Online clinical reasoning assessment with the Script Concordance test: a feasibility study

BACKGROUND: The script concordance (SC) test is an assessment tool that measures capacity to solve ill-defined problems, that is, reasoning in context of uncertainty. This tool has been used up to now mainly in medicine. The purpose of this pilot study is to assess the feasibility of the test delivered on the Web to French urologists. METHODS: The principle of SC test construction and the development of the Web site are described. A secure Web site was created with two sequential modules: (a) The first one for the reference panel (n = 26) with two sub-tasks: to validate the content of the test and to elaborate the scoring system; (b) The second for candidates with different levels of experience in Urology: Board certified urologists, residents, medical students (5 or 6(th )year). Minimum expected number of participants is 150 for urologists, 100 for residents and 50 for medical students. Each candidate is provided with an individual access code to this Web site. He/she may complete the Script Concordance test several times during his/her curriculum. RESULTS: The Web site has been operational since April 2004. The reference panel validated the test in June of the same year during the annual seminar of the French Society of Urology. The Web site is available for the candidates since September 2004. In six months, 80% of the target figure for the urologists, 68% of the target figure for the residents and 20% of the target figure for the student passed the test online. During these six months, no technical problem was encountered. CONCLUSION: The feasibility of the web-based SC test is successful as two-thirds of the expected number of participants was included within six months. Psychometric properties (validity, reliability) of the test will be evaluated on a large scale (N = 300). If positive, educational impact of this assessment tool will be useful to help urologists during their curriculum for the acquisition of clinical reasoning skills, which is crucial for professional competence

The script concordance test in radiation oncology: validation study of a new tool to assess clinical reasoning

<p>Abstract</p> <p>Background</p> <p>The Script Concordance test (SCT) is a reliable and valid tool to evaluate clinical reasoning in complex situations where experts' opinions may be divided. Scores reflect the degree of concordance between the performance of examinees and that of a reference panel of experienced physicians. The purpose of this study is to demonstrate SCT's usefulness in radiation oncology.</p> <p>Methods</p> <p>A 90 items radiation oncology SCT was administered to 155 participants. Three levels of experience were tested: medical students (n = 70), radiation oncology residents (n = 38) and radiation oncologists (n = 47). Statistical tests were performed to assess reliability and to document validity.</p> <p>Results</p> <p>After item optimization, the test comprised 30 cases and 70 questions. Cronbach alpha was 0.90. Mean scores were 51.62 (± 8.19) for students, 71.20 (± 9.45) for residents and 76.67 (± 6.14) for radiation oncologists. The difference between the three groups was statistically significant when compared by the Kruskall-Wallis test (p < 0.001).</p> <p>Conclusion</p> <p>The SCT is reliable and useful to discriminate among participants according to their level of experience in radiation oncology. It appears as a useful tool to document the progression of reasoning during residency training.</p

Script Concordance Tests: Guidelines for Construction

International audienc

Introducing recent medical graduates as members of Script Concordance Test expert reference panels: what impact?

Published: 08/08/2016The Script Concordance Test (SCT) is being increasingly used in professional development in clinical reasoning, with linear progression in performance in SCT’s observed with increasing clinical experience. One of the limiting factors for the SCT is potential burnout in expert reference panel (ERP) members, which we have attempted to address by the introduction of recent medical graduates as panel members. We sought to evaluate the effect of introducing recent medical graduates in to our ERP’s on pass/fail decisions in the final clinical reasoning examination of the 6-year undergraduate program of the University of Adelaide, Australia. We engaged an ERP comprising 50 faculty members from three collaborating universities and 13 recent medical graduates to answer on line an identical 20 case scenario, 50 question multidisciplinary SCT twice 6 months apart. The questions were used in high stakes end of year assessment of 5th year medical students (n=132). The pass mark set by the experienced, specialist members of the panel was 49.6% and this increased to 50.4% by addition of recent medical graduates to the panel. This difference would have had no effect on fail rates estimated from the data from the cohort of 132 medical student candidates. In the context of assessment of clinical reasoning in medical programs, recent medical graduates are suitable members of SCT ERP’s, and their contribution can enrich the panel and might help to minimise risk of burnout of more experienced faculty.Paul Duggan, Bernard Charli

On line clinical reasoning assessment with Script Concordance test in urology: results of a French pilot study

