Script concordance testing to understand the hypothesis processes of undergraduate nursing students : multiple case study

Background: Albeit essential to clinical reasoning (CR), strategies for generating student nursing clinical hypotheses at the time of transition to professional practice are underdeveloped. While script concordance testing (SCT) has been shown to be a valid and reliable assessment tool for CR in nursing education, the thought processes including the hypothesis processes involved in choosing an answer is not examined. Methods: A multiple case study was used to understand the complex phenomenon of students’ hypothesis activation and confrontation with the combined use of SCT questions and the think-aloud method. Structured individual interviews were conducted. Results: A total of 18 students, nine first-year and nine third-year students participated in the study. The results show that the students demonstrate certain CR cognitive processes, including early representation of a clinical situation, semantic transformation of data, and hypothesis comparison. Conclusions: Results suggest promoting knowledge articulation aloud and the frequent use of micro-judgments to compare and differentiate hypotheses involving the uncertainty of clinical practice, which underpin learning in successive layers

Addressing the development of both knowledge and clinical reasoning in nursing through the perspective of script concordance : an integrative literature review

Background: In clinical practice settings, where situations of uncertainty exist, clinical reasoning is situated or contextualized. It calls upon honed knowledge, wherein nurses rely on highly developed and organized knowledge networks known as “mental scripts”. Methods: The aim of this integrative literature review was to address ways to develop knowledge and clinical reasoning in nursing through the use of mental scripts, and to tackle these pedagogical considerations. The literature search was performed using the following data sources: CINHAL, MEDLINE Google Scholar, PubMed, ProQuest, PsycINFO, Scopus and Web of Science. Results: Script concordance, which optimizes situated clinical reasoning, ties in with the sociocognitive perspective of cognitive companionship, using role models to guide the development of knowledge and clinical reasoning in nursing. Moreover, this perspective proposes implementing new teaching strategies, which focus on situational awareness, reflective acuity, and cognitive dialogue. Conclusions: The perspective of script concordance allows a foreseeable innovative formulation of practices favourable to the development of clinical reasoning in nursing

Élaboration et évaluation des propriétés psychométriques d'un instrument d'évaluation du raisonnement clinique empreint de Human caring

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal

L’apprentissage du raisonnement clinique infirmier par une stratégie éducative numérique basée sur la concordance de scripts

