puzzle test: a tool for non-analytical clinical reasoning assessment

most contemporary clinical reasoning tests typically assess non-automatic thinking. therefore, a test is needed to measure automatic reasoning or pattern recognition, which has been largely neglected in clinical reasoning tests. the puzzle test (pt) is dedicated to assess automatic clinical reasoning in routine situations. this test has been introduced first in 2009 by monajemi et al in the olympiad for medical sciences students.pt is an item format that has gained acceptance in medical education, but no detailed guidelines exist for this test’s format, construction and scoring. in this article, a format is described and the steps to prepare and administer valid and reliable pts are presented. pt examines a specific clinical reasoning task: pattern recognition. pt does not replace other clinical reasoning assessment tools. however, it complements them in strategies for assessing comprehensive clinical reasoning.