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How do cognitive processes influence script concordance test responses?

Nada Gawad1,2, Timothy J Wood2, Lindsay Cowley2

  • 1Division of General Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.

Medical Education
|November 13, 2020
PubMed
Summary
This summary is machine-generated.

The script concordance test (SCT) assesses clinical decision-making (CDM) by comparing learner and expert thought processes. Understanding test-takers' cognitive processes, including comprehension and knowledge gaps, enhances the validity of SCT for CDM assessment.

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Area of Science:

  • Medical Education
  • Cognitive Psychology

Background:

  • The Script Concordance Test (SCT) evaluates clinical decision-making (CDM) by aligning learner thought processes with expert 'scripts'.
  • Understanding the cognitive processes influencing SCT responses is crucial for validating its use in assessing CDM.

Purpose of the Study:

  • To gather response process validity evidence for the SCT.
  • To investigate the cognitive processes influencing SCT responses and determine if it accurately tests CDM.

Main Methods:

  • Administered SCT cases to residents and staff surgeons.
  • Conducted semi-structured cognitive interviews using retrospective verbal probing.
  • Independently analyzed and coded interview data to identify influencing themes.

Main Results:

  • Cognitive interviews revealed variability in CDM and highlighted reliance on experience-based scripts and conscious deliberation.
  • Test-takers' responses were influenced by term comprehension, information needs, disagreement with management, knowledge gaps, and social desirability.
  • Dual process theory principles were observed in decision-making.

Conclusions:

  • SCT rationale is influenced by comprehension, knowledge, social desirability, scripts, and deliberation.
  • Incorporating verbal rationale enhances CDM assessment depth.
  • Improving SCT construction and combining it with verbal responses can optimize its use for CDM assessment.