Abstract
Introduction
The script concordance test (SCT) is an innovative tool for clinical reasoning assessment.
It has previously been shown to be a reliable and valid measure of clinical reasoning
among general surgical residents.
Purpose
To determine if the SCT maintained its validity and reliability when administered
on a national level.
Methods
The test was administered to 202 residents (51 R1, 45 R2, 45 R3, 28 R4, and 33 R5)
in 9 general surgery programs across Canada.
Results
The optimized version of the test had a reliability (Cronbach alpha) of .85. Scores
increased progressively from R1 (64.5 ± 7.6) to R2 (69.5 ± 5.8) to R3 (69.9 ± 6.7)
to R4 (72.0 ± 6.2) with a dip in the R5s (68.3 ± 8.6). The test was able to differentiate
junior (R1+ R2 = 66.8 ± 7.2) from senior residents (R3 + R4 + R5 = 70.0 ± 7.3, P = .001) across all the programs.
Conclusions
The SCT maintained its reliability and validity as a measure of intraoperative clinical
reasoning among general surgical residents when administered across multiple centers.
We believe that the SCT can be developed to measure clinical reasoning in high-stakes
national examinations.
Keywords
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References
- The Reflective Practitioner: How Professionals Think in Action.Basic Books, New York, NY1983
- Shifting paradigms of research in medical education.Acad Med. 1990; 65: 622-623
- Online clinical reasoning assessment with the script concordance test: a feasibility study.BMC Med Inform Decis Mak. 2005; 5: 18
- The script concordance test: a tool to assess the reflective clinician.Teach Learn Med. 2000; 12: 189-195
- Scripts and medical diagnostic knowledge: theory and applications for clinical reasoning instruction and research.Acad Med. 2000; 75: 182-190
- A novel method of assessing clinical reasoning in surgical residents.Surg Innov. 2006; 13: 115-119
- On line clinical reasoning assessment with script concordance test in urology: results of a French pilot study.BMC Med Educ. 2006; 6: 45
- Assessing clinical reasoning in pediatric emergency medicine: validity evidence for a script concordance test.Ann Emerg Med. 2009; 53: 647-652
- The script concordance test in radiation oncology: validation study of a new tool to assess clinical reasoning.Radiol Oncol. 2009; 4: 7
- The script concordance test: a new tool assessing clinical judgement in neurology.Can J Neurol Sci. 2009; 36: 326-331
- Is the script concordance test a valid instrument for assessment of intraoperative decision-making skills?.Am J Surg. 2007; 193: 248-251
- Assessment of intraoperative judgment during gynecologic surgery using the script concordance test.Am J Obstet Gynecol. 2010; 203: e1-e6
- Specialty training requirements in general surgery.(Accessed June 11, 2011)
- Objectives of Surgical Foundations Training.http://rcpsc.medical.org/residency/certification/objectives/surgical_foundations_otr_e.pdf(Accessed June 11, 2011)Date: 2010
- Script concordance tests: guidelines for construction.BMC Med Inform Decis Mak. 2008; 8: 18
- Script concordance testing: more cases or more questions?.Adv Health Sci Educ Theory Pract. 2009; 14: 367-375
- Comparison of an aggregate scoring method with a consensus scoring method in a measure of clinical reasoning capacity.Teach Learn Med. 2002; 14: 150-156
- The psychometric properties of five scoring methods applied to the script-concordance test.Acad Med. 2005; 80: 395-399
- Scripts and medical diagnostic knowledge: theory and applications for clinical reasoning instruction and research.Acad Med. 2000; 75: 182-190
- Assessment in the context of uncertainty using the script concordance test: more meaning for scores.Teach Learn Med. 2010; 22: 180-186
- Exploring how students think: a new method combining think-aloud and concept mapping protocols.Med Educ. 2010; 44: 926-935
Article info
Publication history
Received in revised form:
November 22,
2011
Received:
April 18,
2011
Identification
Copyright
© 2012 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
