Abstract
BackgroundThe Script Concordance test (SC) test is an assessment tool that measures the capacity to solve ill-defined problems, that is, reasoning in a context of uncertainty. This study assesses the feasibility, reliability and validity of the SC test made available on the Web to French urologists.MethodsA 97 items SC test was developed based on major educational objectives of French urology training programmes. A secure Web site was created with two sequential modules: a) The first one for the reference panel to elaborate the scoring system; b) The second for candidates with different levels of experience in urology: Board certified urologists, chief-residents, residents, medical students. All participants were recruited on a voluntary basis. Statistical analysis included descriptive statistics of the participants' scores and factorial analysis of variance (ANOVA) to study differences between groups' means. Reliability was evaluated with Cronbach's alpha coefficient.ResultsThe on line SC test has been operational since June 2004. Twenty-six faculty members constituted the reference panel. During the following 10 months, 207 participants took the test online (124 urologists, 29 chief-residents, 38 residents, 16 students). No technical problem was encountered. Forty-five percent of the participants completed the test partially only. Differences between the means scores for the 4 groups were statistically significant (P = 0.0123). The Bonferroni post-hoc correction indicated that significant differences were present between students and chief-residents, between students and urologists. There were no differences between chief-residents and urologists. Reliability coefficient was 0.734 for the total group of participants.ConclusionFeasibility of Web-based SC test was proved successful by the large number of participants who participated in a few months. This Web site has permitted to quickly confirm reliability of the SC test and develop strategy to improve construct validity of the test when applied in the field of urology. Nevertheless, optimisation of the SC test content, with a smaller number of items will be necessary. Virtual medical education initiative such as this SC test delivered on the Internet warrants consideration in the current context of national pre-residency certification examination in France.
Highlights
The Script Concordance test (SC) test is an assessment tool that measures the capacity to solve ill-defined problems, that is, reasoning in a context of uncertainty
A sound knowledge base, clinical and interpersonal skills are vital for a physician; clinical reasoning represents a major component of clinical competence
We have recently introduced a Web site to promote an on line assessment course of clinical decisionmaking in context of uncertainty with the SC test, in order to allow administration of SC test on a very large number of candidates
Summary
The Script Concordance test (SC) test is an assessment tool that measures the capacity to solve ill-defined problems, that is, reasoning in a context of uncertainty. A significant part of clinical reasoning rests on the capacity of applying well-known solutions from Evidence-Based Medicine (EBM) in defined and s# contexts. Reasoning in the medical profession is much more than simple applications of knowledge, rules and principles. Individual clinical expertise relies on the capacity to deal with uncertainty. Not all the data required to solve a problem are available. These data must be retrieved in order to formulate the problem and solve it. The capacity to reason in the context of uncertainty and to solve poorly defined problems is a hallmark of professional competence in medicine
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