Empirical Analysis of the Three-Dimensional Structure of Clinical Reasoning Ability and Construction of Targeted Python Case Library from the Perspective of Cluster Analysis

Nana MENG; Lu SUN; Shenquan CHEN; Wenwen GUO; Haisi LIANG

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Article Navigation > Journal of Kunming Medical University > 2025 > Accepted Manuscript

Nana MENG, Lu SUN, Shenquan CHEN, Wenwen GUO, Haisi LIANG. Empirical Analysis of the Three-Dimensional Structure of Clinical Reasoning Ability and Construction of Targeted Python Case Library from the Perspective of Cluster Analysis[J]. Journal of Kunming Medical University.

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Empirical Analysis of the Three-Dimensional Structure of Clinical Reasoning Ability and Construction of Targeted Python Case Library from the Perspective of Cluster Analysis

1.
Department of Obstetrics and Pediatrics，Clinical Medical School，Zhaoqing Medical College，Zhaoqing Guangdong 526000
2.
Department of Pediatrics，Guangzhou Women and Children’s Medical Center，Guangzhou Guangdong 510623
3.
Department of Surgery，Zhaoqing First People’s Hospital，Zhaoqing Guangdong 526000，China

Received Date: 2025-08-29

Abstract

Abstract

Objective To clarify the internal structure and population characteristics of clinical reasoning ability among clinical medical interns, construct targeted training tools, and provide evidence for clinical reasoning education reform. Methods A multi-center stratified sampling method was adopted to select 321 clinical medical interns from 6 hospitals. A self-designed "Clinical Thinking Ability Assessment Questionnaire" was used for the survey. Correlation analysis and factor analysis were conducted to explore the ability structure, while K-means clustering was applied to identify group characteristics. Based on these findings, a Python case library was designed and its effectiveness was verified through a randomized controlled trial. Results Clinical thinking ability demonstrated a three-dimensional structure comprising "diagnostic association, decision-making for treatment planning, and knowledge application, " with a cumulative variance explanation rate of 84.21%. Multi-population validation showed good model fit （χ²/df = 2.31～2.45, RMSEA = 0.065～0.069）. Clustering analysis identified three ability groups: high （33.33%）, moderate （42.68%）, and low （23.99%）, with statistically significant differences across all dimensions （P < 0.01）. After intervention with the case library, the improvement of core shortcoming dimensions in the intervention group was significantly higher than that in the control group （diagnostic relevance of high-ability group: F = 32.67; scheme decision-making ability of medium-ability group: F = 48.32; knowledge application ability of low-ability group: F = 41.56, all P < 0.01）. Conclusion The three-dimensional structure and population characteristics of clinical thinking ability provide targeted guidance for precision training. The Python case library facilitates the transition of clinical thinking cultivation toward "data-driven" approaches.
- Clinical thinking ability,
- Three-dimensional structure,
- Cluster analysis,
- Targeted case library,
- Python technology

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References(22)

References

[1]	王颖, 李海潮. 临床医学教育中临床思维能力的培养与评估[J]. 中国高等医学教育, 2021, 41(3): 7-8.
[2]	李梦琪, 张艳, 王建国. 临床医学实习生临床思维同质化问题及破解路径[J]. 中华医学教育探索杂志, 2023, 22(5): 659-663.
[3]	张雪, 刘清泉, 吴疆. 临床医学专业学生临床思维能力评价指标体系的构建与验证[J]. 医学教育杂志, 2022, 42(8): 705-709.
[4]	赵文静, 刘敏, 陈立明. 传统案例教学在临床思维培养中的局限性及优化策略[J]. 医学教育管理, 2024, 10(2): 215-219.
[5]	Chen A, Wang L, Li H. Application of artificial intelligence in clinical reasoning training for medical students[J]. Journal of Medical Education and Curricular Development, 2023, 10: 1-8.
[6]	Zhang Y, Li J, Wang H. Python-based intelligent case bank for clinical reasoning training: A pilot study[J]. BMC Medical Education, 2023, 23(1): 45-53. doi: 10.1186/s12909-023-04016-7
[7]	Schuwirth LW, Van der Vleuten CP, Driessen EW. Update on the framework for assessing clinical reasoning: Expanding core dimensions and indicators[J]. Medical Education, 2022, 56(8): 789-802.
[8]	宋一帆, 韩庆烽, 肖卫忠, 等. 基于德尔菲法的全科住院医师临床思维能力评价体系构建研究[J]. 中国全科医学, 2025, 28(1): 77-82.
[9]	王璐瑶, 陈明华, 李红梅. 基于Delphi法与因子分析的临床思维评估指标体系构建[J]. 中国卫生事业管理, 2023, 40(8): 622-625.
[10]	刘佳, 张伟, 王丽娟. 临床思维案例考核的评分者信度验证与标准制定[J]. 医学教研究与实践, 2024, 32(3): 389-393.
[11]	Liu M, Chen X, Zhang W. K-means clustering for stratifying clinical thinking ability among medical interns[J]. Medical Education Online, 2022, 27(1): 2089456.
[12]	刘畅, 王浩, 陈晨. 聚类分析在医学教育学习者能力分层与精准教学中的应用[J]. 医学教育管理, 2023, 9(3): 356-361.
[13]	陈雨桐, 马晓峰, 刘畅. Scikit-learn与Flask在医学教育案例库中的集成应用[J]. 信息技术与信息化, 2024(6): 187-190.
[14]	Schuwirth L W, van der Vleuten C P. Assessment of clinical reasoning: A review of methods[J]. Medical Education, 2013, 47(10): 952-975.
[15]	Wang L, Zhao J, Huang Y. Validation of a three-dimensional clinical reasoning model: Recognition, decision-making, and application[J]. Academic Medicine, 2024, 99(2): 312-318.
[16]	周琳, 吴敏, 张雪峰. 基于聚类分析的临床医学实习生分层培养模式研究[J]. 中国高等医学教育, 2024(4): 92-93.
[17]	Humbert A J, Johnson M T, Miech E, et al. Assessment of clinical reasoning: A Script Concordance test designed for pre-clinical medical students[J]. Med Teach, 2011, 33(6): 472-477. doi: 10.3109/0142159X.2010.531157
[18]	Chen L, Yang S, Li Q. Effectiveness of a targeted case library for clinical reasoning training in pediatrics[J]. Pediatric Education, 2023, 49(5): 489-496.
[19]	李佳琪, 王浩, 张艳. 智能化案例库与传统案例教学的效果对比研究[J]. 医学教育管理, 2024, 10(4): 498-502.
[20]	闻德亮, 李鸿鹤, 宋鑫智. 基于科学引文数据库的医学教育研究前沿分析(2024)[J]. 中华医学教育杂志, 2024, 44(10): 726-732.
[21]	Eva K W. What every teacher needs to know about clinical reasoning[J]. Med Educ, 2005, 39(1): 98-106. doi: 10.1111/j.1365-2929.2004.01972.x
[22]	Zhao H, Wang Q, Zhang L. Eye-tracking technology for assessing clinical reasoning: A systematic review[J]. Journal of Medical Education, 2022, 56(4): 356-364.

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