Clinical Process Modeling: An Approach for Enhancing the Assessment of Physicians' Clinical Reasoning

Robert J. Cook*, Steven J. Durning

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


To ensure the validity of test interpretation and use, educators must be able to connect the dots between the tasks examinees perform on a test and the decisions educators make based on the results of that test. Toward that end, in this article, the authors introduce an approach called clinical process modeling, which combines clinical reasoning and principled assessment design. The goal of this approach is to better align test item development with the assessment of physicians' application of knowledge. Clinical process modeling involves creating complex decision trees that can mirror clinical reasoning illness scripts and include the steps and pathways a physician could take to address a specific patient presentation from initial presentation to correct diagnosis and therapy. Once created, these decision trees can be used to inform the assessment development process. To illustrate this approach, the authors describe how they developed one such clinical process model for a common presentation of low back pain from the field of internal medicine. They explain the steps they took to develop their model and the corresponding test item. They conclude by discussing potential future directions and additional implications for this work, emphasizing how clinical process models can be used to inform other educational processes and clinical practice.

Original languageEnglish
Pages (from-to)1317-1322
Number of pages6
JournalAcademic Medicine
Issue number9
StatePublished - 1 Sep 2019
Externally publishedYes


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