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The script concordance test as a measure of clinical reasoning: a national validation study

The script concordance test as a measure of clinical reasoning: a national validation study. Nouh et al The American Journal of Surgery 2012; 203: 530-534. SCT-Clinical Reasoning national validation study. SCT- prior single center study, differentiated between Jr and Sr SR

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The script concordance test as a measure of clinical reasoning: a national validation study

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  1. The script concordance test as a measure of clinical reasoning: a national validation study Nouh et al The American Journal of Surgery 2012; 203: 530-534

  2. SCT-Clinical Reasoningnational validation study • SCT- prior single center study, differentiated between Jr and Sr SR • To determine validity and reliability, administered on a national level • Test given to 202 Residents - 9 Gen Surg programs across Canada • SCT distinguishes intra-operative decision making skills of Jr. vs Sr. gen surgical residents

  3. SCT • Based on script theory from cognitive psychology • Uses authentic clinical scenarios to compare a trainee’s judgment skills with those of experts • SCT scores- intended to reflect respondents’ competence, interpreting clinical data under conditions of uncertainty

  4. Script TheoryElements • Clinical encounter: • perceiving features of situation • assessing relevant hypotheses • checking for sx & signs that confirm or refute hypotheses • Using related knowledge to guide investigations + Rx Charlin et al Med Educ 2007: 41,1178-1184

  5. Script TheoryElements • Provides explanations for how events are processed • Fields of computer science and psychology • Organization of experiences in script-like formations • Referred to in future • Understand same or similar new situations

  6. SCTA Practical + Reliable Instrument • 2004 Radiology • 2006 Surgery • 2009 Radiation oncology • Neurology • Pediatric emerg med • 2011 Dermatology • ENT • Preclinical med students • 2012 Geriatrics

  7. SCTExample

  8. SCT- Natl Study Methods • Res level of training: post grad yrs 1-5 • Jr = R1-2 • Sr= R3,4,5 • Test development: 9 prgrm dir; scenario,2-6(?)s • Ans key: 5 pt scale, ranging from (-2), comp contra-ind to (+2), comp indic • 153 (?)s

  9. SCT- Natl Study MethodsScoring • Every choice sel by expert→ Credit • 22 Gen Sur experts took test • Credit for each answer was transformed proportionally to get a max score of 1 for the modal experts’ choice on each item • Stat analysis

  10. SCT- Natl Study MethodsResults • Scores  progressively from R1to R4 with a dip in R5 • Test differentiated R1+2 from R3+4+5 • Site of training had sig effect on scores

  11. Discussion • Limitations • No observed drop in variability from R1 to R5 • Choice of scale unsettled • Scores depend on cohort of experts • Influence of generalist vs subspecialist • Item production • Setting of “passing” scores • Advantages • Ease of administration; online • Reliable; valid (?)

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