Begun Yakira S, Stange Lila R, Davis Claire R
Sarah Lawrence College Joan H. Marks Graduate Program in Human Genetics, Bronxville, New York, USA.
J Genet Couns. 2023 Dec;32(6):1121-1130. doi: 10.1002/jgc4.1752. Epub 2023 Jul 13.
Clinical reasoning is a complex skill that represents a trainee's ability to use their professional knowledge and skills to assess and solve the problems that arise in clinical practice. As an integral tenet of the genetic counseling process, clinical reasoning skills underlie many of the Practice-Based Competencies (2019) across a variety of domains. Despite the long-lasting recognition of the importance of this complex skill in the training of genetic counselors, clinical reasoning has traditionally been difficult to assess in a standardized way in healthcare education. Script concordance testing is a standardized method of assessing clinical reasoning skills in ambiguous clinical situations. The tool has been used to successfully measure the clinical reasoning skills of trainees in various healthcare training programs and has never been used in a genetic counseling training program. We conducted a pilot study to assess the utility of script concordance testing in the field of genetic counseling as an objective measure of clinical reasoning in trainees. The script concordance test was constructed for the field of genetic counseling and administered to 22 second year genetic counseling students in the Joan H. Marks Graduate Program in Human Genetics at Sarah Lawrence College. Twelve genetic counselors served on a panel to provide expert clinical reasoning responses and a scoring grid was developed using the aggregate scores method. The utility of the tool was measured using Cronbach's alpha coefficient, and scores of students and the panel were compared using Hedge's g. Results revealed statistically significant differences between the scores of panelists and students and good reliability. This study shows that script concordance testing can be used to measure clinical reasoning skills in genetic counseling trainees in a way that is reliable, standardized, and easy to use, thereby allowing programs to better assess the clinical reasoning skills of trainees prior to graduation.
临床推理是一项复杂的技能，它体现了受训者运用专业知识和技能来评估和解决临床实践中出现的问题的能力。作为遗传咨询过程的一个重要原则，临床推理技能是2019年基于实践的多种领域能力的基础。尽管长期以来人们都认识到这项复杂技能在遗传咨询师培训中的重要性，但在医疗保健教育中，传统上一直难以以标准化的方式对临床推理进行评估。脚本一致性测试是一种在模糊临床情况下评估临床推理技能的标准化方法。该工具已成功用于测量各种医疗培训项目中学员的临床推理技能，且从未在遗传咨询培训项目中使用过。我们进行了一项试点研究，以评估脚本一致性测试在遗传咨询领域作为学员临床推理客观测量方法的效用。为遗传咨询领域构建了脚本一致性测试，并将其应用于莎拉劳伦斯学院琼·H·马克斯人类遗传学研究生项目的22名二年级遗传咨询专业学生。12名遗传咨询师组成一个小组，提供专家临床推理答案，并使用综合评分法制定了评分网格。使用克朗巴哈α系数测量该工具的效用，并使用赫奇斯g比较学生和小组的分数。结果显示小组成员和学生的分数之间存在统计学上的显著差异，且可靠性良好。这项研究表明，脚本一致性测试可用于可靠、标准化且易于使用地测量遗传咨询学员的临床推理技能，从而使项目能够在学员毕业前更好地评估他们的临床推理技能。
