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The script concordance test in paediatric rheumatology (SCT-PR): a novel tool to assess clinical reasoning competence
  1. M J Cidon

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Background

ACGME competency based outcome standards mandate use of multiple assessment methods to evaluate resident progress. Currently, there are no validated tools to evaluate clinical reasoning in paediatric rheumatology.

Objective

To describe the development of the first clinical reasoning tool in paediatric rheumatology for residents based on script concordance methodology.

Design

Content domain of the SCT-PR is developed from congruent curricular concepts from two sources (Academic Pediatric Association, a UCSF survey). SCT-PR test items are rated by 9 paediatric rheumatologists for content validity using Lawshe's methodology. SCT-PR test items with a validity ratio of 0.62 are assessed for face validity, generating a blueprint of 20 clinical vignettes with 60 selected SCT-PR test items. The SCT-PR construct is administered to 6 paediatric rheumatologists to generate a scoring grid to interpret the SCT-PR test scores of 25 paediatric residents at Lucile Packard Children's Hospital. Data analyses includes univariate descriptive statistics of SCT-PR test scores, reliability assessment (Cronbach alpha) and test item discrimination.

Results

See tables 1 and 2.

Table 1

Blueprint of SCT-PR items

Table 2

Sample of a clinical vignette with script test items

The SCT-PR demonstrates moderate difficulty (P=66%) of test items and good internal reliability (a = 0.79). The mean discrimination index of the 60 test item SCT-PR is 0.29 with a value range between −0.42 and 0.73. There are 22 items with a discrimination index below 0.20. Test items with a low discrimination index had a mean difficulty measure of 0.78 in comparison to the mean difficulty level of 0.60 of test items with good discrimination.

Conclusions

The SCT-PR has the potential to be an effective assessment and teaching application in medical clinical reasoning for paediatric residents.

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