ABSTRACT
OBJECTIVES: This study investigated whether medical student responses to Script Concordance Testing (SCT) items represent valid clinical reasoning. Using a think-aloud approach students provided written explanations of the reasoning that underpinned their responses, and these were reviewed for concordance with an expert reference panel. METHODS: A set of 12, 11 and 15 SCT items were administered online to Year 3 (2018), Year 4 (2018) and Year 3 (2019) medical students respectively. Students' free-text descriptions of the reasoning supporting each item response were analysed, and compared with those of the expert panel. Response process validity was quantified as the rate of true positives (percentage of full and partial credit responses derived through correct clinical reasoning); and true negatives (percentage of responses with no credit derived through faulty clinical reasoning). RESULTS: Two hundred and nine students completed the online tests (response rate = 68.3%). The majority of students who had chosen the response which attracted full or partial credit also provided justifications which were concordant with the experts (true positive rate of 99.6% for full credit; 99.4% for partial credit responses). Most responses that attracted no credit were based on faulty clinical reasoning (true negative of 99.0%). CONCLUSIONS: The findings provide support for the response process validity of SCT scores in the setting of undergraduate medicine. The additional written think-aloud component, to assess clinical reasoning, provided useful information to inform student learning. However, SCT scores should be validated on each testing occasion, and in other contexts.
Subject(s)
Clinical Reasoning , Educational Measurement/methods , Problem Solving , Students, Medical , Adult , Clinical Competence , Cohort Studies , Female , Humans , Male , Middle Aged , Reproducibility of Results , Speech , Students, Medical/psychology , Surveys and Questionnaires , Thinking/physiology , Young AdultABSTRACT
OBJECTIVES: To investigate the construct validity of Script Concordance Testing (SCT) scores as a measure of the clinical reasoning ability of medical students and practising General Practitioners with different levels of clinical experience. METHODS: Part I involved a cross-sectional study, where 105 medical students, 19 junior registrars and 13 experienced General Practitioners completed the same set of SCT questions, and their mean scores were compared using one-way ANOVA. In Part II, pooled and matched SCT scores for 5 cohorts of students (2012 to 2017) in Year 3 (N=584) and Year 4 (N=598) were retrospectively analysed for evidence of significant progression. RESULTS: A significant main effect of clinical experience was observed [F(2, 136)=6.215, p=0.003]. The mean SCT score for General Practitioners (M=70.39, SD=4.41, N=13) was significantly higher (p=0.011) than that of students (M = 64.90, SD = 6.30, N=105). Year 4 students (M=68.90, SD= 7.79, N=584) scored a significantly higher mean score [t(552)=12.78, p<0.001] than Year 3 students (M = 64.03, SD=7.98, N=598). CONCLUSIONS: The findings that candidate scores increased with increasing level of clinical experience add to current evidence in the international literature in support of the construct validity of Script Concordance Testing. Prospective longitudinal studies with larger sample sizes are recommended to further test and build confidence in the construct validity of SCT scores.
