TITLE:
Development of a Method to Measure Clinical Reasoning in Pediatric Residents: The Pediatric Script Concordance Test
AUTHORS:
Suzette Cooke, Jean-François Lemay, Tanya Beran, Amonpreet Sandhu, Harish Amin
KEYWORDS:
Clinical Reasoning, Script Concordance Test, Post-Graduate Medical Education, Assessment
JOURNAL NAME:
Creative Education,
Vol.7 No.6,
May
9,
2016
ABSTRACT: Introduction: The Script Concordance Test (SCT) is an assessment method of clinical reasoning skills. SCT is designed to assess a candidate’s ability to reason when faced with decisions encountered in the three phases of clinical decision-making: diagnosis, investigation and treatment. Challenges have been raised related to psychometric properties of SCT scores. Data about accept- ability of the SCT method are also needed. Objectives: 1) To examine the validity of a Pediatric Script Concordance Test (PSCT) in discriminating clinical reasoning ability between junior postgraduate year (PGY) 1 - 2 and senior PGY 3 - 4 pediatric residents, and pediatricians, 2) To determine if higher reliability could be achieved by applying specific test design strategies to the PSCT and 3) To explore trainees’/physicians’ acceptability of the PSCT. Methods: A 24-case/137 question PSCT was administered to 91 residents from four Canadian training centers. Each resident’s PSCT was scored based on the aggregate responses of 21 pediatricians (Panel of Experts (POE)). ANOVA was used to compare across the 3 levels of experience. Reliability was calculated using Cronbach’s α coefficient. Participants completed a post-test survey about the acceptability of PSCT. Results: Overall, a statistical difference in performance was noted across all levels of experience, F = 22.84 (df = 2); p α) was 0.85. Participants expressed keen interest and engagement in the PSCT. Conclusions: PSCT is a valid, reliable, feasible and acceptable method to assess the core competency of clinical reasoning. We suggest the PSCT may be effectively integrated into formative residency assessment and with increasing exposure, experience and refinement may soon be ready to pilot within summative assessments in pediatric medical education.