title: Assessing clinical reasoning in optometry using the script concordance test.
abstract: BACKGROUND
  Clinical reasoning is central to any health profession but its development among learners is difficult to assess. Over the last few decades, the script concordance test (SCT) has been developed to solve this dilemma and has been used in many health professions; however, no study has been published on the use of the script concordance test in optometry. The purpose of this study was to develop and validate a script concordance test for the field of optometry.
  
  
  METHODS
  A 101-question script concordance test (27 short clinical scenarios) was developed and administered online to a convenience sample of 23 second-year and 19 fourth-year students of optometry. It was also administered to a reference panel of 12 experienced optometrists to develop the scoring key. An item-total correlation was calculated for each question. Cronbach's alpha coefficient was used to evaluate the script concordance test reliability and a t-test compared the two groups.
  
  
  RESULTS
  A final 77-question script concordance test was created by eliminating questions with low item-total correlation. Cronbach's alpha for this optimised 77-question script concordance test was 0.80. A group comparison revealed that the second-year students' scores (n = 23; mean score = 66.4 ± 7.87 per cent) were statistically lower (t = -4.141; p < 0.001) than those of the fourth-year students (n = 19; mean score = 75.5 ± 5.97 per cent).
  
  
  CONCLUSIONS
  The online script concordance test developed for this study was found to be both reliable and capable of discriminating between second- and fourth-year optometric students. These results demonstrate that the script concordance test may be considered as a new tool in the optometric educators' assessment arsenal. Further studies will be needed to cover additional levels of professional development.
authors.affiliation: École d'optométrie, Université de Montréal, Montréal, Canada. caroline.faucher@umontreal.ca.
authors.forename: Caroline
authors.initials: C
authors.lastname: Faucher
authors.affiliation: VU, Montréal, Canada.
authors.forename: Marie-Pier
authors.initials: MP
authors.lastname: Dufour-Guindon
authors.affiliation: Clinique d'optométrie Lapointe et Qualizza, Montréal, Canada.
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Lapointe
authors.affiliation: Centre de pédagogie appliquée aux sciences de la santé, Faculté de médecine, Université de Montréal, Montréal, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Gagnon
authors.affiliation: Centre de pédagogie appliquée aux sciences de la santé, Faculté de médecine, Université de Montréal, Montréal, Canada.
authors.forename: Bernard
authors.initials: B
authors.lastname: Charlin
mesh_terms: D004521:Educational Measurement / Q000379:methods*; D006801:Humans; D009907:Optometry / Q000193:education*; D015203:Reproducibility of Results
keywords: assessment; clinical reasoning; education; optometry; script concordance test