School of Medical Sciences, University Medical Center Utrecht, Utrecht, the Netherlands.
Perspect Med Educ. 2012 Aug;1(3):119-28. doi: 10.1007/s40037-012-0017-0. Epub 2012 Aug 21.
The script concordance test (SCT) is designed to assess clinical reasoning by adapting the likelihood of a case diagnosis, based on provided new information. In the standard instructions students are asked to exclude alternative diagnoses they have in mind when answering the questions, but it might be more authentic to include these. Fifty-nine final-year medical students completed an SCT. Twenty-nine were asked to take their differential diagnosis into account (adapted instructions). Thirty students were asked not to consider other diagnoses (standard instructions). All participants were asked to indicate for each question whether they were confused answering it with the given instructions ('confusion indication'). Mean score of the test with the adapted instructions was 81.5 (SD 3.8) and of the test with the standard instructions 82.9 (SD 5.0) (p = 0.220). Cronbach's alpha was 0.39 for the adapted instructions and 0.66 for the standard instructions. The mean number of confusion indications was 4.2 (SD 4.4) per student for the adapted instructions and 16.7 (SD 28.5) for the standard instructions (p = 0.139). Our attempt to improve SCTs reliability by modifying the instructions did not lead to a higher alpha; therefore we do not recommend this change in the instructional format.
脚本一致性测试（SCT）旨在通过根据提供的新信息来调整病例诊断的可能性来评估临床推理能力。在标准说明中，要求学生在回答问题时排除他们心中的其他诊断，但包括这些可能更真实。59 名医学专业的最后一年学生完成了 SCT。29 名学生被要求考虑他们的鉴别诊断（适应说明）。30 名学生被要求不考虑其他诊断（标准说明）。所有参与者都被要求在每个问题上表示他们在给定说明下回答该问题时是否感到困惑（“困惑指示”）。适应说明的测试平均得分为 81.5（SD 3.8），标准说明的测试平均得分为 82.9（SD 5.0）（p=0.220）。适应说明的 Cronbach 的 alpha 为 0.39，标准说明的 Cronbach 的 alpha 为 0.66。适应说明的每个学生的困惑指示平均数为 4.2（SD 4.4），标准说明的每个学生的困惑指示平均数为 16.7（SD 28.5）（p=0.139）。我们试图通过修改说明来提高 SCT 的可靠性，但这并没有导致更高的 alpha；因此，我们不建议在教学格式上进行此更改。
