The Script Concordance Test in anesthesiology: Validation of a new tool for assessing clinical reasoning

Assessing clinical reasoning in anesthesiology: Making the case for the Script Concordance Test

“…Such studies have been conducted in students of numerous medical specialties, including pediatric emergency medicine [8], radiology [9], otorhinolaryngology [10], gynecology [11], radio-oncology [12], internal medicine [13], surgery [14] and neurology [15]. The article by Ducos et al, [2] in the present issue of Anaesthesia Critical Care & Pain Medicine concludes that SCTs can also discriminate between experts, junior trainees, and senior students in the field of anesthesiology. The SCT has also been studied outside of medicine per se and has proven reliable in nursing education [16] and for veterinarians [17].…”

“…or should also take into account the need for teamwork and collaborative skills which are necessary to bring the patient's situation to a proper resolution is a matter of opinion and taxonomy. In this issue of Anaesthesia Critical Care & Pain Medicine, the reader will find two articles pertaining to the evaluation of clinical reasoning, or, in a broader sense, problem solving in anesthesiology trainees [1,2]. An original note about these articles is that the authors used, as evaluation tool, the Script Concordance Test (SCT), a method that has been the subject of many publications worldwide, a sizable part of them authored by pioneer researchers at the Université de Montré al [3,4].…”

Using the script concordance test to assess clinical reasoning skills in undergraduate and postgraduate medicine

“…Empirical evidence supporting the construct validity based on progression of SCT scores with clinical experience from undergraduate students to postgraduate training has also been reported. 2,5,24,30,31 The construct validity of SCT has been questioned because of the logical inconsistencies as a result of partial credit scoring methodology making it possible for a hypothesis to be simultaneously more likely and less likely. 32 Nonetheless, a certain degree of variability in panel scores has been shown to be a key determinant of the discriminatory power of the test and allows richness of thinking about clinical cases.…”

“…Initial pilot examinations can be set as a formative exercise to enhance candidates' feedback and learning. 24 Further collaboration with other institutions to develop, score, and share question items can ensure effective and efficient delivery of such examinations.…”

“…Script concordance test can also be used to identify borderline students with suboptimal clinical reasoning skills for appropriate remedial measures such as bedside teaching, tutorials, or clinical simulations. 24 For summative assessment purposes, particularly where there is not a large pool of SCT items, it is important to avoid constructing irrelevant variance in SCT scores, by not releasing or discussing post-examination, the expected responses (based on expert panel's responses), and the associated score for each of the answer options in SCT items.…”