Gudorf Helena-Fee, Heidrich Maximilian, Rauchstädt Kristoph, Scherbaum Raphael, Tönges Lars, Biesalski Anne-Sophie
Faculty of Medicine, Ruhr University Bochum, Universitätsstrasse 150, Bochum, 44801, Germany.
Department of Internal Medicine, Evangelisches Krankenhaus Hattingen, Bredenscheiderstrasse 54, Hattingen, 45525, Germany.
BMC Med Educ. 2025 Jun 19;25(1):852. doi: 10.1186/s12909-025-06814-7.
Clinical reasoning is an essential medical competence that should be taught and assessed from the beginning of medical studies. These skills can be evaluated using the Script Concordance Test (SCT), which presents daily clinical scenarios characterised by uncertainty. Due to the lack of validated research on this method in Germany, particularly in the field of neurology, we developed and implemented an SCT at Ruhr University Bochum. We compared different teaching methods (clinical seminar vs. digital video course) and their outcomes on the examination.
A group of 6th-year medical students who had received the same education completed an SCT after participating in either a clinical seminar or a digital video course. The SCT was developed using blueprints on stroke and epilepsy. The test consisted of 40 case vignettes with a total of 120 items. Initially, experts completed the test to establish the reference panel. The final high-stakes examination was created using the aggregate scoring method and an item analysis.
The SCT was completed by 15 experts and 59 students. The final SCT consisted of 112 items and achieved a Cronbach's alpha of 0.85. A significant difference (p < 0.05) was observed between the experts, who achieved a mean score of 81.75, and the students on the first assessment day, who achieved a mean score of 68.92. No significant differences were found between the groups (interactive video course and seminar) or assessment time points. The questionnaire revealed a sense of insecurity in clinical decision-making before the SCT and highlighted the need to incorporate clinical reasoning practices from the beginning of medical studies to mitigate fear in uncertain situations. The SCT helped students structure decision-making processes and and improved their confidence in making decisions.
The SCT is a reliable and valid tool for assessing medical students throughout their university education. Regular exposure to the SCT format would facilitate familiarity with its structure. We propose utilising the SCT as a learning tool rather than solely for assessment purposes. For instance, it could be integrated into teaching methodologies as a think-aloud exercise or incorporated into progress tests.
临床推理是一项重要的医学能力，应在医学学习伊始就进行教授和评估。这些技能可通过脚本一致性测试（SCT）进行评估，该测试呈现以不确定性为特征的日常临床场景。由于德国缺乏对该方法的验证性研究，尤其是在神经病学领域，我们在波鸿鲁尔大学开发并实施了一项SCT。我们比较了不同的教学方法（临床研讨会与数字视频课程）及其在考试中的效果。
一组接受相同教育的六年级医学生在参加临床研讨会或数字视频课程后完成了一项SCT。SCT是根据中风和癫痫的蓝图开发的。该测试由40个病例 vignettes 组成，共120个项目。最初，专家们完成测试以建立参考小组。最终的高风险考试采用综合评分法和项目分析创建。
15名专家和59名学生完成了SCT。最终的SCT由112个项目组成，克朗巴哈系数为0.85。在第一次评估日，专家的平均得分81.75与学生的平均得分68.92之间存在显著差异（p < 0.05）。在不同组（交互式视频课程和研讨会）或评估时间点之间未发现显著差异。问卷显示在SCT之前临床决策中存在不安全感，并强调需要从医学学习开始就纳入临床推理实践，以减轻在不确定情况下的恐惧。SCT帮助学生构建决策过程并提高了他们决策的信心。
SCT是评估医学生整个大学教育过程的可靠且有效的工具。定期接触SCT格式将有助于熟悉其结构。我们建议将SCT用作学习工具，而不仅仅用于评估目的。例如，它可以作为出声思考练习整合到教学方法中，或纳入进度测试中。
