title: Measuring gains in the clinical reasoning of medical students: longitudinal results from a school-wide script concordance test.
abstract: OBJECTIVE
  Medical students develop clinical reasoning skills throughout their training. The Script Concordance Test (SCT) is a standardized instrument that assesses clinical reasoning; test takers with more clinical experience consistently outperform those with less experience. SCT studies to date have been cross-sectional, with no studies examining same-student longitudinal performance gains.
  
  
  METHODS
  This four-year observational study took place between 2008 and 2011 at the Indiana University School of Medicine. Students in two different cohorts took the same SCT as second-year medical students and then again as fourth-year medical students. The authors matched and analyzed same-student data from the two SCT administrations for the classes of 2011 and 2012. They used descriptive statistics, correlation coefficients, and paired t tests.
  
  
  RESULTS
  Matched data were available for 260 students in the class of 2011 (of 303, 86%) and 264 students in the class of 2012 (of 289, 91%). The mean same-student gain for the class of 2011 was 8.6 (t[259] = 15.9; P < .0001) and for the class of 2012 was 11.3 (t[263] = 21.4; P < .0001). Each cohort gained more than one standard deviation.
  
  
  CONCLUSIONS
  Medical students made statistically significant gains in their performance on an SCT over a two-year period. These findings demonstrate same-student gains in clinical reasoning over time as measured by the SCT and suggest that the SCT as a standardized instrument can help to evaluate growth in clinical reasoning skills.
authors: Dr. Humbert is associate professor of clinical emergency medicine, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana. Dr. Miech is a research scientist in health services research, Regenstrief Institute, Indianapolis, Indiana.
authors: Aloysius J
authors: AJ
authors: Humbert
authors: Edward J
authors: EJ
authors: Miech
mesh_terms: D002983:Clinical Competence; D015331:Cohort Studies; D004504:Education, Medical, Undergraduate; D004521:Educational Measurement; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D013337:Students, Medical