenario which is very common (so that most candidates can be reasonably deemed to know about such problems), in which case the candidate responses may not be particularly discriminatory. Alternatively, it can risk a scenario which is uncommon, in which case there will be difficulties in discriminating between candidates who have good breadth of knowledge (true positives), ones who have narrow knowledge but happen to know about the particular problem (false positive), candidates who have good breadth of knowledge but did not study the particular problem (false negatives), and those candidates who have generally poor clinical knowledge (true negatives).
Thirdly, to give sufficient information about a clinical problem, it is often required that the information be provided to the candidate in a written format. This can take up precious time in the interview whilst the candidate reads the question. This final issue can be countered by asking candidates to arrive early so that they can read through the problem, but this then raises the issue as to whether candidates then need to be supervised or whether using “Dr Google” is an acceptable tool for dealing with clinical problems. A reading station in a Multiple Mini Interview may provide another alternative for addressing this problem.
Clinical problems can still be of use in an interview so long as what is being assessed is not just clinical knowledge but other abilities such as clinical reasoning skills. They may, for example, provide useful insights as to how candidate’s think or reason.
Another use for a clinical problem may be to provide an example to a candidate to allow them to provide their own example of past behaviours. For example:
“In our hospital it is not unusual to have a scenario where a male patient over 60 presents to the emergency department with unstable diabetes and non-specific chest pain with no obvious changes on their electrocardiogram.
“Can you give us an example of a scenario that sounds like this? It should be something you have dealt with yourself in the past? Describe the scenario and how you managed it?”