Using script concordance tests for assessing clinical reasoning skills of medical students

Background: The Script Concordance (SC) approach was used as an alternative test format to measure the presence of knowledge organization reflective in one’s clinical reasoning skills (i.e., diagnostic, investigation and treatment knowledge).Methods: The present study investigated the reliability and validity of a 40-item paediatric version of the SC test with three groups representing 53 medical students (novices), 42 paediatric residents (intermediates) and 11 paediatricians (experts).Results: A comparison between scoring techniques based on experts’ ratings of the items showed internal reliability coefficients from .74 for the one-best answer up to .78 for alternative scoring techniques. An ANOVA showed an increase in test performance from medical students through to expert paediatricians (F(2,103) = 84.05, p < .001), but did not differentiate between the postgraduate year 1 to 3 paediatric residents. A large effect size (Cohen’s d) difference of 1.06 was found between medical students and residents total SC test scores.Conclusions: These results support other findings indicating the SC test format can be used to differentiate between the clinical reasoning skills of novices, intermediates and experts in paediatrics. An alternative scoring method that includes one best answer and partial marks was also supported for grading SC test items.

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The Use of a Modified Script Concordance Test in Clinical Rounds to Foster and Assess Clinical Reasoning Skills

Journal of Veterinary Medical Education ◽

10.3138/jvme-2021-0090 ◽

2021 ◽

Author(s):

Jordan D. Tayce ◽

Ashley B. Saunders

Keyword(s):

Clinical Reasoning ◽

Assessment For Learning ◽

Learning Activity ◽

Free Text ◽

Valuable Insight ◽

Script Concordance Test ◽

Concordance Test ◽

Script Concordance ◽

Reasoning Skills ◽

Clinical Reasoning Skills

The development of clinical reasoning skills is a high priority during clinical service, but an unpredictable case load and limited time for formal instruction makes it challenging for faculty to foster and assess students’ individual clinical reasoning skills. We developed an assessment for learning activity that helps students build their clinical reasoning skills based on a modified version of the script concordance test (SCT). To modify the standard SCT, we simplified it by limiting students to a 3-point Likert scale instead of a 5-point scale and added a free-text box for students to provide justification for their answer. Students completed the modified SCT during clinical rounds to prompt a group discussion with the instructor. Student feedback was positive, and the instructor gained valuable insight into the students’ thought process. A modified SCT can be adopted as part of a multimodal approach to teaching on the clinic floor. The purpose of this article is to describe our modifications to the standard SCT and findings from implementation in a clinical rounds setting as a method of formative assessment for learning and developing clinical reasoning skills.

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