Cette thèse doctorale porte sur l’apprentissage du raisonnement clinique infirmier (RCI) par une stratégie éducative numérique qui s’appuie sur la notion de la concordance de scripts. Elle repose sur un devis de recherche multiméthode visant le développement, la mise à l’essai et l’évaluation de la stratégie éducative auprès d’étudiants au premier cycle de formation universitaire en sciences infirmières à l’Université de Montréal. La thèse, qui comporte cinq chapitres, est rédigée selon le mode de présentation par articles. L’étude a été orientée par un cadre de référence incluant la théorie des scripts relevant des sciences cognitives de l’apprentissage et l’approche pédagogique de compagnonnage cognitif. Un devis de recherche multiméthode intégrant un devis de recherche-développement, une étude descriptive qualitative et une étude de cas multiples a été privilégié. Des experts collaborateurs (n = 5), des experts-panélistes (n = 12) et des étudiants (n = 45) ont participé à l’étude. Les résultats montrent que l’approche de recherche-développement a contribué à bonifier l’élaboration de la stratégie éducative numérique basée sur la concordance de scripts (SENBCS) et à assurer sa validation. Globalement, les étudiants ont apprécié la SENBCS, notamment la rétroaction variée et formative d’experts et l’opportunité d’apprendre la priorisation des hypothèses infirmières. L’intégration d’un devis descriptif a soutenu l’identification des stratégies d’apprentissage chez les étudiants lors de l’utilisation de la SENBCS. Les résultats montrent que les étudiants ont sollicité certaines stratégies d’apprentissage cognitives de traitement et d’exécution des données ainsi que des stratégies métacognitives d’autorégulation. Les résultats de l’étude de cas multiples montrent que les étudiants mettent en évidence certains processus cognitifs du RCI, à l’aide des vignettes du test de concordance de scripts (TCS) et de la pensée à voix haute, notamment : la représentation précoce d’une situation clinique, la transformation sémantique des données et la confrontation d’hypothèses. La SENBCS améliore la visibilité des savoirs d’experts, lesquels sont absents dans une classe traditionnelle ou même en stage clinique. Cela constitue une avancée certaine que de considérer l’apport des stratégies éducatives numériques dans les programmes de formation universitaire en sciences infirmières ou dans d’autres programmes pour soutenir le développement du raisonnement clinique. L’étude a permis de mettre à profit une riche documentation scientifique entourant l’élaboration de la SENBCS. Les résultats informent au regard de son utilisation efficiente afin qu’elle soit complémentaire à d’autres stratégies éducatives pour soutenir plus globalement la complexité de l’apprentissage du RCI. Des retombées pour les cinq domaines de la pratique infirmière sont générées par cette étude, elles offrent certaines pistes qui pourraient favoriser l’apprentissage du RCI. L’une d’elles vise à favoriser l’articulation des connaissances et de solliciter fréquemment des microjugements pour confronter et différencier des hypothèses relevant de l’incertitude de la pratique clinique, sous-entendant des apprentissages par couches successives.This doctoral thesis focuses on learning clinical reasoning in nursing using a digital educational strategy based on the notion of script concordance. The thesis is based on a multi-method research design aimed at developing, testing and evaluating an educational strategy for undergraduate students in nursing at the University of Montreal. The thesis, which has five chapters, is written according to the mode of presentation by journal articles. This study was guided by a framework based on script theory, from cognitive science, and the pedagogical approach of cognitive companionship. A multi-method research design integrating a research-development approach, a descriptive qualitative study and a multiple case study was used. Collaborative experts (n=5), expert panellists (n=12) and students (n=45) participated in the study. The results show that the research-development approach enriched the development of a digital education strategy based on script concordance (DESBCS) while ensuring its validation. Overall, students appreciated the DESBCS, especially the varied and formative feedback received from experts while learning how to prioritize nursing hypotheses. A descriptive qualitative study design facilitated the identification of student learning strategies. Results demonstrate that when using a DESBCS, students used certain cognitive apprenticeship strategies for data processing and execution as well as for metacognitive self-monitoring. The results from the multiple case study show that students practised certain cognitive processes of clinical reasoning in nursing, using the vignettes from the script concordance test (SCT) and a think aloud approach, in particular: the early representation of a clinical situation, the semantic transformation of data and the confrontation of hypotheses. The DESBCS improves the visibility of expert knowledge usually absent in a traditional class or even in clinical training. It is a definite advancement to consider the contribution of digital educational strategies in university nursing education programs, or in other programs, to support the development of clinical reasoning. This study highlights the use of a wealth of scientific documentation surrounding the development of DESBCS. Study results inform instructors about effective DESBSC use to make it complementary to other educational strategies by supporting the complexities of learning clinical reasoning in nursing. Implications for the five domains of nursing practice emerge from this study and offer avenues to promote learning and development of clinical reasoning in nursing. One of these aims to promote knowledge articulation and the frequent solicitation of microjudgments to confront and differentiate hypotheses that arise from the uncertainty of clinical practice, implying learning in successive layers

Le développement du jugement clinique infirmier lors d’activités en simulation clinique haute fidélité (SCHF): Rapport de recherche expérimentation

Autre éditeur: Pôle de spécialisation et d’innovation en sant

Learning strategies used by undergraduate nursing students in the context of a digitial educational strategy based on script concordance : a descriptive study

