title: Assessment of clinical reasoning: A Script Concordance test designed for pre-clinical medical students.
abstract: 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.
  
  
  OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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.
authors: Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA. ahumbert@iupui.edu
authors: Aloysius J
authors: AJ
authors: Humbert
authors: Mary T
authors: MT
authors: Johnson
authors: Edward
authors: E
authors: Miech
authors: Fred
authors: F
authors: Friedberg
authors: Janice A
authors: JA
authors: Grackin
authors: Peggy A
authors: PA
authors: Seidman