15 Assessing the Clinical Reasoning Skills of Emergency Medicine Clerkship Students Using a Script Concordance Test

Abstract

Fourth‐year medical students in emergency medicine (EM) clerkships are evaluated by various methods. Multiple choice examinations are frequently used to supplement clinical evaluations. These are limited in their ability to evaluate students’ clinical reasoning skills. The Script Concordance Test (SCT) is an innovative assessment method developed to evaluate clinical reasoning. The SCT consists of a series of clinical vignettes, each followed by a series of specific questions that present an additional piece of data (a lab result, a physical finding, etc.) to the student. The students then indicate how the additional data affect their thinking regarding a possible diagnosis, an investigational strategy, or a therapeutic intervention, using a 5 point Likert scale (‐2,‐1,0,+1,+2). SCT questions have no single correct answer; instead, students receive credit based upon the level of agreement between their answers and those of a panel of 10 to 20 expert physicians who take the test to derive the answer key. The SCT is easily administered. In other disciplines, the SCT has demonstrated the ability to differentiate between the clinical reasoning skills of experienced and novice clinicians. The clerkship directors developed an EM SCT using an expert panel of 10 EM attending physicians. For the 07‐08 academic year, SCT questions have been incorporated into the EM clerkship end‐of‐rotation written examination. The EM SCT shows promise as a measure of a student's clinical reasoning ability. Future studies will assess in greater detail the performance and statistical properties of the SCT in the setting of the EM clerkship.