Department of Anesthesiology and Intensive Care, Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, DKI Jakarta, Indonesia.
Med Educ Online. 2022 Dec;27(1):2135421. doi: 10.1080/10872981.2022.2135421.
Clinical reasoning is a core competency for physicians. In the field of anesthesia, many situations require residents to use their clinical reasoning to make quick and appropriate decisions such as during emergency airway cases. The Script Concordance Test (SCT) is a test developed in recent years and validated that objectively assess clinical reasoning ability. However, studies involving SCT to assess clinical reasoning in airway management is scarce.
To evaluate SCT in assessing clinical reasoning for airway management in anesthesiology residents.
A cross-sectional study involving residents and anesthesiology consultants from the Department of Anesthesiology and Intensive Care, Faculty of Medicine Universitas Indonesia was conducted to complete SCT. A panel of five anesthesiology consultants with more than 15 years of work experience constructed 20 SCT vignettes based on prevalent airway cases in our center from the past 10 years. Each SCT has three nested questions, with a total of 60 questions, to be answered within 120 min.
The SCT of 20 case vignettes with three nested questions were tested on 99 residents from the junior, intermediate, and senior residents, compared to answers from the expert group consisting of ten anesthesiology consultants with more than 5 years of experience. There were significant differences in mean SCT scores in the junior, intermediate, senior and expert groups, 59.3 (46.1-72.8), 64.7 (39.9-74.9), 67.5 (50.6-78.3), and 79.6 (78.4-84.8); p < 0,001 consecutively. Cronbach Alpha 0.69 was obtained, indicating good reliability.
Our SCT was proven to be a valid and reliable test instrument to assess the clinical reasoning in airway management for anesthesiology residents. SCT was able to discriminate between groups of different clinical experiences and should be included to evaluate airway competencies in anesthesiology residents.
临床推理是医生的核心能力。在麻醉领域，许多情况下需要住院医师运用临床推理能力快速做出适当的决策，例如在紧急气道病例中。脚本一致性测试（SCT）是近年来开发并经过验证的一种客观评估临床推理能力的测试。然而，涉及 SCT 评估气道管理临床推理的研究很少。
评估 SCT 在评估麻醉住院医师气道管理临床推理能力中的作用。
进行了一项涉及印度尼西亚大学医学院麻醉学和重症监护系住院医师和麻醉学顾问的横断面研究，以完成 SCT。由五名具有 15 年以上工作经验的麻醉学顾问组成的小组根据过去 10 年中心常见的气道病例构建了 20 个 SCT 病例。每个 SCT 有三个嵌套问题，共 60 个问题，需要在 120 分钟内回答。
对 99 名初级、中级和高级住院医师进行了 20 个案例的 SCT 测试，这些案例有三个嵌套问题，与由 10 名具有 5 年以上经验的麻醉学顾问组成的专家组的答案进行了比较。初级、中级、高级和专家组成员的 SCT 平均得分存在显著差异，分别为 59.3（46.1-72.8）、64.7（39.9-74.9）、67.5（50.6-78.3）和 79.6（78.4-84.8）；p<0.001。Cronbach Alpha 为 0.69，表明可靠性良好。
我们的 SCT 被证明是一种有效的、可靠的测试工具，可评估麻醉住院医师气道管理的临床推理能力。SCT 能够区分不同临床经验的组别，应该包括在内以评估麻醉住院医师的气道能力。
