Nazim Syed Muhammad, Talati Jamsheer J, Pinjani Sheila, Biyabani Syed Raziuddin, Ather Muhammad Hammad, Norcini John J
Section of Urology, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan.
Department for Educational development, The Aga Khan University Hospital, Karachi, Pakistan.
J Adv Med Educ Prof. 2019 Jan;7(1):7-13. doi: 10.30476/JAMP.2019.41038.
Clinical reasoning skill is the core of medical competence. Commonly used assessment methods for medical competence have limited ability to evaluate critical thinking and reasoning skills. Script Concordance Test (SCT) and Extended Matching Questions (EMQs) are the evolving tests which are considered to be valid and reliable tools for assessing clinical reasoning and judgment. We performed this pilot study to determine whether SCT and EMQs can differentiate clinical reasoning ability among urology residents, interns and medical students.
This was a cross-sectional study in which an examination with 48 SCT-based items on eleven clinical scenarios and four themed EMQs with 21 items were administered to a total of 27 learners at three differing levels of experience i.e. 9 urology residents, 6 interns and 12 fifth year medical students. A non-probability convenience sampling was done. The SCTs and EMQs were developed from clinical situations representative of urological practice by 5 content experts (urologists) and assessed by a medical education expert. Learners' responses were scored using the standard and the graduated key. A one way analysis of variance (ANOVA) was conducted to compare the mean scores across the level of experience. A p-value of < 0.05 was considered statistically significant. Test reliability was estimated by Cronbach α. A focused group discussion with candidates was done to assess their perception of test.
Both SCT and EMQs successfully differentiated residents from interns and students. Statistically significant difference in mean score was found for both SCT and EMQs among the 3 groups using both the standard and the graduated key. The mean scores were higher for all groups as measured by the graduated key compared to the standard key. The internal consistency (Cronbach's α) was 0.53 and 0.6 for EMQs and SCT, respectively. Majority of the participants were satisfied with regard to time, environment, instructions provided and the content covered and nearly all felt that the test helped them in thinking process particularly clinical reasoning.
Our data suggest that both SCT and EMQs are capable of discriminating between learners according to their clinical experience in urology. As there is a wide acceptability by all candidates, these tests could be used to assess and enhance clinical reasoning skills. More research is needed to prove validity of these tests.
临床推理能力是医学能力的核心。常用的医学能力评估方法在评估批判性思维和推理能力方面能力有限。脚本一致性测试（SCT）和扩展匹配题（EMQ）是不断发展的测试，被认为是评估临床推理和判断的有效且可靠的工具。我们开展了这项初步研究，以确定SCT和EMQ是否能够区分泌尿外科住院医师、实习医生和医学生的临床推理能力。
这是一项横断面研究，针对11个临床场景设置了48道基于SCT的题目，并设置了4个主题的EMQ，共21道题目，对总共27名不同经验水平的学习者进行测试，即9名泌尿外科住院医师、6名实习医生和12名五年级医学生。采用非概率便利抽样。SCT和EMQ由5名内容专家（泌尿科医生）根据泌尿外科临床实践中的代表性临床情况编制，并由一名医学教育专家进行评估。学习者的回答使用标准评分键和分级评分键进行评分。进行单因素方差分析（ANOVA）以比较不同经验水平的平均得分。p值<0.05被认为具有统计学意义。通过Cronbach α估计测试信度。与考生进行了焦点小组讨论，以评估他们对测试的看法。
SCT和EMQ都成功区分了住院医师与实习医生和医学生。使用标准评分键和分级评分键时，3组之间的SCT和EMQ平均得分均存在统计学显著差异。与标准评分键相比，使用分级评分键时所有组的平均得分更高。EMQ和SCT的内部一致性（Cronbach's α）分别为0.53和0.6。大多数参与者对时间、环境、提供的指导和涵盖的内容感到满意，几乎所有人都认为该测试有助于他们的思维过程，尤其是临床推理。
我们的数据表明，SCT和EMQ都能够根据学习者在泌尿外科的临床经验对他们进行区分。由于所有考生对这些测试的接受度都很高，因此这些测试可用于评估和提高临床推理能力。需要更多研究来证明这些测试的有效性。
