Abstract：
BACKGROUND: Diagnostic reasoning is an essential skill for optometry practice and a vital part of the curriculum for optometry trainees but there is limited understanding of how diagnostic reasoning is performed in optometry or how this skill is best developed. A validated and reliable self-reflective inventory for diagnostic reasoning in optometry, would enable trainees and registered practitioners to benchmark their diagnostic reasoning skills, identify areas of strength and areas for improvement.
METHODS: A 41 item self-reflective inventory, the Diagnostic Thinking Inventory, used extensively in the medical field was adapted for use in optometry and called the Diagnostic Thinking Inventory for Optometry (DTI-O). The inventory measures two subdomains of diagnostic reasoning, flexibility in thinking and structured memory. Context based changes were made to the original inventory and assessed for face and content validity by a panel of experts. The inventory was administered to two groups, experienced (qualified) optometrists and second-year optometry students to establish validity and reliability of the self-reflective tool in optometry.
RESULTS: Exploratory Factor Analysis uncovered 13 domain specific items were measuring a single construct, diagnostic reasoning. One misfitting item was removed following Rasch analysis. Two unidimensional subdomains were confirmed in the remaining 12 items: Flexibility in Thinking (χ2 = 12.98, P = 0.37) and Structured Memory (χ2 = 8.74, P = 0.72). The \'Diagnostic Thinking Inventory for Optometry Short\' (DTI-OS) tool was formed from these items with the total and subdomain scores exhibiting strong internal reliability; Total score Cα = 0.92. External reliability was established by test-retest methodology (ICC 0.92, 95% CI 0.83-0.96, P < .001) and stacked Rasch analysis (one-way ANOVA, F = 0.07, P = 0.80). Qualified optometrists scored significantly higher (P < .001) than students, demonstrating construct validity.
CONCLUSIONS: This study showed that the DTI-O and DTI-OS are valid and reliable self-reflective inventories to quantify diagnostic reasoning ability in optometry. With no other validated tool to measure this metacognitive skill underpinning diagnostic reasoning a self-reflective inventory could support the development of diagnostic reasoning in practitioners and guide curriculum design in optometry education.
METHODS: A 41 item self-reflective inventory, the Diagnostic Thinking Inventory, used extensively in the medical field was adapted for use in optometry and called the Diagnostic Thinking Inventory for Optometry (DTI-O). The inventory measures two subdomains of diagnostic reasoning, flexibility in thinking and structured memory. Context based changes were made to the original inventory and assessed for face and content validity by a panel of experts. The inventory was administered to two groups, experienced (qualified) optometrists and second-year optometry students to establish validity and reliability of the self-reflective tool in optometry.
RESULTS: Exploratory Factor Analysis uncovered 13 domain specific items were measuring a single construct, diagnostic reasoning. One misfitting item was removed following Rasch analysis. Two unidimensional subdomains were confirmed in the remaining 12 items: Flexibility in Thinking (χ2 = 12.98, P = 0.37) and Structured Memory (χ2 = 8.74, P = 0.72). The \'Diagnostic Thinking Inventory for Optometry Short\' (DTI-OS) tool was formed from these items with the total and subdomain scores exhibiting strong internal reliability; Total score Cα = 0.92. External reliability was established by test-retest methodology (ICC 0.92, 95% CI 0.83-0.96, P < .001) and stacked Rasch analysis (one-way ANOVA, F = 0.07, P = 0.80). Qualified optometrists scored significantly higher (P < .001) than students, demonstrating construct validity.
CONCLUSIONS: This study showed that the DTI-O and DTI-OS are valid and reliable self-reflective inventories to quantify diagnostic reasoning ability in optometry. With no other validated tool to measure this metacognitive skill underpinning diagnostic reasoning a self-reflective inventory could support the development of diagnostic reasoning in practitioners and guide curriculum design in optometry education.
摘要：
背景：诊断推理是验光实践的一项基本技能，也是验光学员课程的重要组成部分，但对如何在验光中执行诊断推理或如何最好地发展这项技能的理解有限。一个经过验证和可靠的自我反思清单，用于验光术中的诊断推理，将使受训者和注册从业人员能够对他们的诊断推理技能进行基准测试，确定优势领域和需要改进的领域。
方法：41项自我反省清单，诊断思维清单，在医学领域广泛使用，适用于验光，并称为验光诊断思维清单（DTI-O）。清单测量诊断推理的两个子域，思维和结构化记忆的灵活性。对原始清单进行了基于上下文的更改，并由专家小组评估了面部和内容的有效性。清单分为两组，有经验的（合格）验光师和二年级验光学生，以建立验光中自我反思工具的有效性和可靠性。
结果：探索性因素分析揭示了13个特定领域的项目正在测量一个单一的结构，诊断推理。在Rasch分析后，删除了一个不合适的项目。在其余12个项目中确认了两个一维子域：思维灵活性（χ2=12.98，P=0.37）和结构记忆（χ2=8.74，P=0.72）。“验光短诊断思维清单”（DTI-OS）工具是由这些项目组成的，总和子领域得分表现出很强的内部可靠性；总分Cα=0.92。外部可靠性是通过测试重测方法（ICC0.92，95％CI0.83-0.96，P<.001）和堆叠Rasch分析（单因素方差分析，F=0.07,P=0.80)。合格的验光师得分明显高于学生(P<.001),证明结构有效性。
结论：这项研究表明，DTI-O和DTI-OS是有效和可靠的自我反思清单，可以量化验光术中的诊断推理能力。由于没有其他经过验证的工具来衡量这种元认知技能作为诊断推理的基础，因此自我反思清单可以支持从业者诊断推理的发展，并指导验光教育中的课程设计。
方法：41项自我反省清单，诊断思维清单，在医学领域广泛使用，适用于验光，并称为验光诊断思维清单（DTI-O）。清单测量诊断推理的两个子域，思维和结构化记忆的灵活性。对原始清单进行了基于上下文的更改，并由专家小组评估了面部和内容的有效性。清单分为两组，有经验的（合格）验光师和二年级验光学生，以建立验光中自我反思工具的有效性和可靠性。
结果：探索性因素分析揭示了13个特定领域的项目正在测量一个单一的结构，诊断推理。在Rasch分析后，删除了一个不合适的项目。在其余12个项目中确认了两个一维子域：思维灵活性（χ2=12.98，P=0.37）和结构记忆（χ2=8.74，P=0.72）。“验光短诊断思维清单”（DTI-OS）工具是由这些项目组成的，总和子领域得分表现出很强的内部可靠性；总分Cα=0.92。外部可靠性是通过测试重测方法（ICC0.92，95％CI0.83-0.96，P<.001）和堆叠Rasch分析（单因素方差分析，F=0.07,P=0.80)。合格的验光师得分明显高于学生(P<.001),证明结构有效性。
结论：这项研究表明，DTI-O和DTI-OS是有效和可靠的自我反思清单，可以量化验光术中的诊断推理能力。由于没有其他经过验证的工具来衡量这种元认知技能作为诊断推理的基础，因此自我反思清单可以支持从业者诊断推理的发展，并指导验光教育中的课程设计。
