Academic Clinic Fellow, Nuffield Department of Primary Care Health Sciences, University of Oxford Medical Sciences Division, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Oxford, United Kingdom.
Educ Prim Care. 2022 Jul;33(4):229-236. doi: 10.1080/14739879.2022.2057240. Epub 2022 Apr 4.
General practitioners (GPs) make timely and accurate clinical decisions, often in the contexts of complexity and uncertainty. However, structured approaches to facilitate development of these complex decision-making skills remain largely unexplored. Here, the educational use of formative script concordance testing (SCT), a written assessment format originally designed to test clinical reasoning, is evaluated in this context through an in-depth qualitative exploration of the learning experiences of participating GP trainees. A 'think-aloud' approach to SCT is used, which requires question responses to be justified with a short clinical rationale. Eleven 1st-year GP trainees in Oxford (United Kingdom) completed the formative SCT activity, before taking part in individual semi-structured interviews. Data exploring their learning experiences was transcribed and analysed using reflexive thematic analysis. Thirty-seven codes were generated, and schematically organised into six sub-themes, that provide a descriptive summary of the data and insights into the practical educational utility of the SCT format. Three overarching themes were subsequently produced that relate specifically to aim of exploring in-depth the learning experiences of GP trainees to formative think-aloud SCT: 1) developing complex decision-making skills; 2) opportunity for self-evaluation and awareness; and 3) promoting community and professional identity. The development of complex clinical decision-making and reasoning skills is proposed to occur through guided reflection on performance, facilitated by the think-aloud approach to questioning. Together, this suggests a potential role for think-aloud SCT as a distinctive, structured learning activity to complement trainees' professional development.
全科医生（GP）通常在复杂和不确定的情况下及时做出准确的临床决策。然而，促进这些复杂决策技能发展的结构化方法在很大程度上仍未得到探索。在这里，通过深入探讨参与的 GP 受训者的学习经验，评估了形成性脚本一致性测试（SCT）在教育中的应用，这是一种最初用于测试临床推理的书面评估形式。在 SCT 中使用了“出声思考”方法，要求对问题的回答用简短的临床原理进行证明。牛津（英国）的 11 名第一年 GP 受训者完成了形成性 SCT 活动，然后参加了个人半结构化访谈。使用反思性主题分析对探索学习经验的数据进行了转录和分析。生成了 37 个代码，并以六个子主题的形式进行了示意性组织，这些子主题提供了数据的描述性总结，并深入了解了 SCT 格式的实际教育效用。随后产生了三个总体主题，这些主题特别涉及深入探讨 GP 受训者对形成性出声思考 SCT 的学习经验的目的：1）发展复杂的决策技能；2）自我评估和意识的机会；3）促进社区和专业认同。通过出声思考方法对表现进行有指导的反思，提出了复杂临床决策和推理技能的发展，这是通过出声思考方法实现的。综上所述，出声思考 SCT 作为一种独特的结构化学习活动，可能会补充受训者的专业发展。
