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Experts' responses in script concordance tests: a response process validity investigation.

Matthew Lineberry1, Eduardo Hornos2, Eduardo Pleguezuelos2

  • 1Zamierowski Institute for Experiential Learning, University of Kansas Medical Center and University of Kansas Health System, Kansas City, Kansas, USA.

Medical Education
|February 20, 2019
PubMed
Summary
This summary is machine-generated.

The script concordance test (SCT) may not accurately reflect clinical reasoning due to inconsistent expert responses and varied interpretations of simulated patient cases. Alternative uses, like guiding learning assessments, are suggested.

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Area of Science:

  • Medical Education
  • Clinical Reasoning Assessment

Background:

  • The script concordance test (SCT) is used to assess clinical reasoning but lacks response process validity evidence.
  • Divergent expert beliefs on how clinical data influence proposed actions in simulated cases require investigation.

Purpose of the Study:

  • To explore the response processes of experts on an SCT scoring panel.
  • To understand experts' reasoning regarding new clinical data and proposed actions in simulated patient cases.

Main Methods:

  • 10 Argentine gastroenterologists re-answered 15 SCT cases after 9 months.
  • Experts provided reasoning and reacted to other experts' perspectives.

Main Results:

  • Experts often disregarded proposed actions or sought more data (20% and 36% respectively).
  • Significant disagreement existed on action suitability before new data was introduced (89%).
  • Expert responses showed limited consistency over time (kappa = 0.33) and were influenced by local practice environments.

Conclusions:

  • Expert response processes challenge the classical interpretation of SCT scores.
  • Alternative applications for SCT-like methods, such as formative learning assessments, are proposed.