BACKGROUND: The Script Concordance test (SC) test is an assessment tool that measures the capacity to solve ill-defined problems, that is, reasoning in a context of uncertainty. This study assesses the feasibility, reliability and validity of the SC test made available on the Web to French urologists. METHODS: A 97 items SC test was developed based on major educational objectives of French urology training programmes. A secure Web site was created with two sequential modules: a) The first one for the reference panel to elaborate the scoring system; b) The second for candidates with different levels of experience in urology: Board certified urologists, chief-residents, residents, medical students. All participants were recruited on a voluntary basis. Statistical analysis included descriptive statistics of the participants' scores and factorial analysis of variance (ANOVA) to study differences between groups' means. Reliability was evaluated with Cronbach's alpha coefficient. RESULTS: The on line SC test has been operational since June 2004. Twenty-six faculty members constituted the reference panel. During the following 10 months, 207 participants took the test online (124 urologists, 29 chief-residents, 38 residents, 16 students). No technical problem was encountered. Forty-five percent of the participants completed the test partially only. Differences between the means scores for the 4 groups were statistically significant (P = 0.0123). The Bonferroni post-hoc correction indicated that significant differences were present between students and chief-residents, between students and urologists. There were no differences between chief-residents and urologists. Reliability coefficient was 0.734 for the total group of participants. CONCLUSION: Feasibility of Web-based SC test was proved successful by the large number of participants who participated in a few months. This Web site has permitted to quickly confirm reliability of the SC test and develop strategy to improve construct validity of the test when applied in the field of urology. Nevertheless, optimisation of the SC test content, with a smaller number of items will be necessary. Virtual medical education initiative such as this SC test delivered on the Internet warrants consideration in the current context of national pre-residency certification examination in France

Summative assessment of 5th year medical students' clinical reasoning by script concordance test: requirements and challenges

Background: The Script Concordance Test (SCT) has not been reported in summative assessment of students across the multiple domains of a medical curriculum. We report the steps used to build a test for summative assessment in a medical curriculum. Methods: A 51 case, 158-question, multidisciplinary paper was constructed to assess clinical reasoning in 5th-year. 10–16 experts in each of 7 discipline-based reference panels answered questions on-line. A multidisciplinary group considered reference panel data and data from a volunteer group of 6th Years, who sat the same test, to determine the passing score for the 5th Years. Results: The mean (SD) scores were 63.6 (7.6) and 68.6 (4.8) for the 6th Year (n = 23, alpha = 0.78) and and 5th Year (n = 132, alpha =0.62) groups (p < 0.05), respectively. The passing score was set at 4 SD from the expert mean. Four students failed. Conclusions: The SCT may be a useful method to assess clinical reasoning in medical students in multidisciplinary summative assessments. Substantial investment in training of faculty and students and in the development of questions is required.Paul Duggan and Bernard Charli

The disappearance of the "revolving door" patient in Scottish general practice: successful policies

&lt;b&gt;Background&lt;/b&gt; We describe the health of "revolving door" patients in general practice in Scotland, estimate changes in their number over the timescale of the study, and explore reasons for changes, particularly related to NHS and government policy.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Methods&lt;/b&gt; A mixed methods predominantly qualitative study, using a grounded theory approach, set in Scottish general practice. Semi-structured interviews were conducted with professional key informants, 6 Practitioner Services staff who administer the GP registration system and 6 GPs with managerial or clinical experience of working with "revolving door" patients. Descriptive statistical analysis and qualitative analysis of patient removal episodes linked with routine hospital admissions, outpatient appointments, drug misuse treatment episodes and deaths were carried out with cohorts of "revolving door" patients identified from 1999 to 2005 in Scotland.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Results&lt;/b&gt; A "revolving door" patient is removed 4 or more times from GP lists in 7 years. Patients had complex health issues including substance misuse, psychiatric and physical health problems and were at high risk of dying. There was a dramatic reduction in the number of "revolving door" patients during the course of the study.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Conclusions&lt;/b&gt; "Revolving door" patients in general practice had significant health problems. Their numbers have reduced dramatically since 2004 and this probably resulted from improved drug treatment services, pressure from professional bodies to reduce patient removals and the positive ethical regulatory and financial climate of the 2004 GMS GP contract. This is a positive development for the NHS

Bi-cultural bi-national benchmarking and assessment of clinical reasoning in Obstetrics and Gynaecology

Published: 23/06/2016Background: The Script Concordance Test (SCT) is being increasingly used in professional development in clinical reasoning (CR) in postgraduate medicine. On-line delivery favours multi-institutional collaboration. Objectives: To establish if: 1) SCT questions developed in the French-speaking University of Montreal were readily adaptable for use in the English-speaking University of Adelaide 2) expert reference panels (ERP) from both institutions could be used interchangeably 3) student cohorts would perform similarly in the same test. Study Design: 82 SCT questions based on 27 clinical cases in Obstetrics and Gynaecology were developed in Montreal and run in a volunteer cohort of year 3 and year 4 medical students (n=154). Local faculty translated all questions, selecting 31 based on 17 clinical cases for use in summative examinations a year 5 student cohort in Adelaide (n=123). Results: Mean (SD) percentage scores using each ERP key were: 74.2 (6.4) versus 73.3 (6.9), p<0.001 for Adelaide students and 72.5 (7.8) versus 70.6 (8.8), p<0.001 for Montreal students. The correlation coefficients were ≥ 0.928 (p<0.001). Conclusions: Student cohorts performed similarly regardless of which ERP key was used. With appropriate editorial control, SCT’s can be effectively shared between French and English-speaking institutions located in different hemispheres. Potential advantages include the creation of an international database of assessment items, benchmarking and cost sharing.Paul Duggan, Patricia Monnier, Alphonse Roex, Marie-Josée Bédard, Bernard Charli

Getting the basics right-staging in head and neck cancer

The cornerstone of oncology literature and therefore medical practice is the ability to compare outcomes of treatment modalities for different stages of cancer