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Updated: Jun 1, 2026

Problem-Solving Before Instruction (PS-I): A Protocol for Assessment and Intervention in Students with Different Abilities
Published on: September 11, 2021
Assessment of clinical reasoning: A Script Concordance test designed for pre-clinical medical students
Aloysius J Humbert1, Mary T Johnson, Edward Miech
1Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA. ahumbert@iupui.edu
Background:
The Script Concordance test (SCT) measures clinical reasoning in the context of uncertainty by comparing the responses of examinees and expert clinicians. It uses the level of agreement with a panel of experts to assign credit for the examinee's answers.
Aim:
This study describes the development and validation of a SCT for pre-clinical medical students.
Methods:
Faculty from two US medical schools developed SCT items in the domains of anatomy, biochemistry, physiology, and histology. Scoring procedures utilized data from a panel of 30 expert physicians. Validation focused on internal reliability and the ability of the SCT to distinguish between different cohorts.
Results:
The SCT was administered to an aggregate of 411 second-year and 70 fourth-year students from both schools. Internal consistency for the 75 test items was satisfactory (Cronbach's alpha = 0.73). The SCT successfully differentiated second- from fourth-year students and both student groups from the expert panel in a one-way analysis of variance (F(2,508) = 120.4; p < 0.0001). Mean scores for students from the two schools were not significantly different (p = 0.20).
Conclusion:
This SCT successfully differentiated pre-clinical medical students from fourth-year medical students and both cohorts of medical students from expert clinicians across different institutions and geographic areas. The SCT shows promise as an easy-to-administer measure of "problem-solving" performance in competency evaluation even in the beginning years of medical education.
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