Assessing clinical reasoning skills of final year medical students using the script concordance test

Abstract

Background: Clinical reasoning is the name given to the cognitive processes by which doctors evaluate and analyse information from patients. It is a skill developed by experiential learning and is difficult to assess objectively. The script concordance test, an assessment tool introduced into the health sciences about 15 years ago, is a way of assessing clinical reasoning ability in an objective manner and allows comparisons of the decisions made by medical students and experts in situations of uncertainty. Methods: Twenty-six final year medical students from the International Medical University, Kuala Lumpur, were tested on their decision making skills regarding a young febrile patient. The students evaluated different pieces of information in five different scenarios and made decisions on a five-point Likert scale in the standard format of the script concordance test. Their decisions were compared to the decisions of a panel of experienced clinicians in Internal Medicine. Results: The script concordance test scores for the different scenarios were calculated with higher scores being indicative of greater concordance between the reasoning of students and doctors. The students showed poor concordance with doctors in evaluating clinical information. Overall, only 20 percent of the choices made by students were the same as the choices made by the majority of doctors. Conclusion: Medical students vary in their ability to interpret the significance of clinical information. Using the script concordance test, this preliminary study looked at the ability of final year medical students to interpret information about a patient with a febrile illness. The results showed poor concordance between students and doctors in the way they interpreted clinical information. The script concordance test has the potential to be a tool for teaching and assessing clinical reasoning.