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Habes E, Kolk J, Van Brunschot M, Bouwes A. Development of script concordance test for assessment of clinical reasoning in nursing: Lessons learned regarding construct validity. Heliyon 2024; 10:e35151. [PMID: 39161805 PMCID: PMC11332874 DOI: 10.1016/j.heliyon.2024.e35151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 07/17/2024] [Accepted: 07/23/2024] [Indexed: 08/21/2024] Open
Abstract
Background The script concordance test (SCT) has been shown to be an effective tool to assess the clinical reasoning skills of nursing students. Various nursing studies have demonstrated the construct validity of this test. However, studies on the barriers that may impede construct validity during the development process are limited. Objective This evaluation describes the barriers to the development of SCT for Bachelor's nursing students and the lessons learned regarding construct validity. Methods We conducted a descriptive evaluation of the SCT development and a validation process was performed. The evaluation was based on written comments during the assessment (N = 327), a Student's Perspective Questionnaire (N = 100), and student feedback during three live review sessions (N = 27). Results Despite consideration of the guidelines during SCT development, we encountered three main barriers that may impede construct validity. We undertook the necessary efforts to recruit an appropriate expert panel. We overestimated the experts' and students' understanding of the SCT methodology. Additionally, four potential causes of invalid item construction were identified. These possible causes were 'questionable intervention, hypothesis, or investigation', 'blurred data in new information', 'regression to the middle', and 'misinterpretation of the midpoint'. Conclusion The three lessons learned are as follows: 1) The recruitment of an appropriate expert panel must not be underestimated. Besides clinical expertise, experts need training in SCT methodology, including awareness of possible pitfalls; 2) SCT training is a prerequisite for SCT as an assessment; and 3) student feedback may offer a deeper understanding of potential hidden script errors and causes for misinterpretation of SCT. Further studies are necessary to identify additional causes which may impede the construct validity of SCT in nursing education.
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Affiliation(s)
- E.V. Habes
- Institute of Nursing Studies, HU University of Applied Sciences Utrecht, Utrecht, the Netherlands
| | - J.E.M. Kolk
- Institute of Nursing Studies, HU University of Applied Sciences Utrecht, Utrecht, the Netherlands
| | | | - A. Bouwes
- Institute of Nursing Studies, HU University of Applied Sciences Utrecht, Utrecht, the Netherlands
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Vaillant-Corroy AS, Girard F, Virard F, Corne P, Gerber Denizart C, Wulfman C, Vital S, Gosset M, Naveau A, Delbos Y, Vergnes JN, Thivichon-Prince B, Antoine J, Mainville G, Nader M, Richert R, Charlin B, Ducret M. Concordance of judgement: A tool to foster the development of professionalism in dentistry. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2024; 28:789-796. [PMID: 38581208 DOI: 10.1111/eje.13007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 01/25/2024] [Accepted: 02/16/2024] [Indexed: 04/08/2024]
Abstract
INTRODUCTION Developing professionalism notably involves learning how to make professional judgements in ambiguous situations. The Concordance of Judgement Test (CJT) is a learning tool that was proposed to develop professionalism competencies, but it was never performed in dentistry or used with a synchronous methodology. The present study evaluated the feasibility of the use of CJT in the context of dental education, to foster professionalism and stimulate reflexivity and discussion. MATERIALS AND METHODS After different steps of optimization, a questionnaire presenting 12 vignettes was submitted to 33 Canadian students. Second, after an additional optimization, a questionnaire of 7 vignettes was submitted to 87 French students. An immediate educational feedback was proposed after each vignette to promote reflexivity and discussions during the experience. RESULTS The overall experience of the students was reported as good, thanks to the feedback of real-life situations. This promoted reflexivity and stimulated discussion between students and educators regarding professionalism issues. The students considered CJT as a relevant and well-adapted tool, and reported positive feelings regarding the inter-university aspect of the activity. The mean score of the panel members was close to 80/100 and the mean score of the students was 5 to 10 points lower, which is in agreement with docimological performance. CONCLUSION The results suggested that the use of CJT in a synchronous way was a feasible and relevant tool to motivate the students to improve their professionalism, and to stimulate their reflexivity and discussion. The students reported positive experience with CJT, and we believe that this tool can be integrated in the dental curriculum.
