Department of Pediatrics, The Barbara Bush Children's Hospital at Maine Medical Center (MC Ottolini), Portland, Maine.
Department of Pediatrics, Children's National Medical Center, George Washington University School of Medicine and Health Sciences (I Chua and J Campbell), Washington, DC.
Acad Pediatr. 2021 Mar;21(2):252-258. doi: 10.1016/j.acap.2020.10.003. Epub 2020 Oct 14.
The cognitive expertise of Pediatric Hospitalists (PH) lies not in standard knowledge but in making decisions under conditions of uncertainty. To maintain expertise, PH should engage in deliberate practice via self-assessments that promote higher-level cognitive processes necessary to address problems with missing or ambiguous information. Higher levels of cognition are purported with Script Concordance Test (SCT) questions compared to Multiple Choice Questions (MCQ). To determine if PH use higher levels of cognition when answering SCT versus MCQ questions and to analyze participants' perceptions of the utility of using SCT self-assessment for deliberate practice in addressing clinical problems encountered in daily practice.
This is a mixed methods study comparing the cognitive level expressed according to Bloom's Taxonomy by PH answering MCQ versus SCT questions using a "think aloud" (TA) exercise, followed by qualitative analysis of interviews conducted afterward.
A significantly greater percentage of comments were coded as higher cognitive processes (apply, analyze, evaluate, and create) for SCT versus MCQ (74% vs 19%) compared with lower order (remember, understand); chi-square P < .00001. Analysis of interviews revealed 6 themes.
SCT questions elicited higher level cognition essential to clinical reasoning compared to MCQ questions. PH-indicated MCQ questions measure standard knowledge, while SCT questions better measure decision-making under conditions of uncertainty. PH-perceived SCT could be useful for deliberate practice in Pediatric Hospital Medicine decision-making if they could compare their rationale in answering questions with that of experts.
儿科住院医师的认知专长不在于标准知识，而在于在不确定的情况下做出决策。为了保持专业知识，儿科住院医师应该通过自我评估进行刻意练习，以促进解决信息缺失或模糊问题所需的更高层次的认知过程。与多项选择题 (MCQ) 相比，脚本一致性测试 (SCT) 问题据称具有更高的认知水平。为了确定儿科住院医师在回答 SCT 与 MCQ 问题时是否使用了更高的认知水平，并分析参与者对使用 SCT 自我评估进行刻意练习以解决日常实践中遇到的临床问题的效用的看法。
这是一项混合方法研究，通过“出声思维”（TA）练习比较儿科住院医师回答 MCQ 与 SCT 问题时根据布鲁姆的分类法表达的认知水平，然后对随后进行的访谈进行定性分析。
与较低层次的认知过程（记忆、理解）相比，SCT 与 MCQ 的比较中，编码为更高认知过程（应用、分析、评估和创造）的评论比例显著更高（74% 对 19%）；卡方 P<.00001。访谈分析揭示了 6 个主题。
与 MCQ 问题相比，SCT 问题引出了更高级别的认知，这对临床推理至关重要。儿科住院医师表示，MCQ 问题衡量的是标准知识，而 SCT 问题则更好地衡量了在不确定情况下的决策。如果儿科住院医师能够将他们回答问题的理由与专家进行比较，那么他们可能会认为 SCT 对儿科住院医师决策中的刻意练习有用。
