Journal of the Scientific Society

SHORT COMMUNICATION
Year
: 2021  |  Volume : 48  |  Issue : 2  |  Page : 116--117

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


Saurabh RamBihariLal Shrivastava1, Prateek Saurabh Shrivastava2,  
1 Medical Education Unit Coordinator and Member of the Institute Research Council, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet, Tamil Nadu, India
2 Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet, Tamil Nadu, India

Correspondence Address:
Saurabh RamBihariLal Shrivastava
Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV) – Deemed to be University, Thiruporur - Guduvancherry Main Road, Ammapettai, Nellikuppam, Chengalpet - 603 108, Tamil Nadu
India

Abstract

The clinical reasoning competency has been identified as one of the core competencies, which is expected to be attained by an undergraduate medical student. It is difficult to assess the clinical reasoning skills in a standardized manner using the available existing tests. To address these gaps and to ensure standardization of the assessments, a script concordance test (SCT) has been designed and implemented in the field of medical education to assess different domains. The test is designed in such a way that it indicates the manner in which a doctor in authentic settings organizes their knowledge and attempts to solve the problem using clinical reasoning skills. In conclusion, the SCT in the field of medical education can be employed to assess clinical reasoning skills and the ability of the student to interpret the given findings under the clouds of uncertainty. Moreover, owing to the relative ease to create, administer, and score and because of better psychometric indices, each of the medical colleges should explore its possibility and implement it within their settings as a tool for teaching and assessment.



How to cite this article:
Shrivastava SR, Shrivastava PS. Using script concordance tests for assessing clinical reasoning skills of medical students.J Sci Soc 2021;48:116-117


How to cite this URL:
Shrivastava SR, Shrivastava PS. Using script concordance tests for assessing clinical reasoning skills of medical students. J Sci Soc [serial online] 2021 [cited 2022 Oct 5 ];48:116-117
Available from: https://www.jscisociety.com/text.asp?2021/48/2/116/324074


Full Text



 Introduction



The clinical reasoning competency has been identified as one of the core competencies, which is expected to be attained by an undergraduate medical student.[1] It is difficult to assess the clinical reasoning skills in a standardized manner using the available existing tests (like objective structured clinical examinations or long-case presentation), as they are resource intensive and difficult to administer, score, and even standardize the process of assessment.[1],[2] To address these gaps and to ensure standardization of the assessments, script concordance test (SCT) has been designed and implemented in a number of health and allied fields and that too at both undergraduate and postgraduate level of training.[1],[2],[3]

 Script Concordance Test



The SCT has been employed in the field of medical education to assess different domains (namely judgment for diagnosis, investigation, and treatment) of clinical reasoning.[3] These tests permit the assessment of higher order domains – “knows how” and “show how” level in the Miller's pyramid. One of the key attributes of such tests is that there will be some form of deliberate uncertainty to simulate real-life clinical interactions.[2],[3] It is also important to acknowledge that there is no single correct response to the raised questions, rather a set of responses, all of which are acceptable based on the views of the experts which together constitute the reference panel.[2],[4] The test is designed in such a way that it indicates the manner in which a doctor in authentic settings organizes their knowledge and attempts to solve the problem using clinical reasoning skills.[1]

 Components of Script Concordance Test



In such tests, students are given a brief clinical scenario either on paper or electronic medium (the presence of an online option eliminates the possibility that the teacher has to be physically present at the time of assessment), which is subsequently trailed by a set of questions in three sections.[3],[4] The first part deals with provisional diagnosis - investigation options - treatment modality, while in the second part, some additional information (like physical examination findings or comorbidities or some lab or radiological report results) is incorporated, which may or may not affect the diagnosis. Finally, the given question is answered in the last part by the medical student and their response is measured on a 5-point Likert scale.

 Script Concordance Test: Scoring, Reference panel, and Designing



For each question, the response of the student is compared with the aggregate judgment of an expert panel.[2],[3],[4],[5] The answer selected by the maximum number of experts in the panel is regarded as the best response, and if the student also marks the same, they will get maximum credit; otherwise, partial credit is given to the student.[2],[4] We have to acknowledge the fact that in clinical settings, even experts might differ in their interpretation and clinical reasoning, and thus, there will be some kind of disparity.[2],[3] In general, it has been envisaged that the reference panel should comprise 10–15 subject experts, who are familiar with the medical curriculum to ensure that a credible scoring pattern is accomplished.[3] The designing of each of the SCT is a skilled task and it should not be a case of mere recall of facts but is designed based on a blueprint, in such a way that provision of additional information should trigger the students to re-think about their initial diagnosis or proposed investigation or the line of management.[3],[4],[5],[6]

 Use of Script Concordance Test in Medical Training



These tests can be used in both formative and summative assessments, but we have to always consider the purpose of the test (namely assess performance or high-stakes decisions or renew the certification), the students (undergraduate or postgraduate or doctor), and subject specialty.[5] The findings of the studies have shown that SCT tends to have good feasibility, validity, and reliability; nevertheless, for attaining good reliability, the test should last for 60–90 min and should comprise 25 cases, with each having three subquestions.[3],[4],[5] Some of the studies have also demonstrated that the utility of SCT is assessing the challenging domains of medical ethics and professionalism.[3],[5],[6]

 Conclusion



The SCT in the field of medical education can be employed to assess clinical reasoning skills and the ability of the student to interpret the given findings under the clouds of uncertainty. Moreover, owing to the relative ease to create, administer, and score and because of better psychometric indices, each of the medical colleges should explore its possibility and implement it within their settings as a tool for teaching and assessment.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Mzoughi K, Zairi I, Kedous MA, El Mhamdi S, Ben Dhiab M, Mghaieth F, et al. Script concordance test as a sanctionnal evaluation in cardiology. Tunis Med 2018;96:330-4.
2Custers EJ. The script concordance test: An adequate tool to assess clinical reasoning? Perspect Med Educ 2018;7:145-6.
3Lubarsky S, Dory V, Duggan P, Gagnon R, Charlin B. Script concordance testing: From theory to practice: AMEE guide no. 75. Med Teach 2013;35:184-93.
4Roberti A, Roberti Mdo R, Pereira ER, Costa NM. Script concordance test in medical schools in Brazil: Possibilities and limitations. Sao Paulo Med J 2016;134:116-20.
5Wan SH. Using the script concordance test to assess clinical reasoning skills in undergraduate and postgraduate medicine. Hong Kong Med J 2015;21:455-61.
6Kazour F, Richa S, Zoghbi M, El-Hage W, Haddad FG. Using the script concordance test to evaluate clinical reasoning skills in psychiatry. Acad Psychiatry 2017;41:86-90.