Background: the digital educational strategy based on script concordance is an educational method that has been attracting increasing attention in healthcare education programs to fostering the development of clinical reasoning. It includes a digitized Script Concordance Test with incorporated expert feedback. However, the learning strategies required of students in the context of its use remain unknown. Objective: This study aimed to identify the learning strategies that undergraduate nursing students need to use in the context of the digital educational strategy based on script concordance. Method: A qualitative descriptive design was used to identify student learning strategies. Data was collected using an online questionnaire and semi-directed focus group interviews. Bégin’s taxonomy provided the framework for linking the data collected to learning strategies required of students. Results: Forty-four students participated in the study. Results show that when using a digital educational strategy based on script concordance, students are called to rely on their nascent scripts in order to select the data in short ill-defined clinical vignettes, evaluate new information repeatedly, anticipate microjudgments, and thus, gradually increase their knowledge and refine their scripts. Viewing the experts’ feedback and consulting the referencing tools helped students self-monitor their knowledge, a key metacognitive strategy to learning clinical reasoning. Completed individually or with peers, the digital educational strategy could be used to learn a particular concept or as an integrative activity before an evaluation. Conclusion: This original study has allowed us to link nursing clinical reasoning teaching conditions to the learning strategies used to develop this competency. Study results inform instructors about digital educational strategy based on script concordance to make it complementary with other educational strategies to better support complex learning of nursing clinical reasoning

Script concordance approach in nursing education

Background The script concordance approach aims at triggering judgments in simulated contexts of uncertainty. Problem Nursing students need to be prepared to manage the uncertainty of clinical practice. Approach The purpose of this article is to describe the theoretical foundation and the pedagogical use of the script concordance approach, as well as to present the current state of nursing evidence on the subject. The script concordance approach includes (1) script concordance testing, which is a quantitative examination that evaluates clinical reasoning; (2) a face-to-face script concordance activity; and (3) a digital educational strategy based on script concordance delivered via an online teaching/learning platform that aims to support clinical reasoning development. Conclusions Relying on questioning and experts' modeling, the script concordance offers an innovative pedagogical approach that approximates the uncertainty of clinical practice

Examination of the Aggregate Scoring Method in a Judgment Concordance Test

The use of the aggregate scoring method for scoring concordance tests requires the weighting of test items to be derived from the performance of a group of experts who take the test under the same conditions as the examinees. However, the average score of experts constituting the reference panel remains a critical issue in the use of these tests. This study aims to examine the distribution of panelists’ scores on the judgment concordance test (JCT) using the aggregate scoring method. A test composed of 32 items was developed and completed by 14 experts. The mean scores of the experts were calculated based on whether their choices of response categories for the 32 JCT items were included or excluded. Descriptive statistics were conducted. The mean scores of the experts showed a difference of 5.76%, depending on the approach used. The approach that excludes the experts’ response category choices was found to be more penalizing (76.16%±8.9) than the method including their own choices (81.92%±8.1). It is recommended that researchers make their computational approaches explicit in addition to outlining the distribution of expert results retained for the purpose of determining scores in the concordance tests. Further research is required to refine our understanding of the quality of score-setting in this type of test

Élaboration d'une autoévaluation par concordance de jugement professionnel des enseignants

PAREA n°PA-2017-025La présente recherche a été subventionnée par le ministère de l'Éducation et de l'Enseignement supérieur dans le cadre du Programme d'aide à la recherche sur l'enseignement et l'apprentissage (PAREA).Comprend des références bibliographiques

Scoring methods in script concordance tests : an exploratory psychometric study

BACKGROUND:Despite the increasingly popular role of script concordance test (SCT) scoring methods in the evaluation of clinical reasoning, studies examining these methods in nursing are relatively scarce. This study explored the psychometric properties of five SCT scoring methods. METHOD:An SCT was administered to 12 experts and 43 learners. Scores were calculated using five methods and descriptive statistics. Differences in scores were assessed with the Mann-Whitney U test, and Spearman correlation coefficients were calculated for the different methods. RESULTS:The median scores of both experts and learners differed substantially according to the scoring method used. Learners' scores were statistically different from experts' scores (p < .01) for each method. Spearman coefficients (range, 0.44 to 0.95) were positive for the different methods. CONCLUSION:Further research is needed to refine the influence of SCT scoring methods for use in certifying assessment of clinical reasoning in nursing. [J Nurs Educ. 2023;62(10):549–555.