title: The script concordance test as a measure of clinical reasoning: a national validation study.
abstract: BACKGROUND
  The script concordance test (SCT) is an innovative tool for clinical reasoning assessment. It has previously been shown to be a reliable and valid measure of clinical reasoning among general surgical residents.
  
  
  OBJECTIVE
  To determine if the SCT maintained its validity and reliability when administered on a national level.
  
  
  METHODS
  The test was administered to 202 residents (51 R1, 45 R2, 45 R3, 28 R4, and 33 R5) in 9 general surgery programs across Canada.
  
  
  RESULTS
  The optimized version of the test had a reliability (Cronbach alpha) of .85. Scores increased progressively from R1 (64.5 ± 7.6) to R2 (69.5 ± 5.8) to R3 (69.9 ± 6.7) to R4 (72.0 ± 6.2) with a dip in the R5s (68.3 ± 8.6). The test was able to differentiate junior (R1+ R2 = 66.8 ± 7.2) from senior residents (R3 + R4 + R5 = 70.0 ± 7.3, P = .001) across all the programs.
  
  
  CONCLUSIONS
  The SCT maintained its reliability and validity as a measure of intraoperative clinical reasoning among general surgical residents when administered across multiple centers. We believe that the SCT can be developed to measure clinical reasoning in high-stakes national examinations.
authors.affiliation: Department of Surgery, McGill University, Montreal, Quebec, Canada.
authors.forename: Thamer
authors.initials: T
authors.lastname: Nouh
authors.forename: Marylise
authors.initials: M
authors.lastname: Boutros
authors.forename: Robert
authors.initials: R
authors.lastname: Gagnon
authors.forename: Susan
authors.initials: S
authors.lastname: Reid
authors.forename: Kenneth
authors.initials: K
authors.lastname: Leslie
authors.forename: David
authors.initials: D
authors.lastname: Pace
authors.forename: Dennis
authors.initials: D
authors.lastname: Pitt
authors.forename: Ross
authors.initials: R
authors.lastname: Walker
authors.forename: Daniel
authors.initials: D
authors.lastname: Schiller
authors.forename: Anthony
authors.initials: A
authors.lastname: MacLean
authors.forename: Morad
authors.initials: M
authors.lastname: Hameed
authors.forename: Paola
authors.initials: P
authors.lastname: Fata
authors.forename: Bernard
authors.initials: B
authors.lastname: Charlin
authors.forename: Sarkis H
authors.initials: SH
authors.lastname: Meterissian
mesh_terms: D000328:Adult; D002170:Canada; D002983:Clinical Competence; D003657:Decision Making; D004503:Education, Medical, Graduate / Q000379:methods*; D004521:Educational Measurement / Q000379:methods*; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D008297:Male; D011340:Problem Solving; D018794:Problem-Based Learning