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Affiliation(s)
- Anne-Sophie Vaillant-Corroy
- UFR d'odontologie de Lorraine, Université de Lorraine, Vandœuvre-lès-Nancy, France
- Service d'odontologie, Centre Hospitalier Régional Universitaire, Nancy, France
- Laboratoire Lorrain de Psychologie et Neurosciences de la Dynamique des Comportements, Université de Lorraine, Nancy, France
| | - Félix Girard
- Faculté de médecine dentaire, Université de Montréal, Montréal, Québec, Canada
| | - François Virard
- UFR d'Odontologie de Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Hospices Civils de Lyon, Service de Consultations et de Traitements Dentaires, Lyon, France
| | - Pascale Corne
- UFR d'odontologie de Lorraine, Université de Lorraine, Vandœuvre-lès-Nancy, France
- Service d'odontologie, Centre Hospitalier Régional Universitaire, Nancy, France
- Laboratoire Lorrain de Psychologie et Neurosciences de la Dynamique des Comportements, Université de Lorraine, Nancy, France
| | | | - Claudine Wulfman
- UFR Odontologie Université Paris Cité, URP 2496, Montrouge, France
- Service de médecine bucco-dentaire, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | - Sibylle Vital
- UFR Odontologie Université Paris Cité, URP 2496, Montrouge, France
- Service de médecine bucco-dentaire, DMU ESPRIT, Hopital Louis Mourier AP-HP, Colombes, France
| | - Marjolaine Gosset
- UFR Odontologie Université Paris Cité, URP 2496, Montrouge, France
- Service de Médecine Bucco-Dentaire, AP-HP, Hôpital Charles Foix, Ivry/seine, France
| | - Adrien Naveau
- UFR des Sciences Odontologiques, Université de Bordeaux, Bordeaux, France
- Service de Médecine Bucco-Dentaire, Hôpital Saint-André, CHU de Bordeaux, Bordeaux, France
| | - Yves Delbos
- UFR des Sciences Odontologiques, Université de Bordeaux, Bordeaux, France
- Service de Médecine Bucco-Dentaire, Hôpital Saint-André, CHU de Bordeaux, Bordeaux, France
| | - Jean-Noël Vergnes
- UFR d'Odontologie de Toulouse, Université Paul Sabatier, Toulouse, France
- Service d'Odontologie, CHU de Toulouse, Toulouse, France
| | | | - Juliette Antoine
- UFR d'Odontologie de Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Hospices Civils de Lyon, Service de Consultations et de Traitements Dentaires, Lyon, France
| | - Gisele Mainville
- Faculté de médecine dentaire, Université de Montréal, Montréal, Québec, Canada
| | - Moussa Nader
- Faculté de médecine dentaire, Université de Montréal, Montréal, Québec, Canada
| | - Raphael Richert
- UFR d'Odontologie de Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Hospices Civils de Lyon, Service de Consultations et de Traitements Dentaires, Lyon, France
| | - Bernard Charlin
- Faculté de médecine dentaire, Université de Montréal, Montréal, Québec, Canada
| | - Maxime Ducret
- UFR d'Odontologie de Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Hospices Civils de Lyon, Service de Consultations et de Traitements Dentaires, Lyon, France
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Dauchet L, Bentegeac R, Ghauss H, Hazzan M, Truffert P, Amouyel P, Gauthier V, Hamroun A. [The expert panel for Script Concordance Tests: A truly adequate reference?]. Rev Med Interne 2024:S0248-8663(24)00630-1. [PMID: 38987065 DOI: 10.1016/j.revmed.2024.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 05/24/2024] [Indexed: 07/12/2024]
Abstract
The Script Concordance Tests (SCTs) are an examination modality introduced by decree in the French National Ranking Exam for medical students in 2024. Their objective is to evaluate clinical reasoning in situations of uncertainty. In practice, SCTs assess the impact of new information on the probability of a hypothesis formulated a priori based on an authentic clinical scenario. This approach resembles probabilistic (or Bayesian) reasoning. Due to the uncertainty associated with the explored clinical situation, SCTs do not compare the student's response to an expected one in a theoretical knowledge reference. Instead, the distribution of responses from a panel of experienced physicians is used to establish the question's scoring scale. Literature data suggest that physicians, even experienced ones, like most humans, often exhibit biased intuitive probabilistic reasoning. These biases raise questions about the relevance of using expert panel responses as scoring scales for SCTs.
