Abstract

IntroductionIn a script concordance test (SCT), examinees are asked to judge the effect of a new piece of clinical information on a proposed hypothesis. Answers are collected using a Likert-type scale (ranging from −2 to +2, with ‘0’ indicating no effect), and compared with those of a reference panel of ‘experts’. It has been argued, however, that SCT may be susceptible to the influences of gaming and guesswork. This study aims to address some of the mounting concern over the response process validity of SCT scores.MethodUsing published datasets from three independent SCTs, we investigated examinee response patterns, and computed the score a hypothetical examinee would obtain on each of the tests if he 1) guessed random answers and 2) deliberately answered ‘0’ on all test items.ResultsA simulated random guessing strategy led to scores 2 SDs below mean scores of actual respondents (Z-scores −3.6 to −2.1). A simulated ‘all-0’ strategy led to scores at least 1 SD above those obtained by random guessing (Z-scores −2.2 to −0.7). In one dataset, stepwise exclusion of items with modal panel response ‘0’ to fewer than 10% of the total number of test items yielded hypothetical scores 2 SDs below mean scores of actual respondents.DiscussionRandom guessing was not an advantageous response strategy. An ‘all-0’ response strategy, however, demonstrated evidence of artificial score inflation. Our findings pose a significant threat to the SCT’s validity argument. ‘Testwiseness’ is a potential hazard to all testing formats, and appropriate countermeasures must be established. We propose an approach that might be used to mitigate a potentially real and troubling phenomenon in script concordance testing. The impact of this approach on the content validity of SCTs merits further discussion.

Highlights

  • In a script concordance test (SCT), examinees are asked to judge the effect of a new piece of clinical information on a proposed hypothesis

  • Calculating the scores a hypothetical examinee would obtain if he had engaged in either of these tactics, and comparing these with the scores obtained by actual examinees on several published Script Concordance Test (SCT), we found several interesting results

  • 28.3 64.0 –2.53 0.859 to practising physician). In general surgery, both residents and practising surgeons were more likely to select responses on the negative than the positive spectrum of the Likert scale, hinting that response tendencies might vary according to discipline of practice

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Summary

Introduction

In a script concordance test (SCT), examinees are asked to judge the effect of a new piece of clinical information on a proposed hypothesis. Answers are collected using a Likert-type scale (ranging from –2 to +2, with ‘0’ indicating no effect), and compared with those of a reference panel of ‘experts’. It has been argued, that SCT may be susceptible to the influences of gaming and guesswork. Stepwise exclusion of items with modal panel response ‘0’ to fewer than 10% of the total number of test items yielded hypothetical scores 2 SDs below mean scores of actual respondents.

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