Assessing Decision-Making Skills with the Script Concordance Test (SCT) in Clinical Neurology and Emergency Medicine

Abstract

Background Clinical reasoning is an essential medical competence that should be taught and assessed from the beginning of medical studies. One method to evaluate these skills is the Script Concordance Test (SCT), which presents daily clinical scenarios filled with uncertainty. Due to the lack of validated research on this method in Germany, particularly in the field of neurology, our study aimed to develop and implement an SCT at Ruhr University Bochum, and to compare different teaching methods (clinical seminar vs. digital video course) and their outcomes in the examination format. Methods A group of 6th-year medical students, who 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, comprising 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. Results The developed 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 had a mean score of 81.75, and the students on the first assessment day, who had a mean score of 68.92. No significant differences were found between the different groups (interactive video course and seminar) or across different 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 structure decision-making processes and increased confidence in personal decisions. Conclusion The SCT proves to be 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 utilizing 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.