Évaluation du raisonnement clinique en médecine d’urgence : les tests de concordance des scripts décèlent mieux l’expérience clinique que les questions à choix multiples à contexte riche

Abstract

Context: Emergency medicine will soon be recognized as a medical specialty in France, thus requiring efficient assessment tools. Goal: To compare the ability of Script Concordance Test (SCT) and rich-context Multiple Choice Questions (MCQ) to identify the degree of experience in emergency medicine by clinical reasoning assessment. Methods: 60 MCQ and 30 SCT were prepared in respect with published guidelines and were given to 20 residents, 16 sixth year medical students and 9 full-time emergency physicians. Item analysis was performed for MCQ with difficulty and discrimination coefficients. Reliability for both MCQ and SCT tests was determined by a Cronbach coefficient computation. Scores were analysed for all groups by one-way ANOVA with Bonferroni's correction for multiple comparisons after a Levene test of variance homo- geneity. Pearson's correlation coefficient was calculated for the group of residents. Results: Both MCQ and SCT were highly reliable, with a Cronbach coefficient values ranging from 0.85 to 0.95 and 0.92 to 0.96, respectively. Degree of experience could only been detected from SCT scores. In the group of residents, SCT and MCQ scores varied in the same way, without any significant correlation. The latter observation suggests that both tests explore complementary competency areas. Conclusion: SCT appears to be a valuable assessment tool in emergency medicine, which may complement other assessment tools.