Dr. Humbert is associate professor of clinical emergency medicine, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana. Dr. Miech is a research scientist in health services research, Regenstrief Institute, Indianapolis, Indiana.
Acad Med. 2014 Jul;89(7):1046-50. doi: 10.1097/ACM.0000000000000267.
Medical students develop clinical reasoning skills throughout their training. The Script Concordance Test (SCT) is a standardized instrument that assesses clinical reasoning; test takers with more clinical experience consistently outperform those with less experience. SCT studies to date have been cross-sectional, with no studies examining same-student longitudinal performance gains.
This four-year observational study took place between 2008 and 2011 at the Indiana University School of Medicine. Students in two different cohorts took the same SCT as second-year medical students and then again as fourth-year medical students. The authors matched and analyzed same-student data from the two SCT administrations for the classes of 2011 and 2012. They used descriptive statistics, correlation coefficients, and paired t tests.
Matched data were available for 260 students in the class of 2011 (of 303, 86%) and 264 students in the class of 2012 (of 289, 91%). The mean same-student gain for the class of 2011 was 8.6 (t[259] = 15.9; P < .0001) and for the class of 2012 was 11.3 (t[263] = 21.4; P < .0001). Each cohort gained more than one standard deviation.
Medical students made statistically significant gains in their performance on an SCT over a two-year period. These findings demonstrate same-student gains in clinical reasoning over time as measured by the SCT and suggest that the SCT as a standardized instrument can help to evaluate growth in clinical reasoning skills.
医学生在培训过程中发展临床推理技能。脚本一致性测试（SCT）是一种评估临床推理的标准化工具；具有更多临床经验的测试者始终比经验较少的测试者表现更好。迄今为止，SCT 研究都是横断面研究，没有研究检查同一学生的纵向表现增益。
这项为期四年的观察性研究于 2008 年至 2011 年在印第安纳大学医学院进行。两个不同队列的学生作为二年级医学生参加了相同的 SCT，然后作为四年级医学生再次参加了相同的 SCT。作者对 2011 年和 2012 年两个班级的两次 SCT 管理中的同学生数据进行了匹配和分析。他们使用描述性统计、相关系数和配对 t 检验。
2011 年班级中有 260 名学生（303 名学生中有 260 名，占 86%）和 2012 年班级中有 264 名学生（289 名学生中有 264 名，占 91%）的匹配数据可用。2011 年班级的同学生平均增益为 8.6（t[259] = 15.9；P <.0001），2012 年班级的同学生平均增益为 11.3（t[263] = 21.4；P <.0001）。每个队列的增益都超过了一个标准差。
医学生在两年内通过 SCT 测试在表现上取得了统计学上的显著进步。这些发现表明，通过 SCT 衡量，临床推理能力随着时间的推移，学生的临床推理能力会有所提高，并且表明 SCT 作为一种标准化工具可以帮助评估临床推理技能的增长。