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Affiliation(s)
- Luc Dauchet
- Service de santé publique, épidémiologie, économie de la santé et prévention, CHU de Lille, 59000 Lille, France; UMR1167 RID-AGE, Institut Pasteur de Lille, Inserm, université de Lille, CHU de Lille, 59000 Lille, France
| | - Raphaël Bentegeac
- Service de santé publique, épidémiologie, économie de la santé et prévention, CHU de Lille, 59000 Lille, France; UMR1167 RID-AGE, Institut Pasteur de Lille, Inserm, université de Lille, CHU de Lille, 59000 Lille, France
| | - Haress Ghauss
- Service de santé publique, épidémiologie, économie de la santé et prévention, CHU de Lille, 59000 Lille, France; UMR1167 RID-AGE, Institut Pasteur de Lille, Inserm, université de Lille, CHU de Lille, 59000 Lille, France
| | - Marc Hazzan
- Service de néphrologie, dialyse, transplantation rénale et aphérèse, hôpital Claude-Huriez, université de Lille, CHU de Lille, 59000 Lille, France
| | - Patrick Truffert
- Service de néonatalogie, hôpital Jeanne-de-Flandres, université de Lille, CHU de Lille, 59000 Lille, France
| | - Philippe Amouyel
- Service de santé publique, épidémiologie, économie de la santé et prévention, CHU de Lille, 59000 Lille, France; UMR1167 RID-AGE, Institut Pasteur de Lille, Inserm, université de Lille, CHU de Lille, 59000 Lille, France
| | - Victoria Gauthier
- Service de santé publique, épidémiologie, économie de la santé et prévention, CHU de Lille, 59000 Lille, France; UMR1167 RID-AGE, Institut Pasteur de Lille, Inserm, université de Lille, CHU de Lille, 59000 Lille, France
| | - Aghilès Hamroun
- Service de santé publique, épidémiologie, économie de la santé et prévention, CHU de Lille, 59000 Lille, France; UMR1167 RID-AGE, Institut Pasteur de Lille, Inserm, université de Lille, CHU de Lille, 59000 Lille, France.
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Moothedath M. Reliability of rubrics in the assessment of clinical oral presentation: A prospective controlled study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 13:182. [PMID: 39268433 PMCID: PMC11392252 DOI: 10.4103/jehp.jehp_1016_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/16/2023] [Indexed: 09/15/2024]
Abstract
BACKGROUND Rubrics are assessment tools customarily designed to judge a student's skills in diagnosis, clinical assessment, presentations. as well as academic performance. The aim of the present study was to assess the reliability of rubrics in clinical oral presentations by students. MATERIALS AND METHODS This was a prospective control study that enrolled 300 undergraduate students, students in their internships, and post-graduate students in various clinical streams. Ethical committee approval was obtained before finalizing the study from appropriate regulatory and institutional bodies. A pre-validated questionnaire was designed and distributed to all the participating students. All students were assessed using the traditional examination method as well as by rubric assessment. The responses obtained were compared and statistically analyzed using one-way ANOVA and the Chi-square statistical tool. RESULTS Rubric assessment was found to have high statistical significance (P < 0.0001) when compared with the traditional method of examination. CONCLUSION In the present study, rubrics were found to serve as an effective method for judging student skills following a clinical oral presentation. However, due to contradictory scientific evidence, there is a requirement for a large sample size to be included for rubric or traditional assessment method studies.
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Affiliation(s)
- Muhamood Moothedath
- Department of Public Health, Unit of Scientific Research, College of Applied Medical Sciences, Qassim University, AlQassim, Kingdom of Saudi Arabia
- Centre for Global Health Research, Saveetha Medical College, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India
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Gama ACC, Mourão AM, Medeiros AM, Mancini PC, Machado TH, Santos LG, Gomes NR. Test for clinical reasoning evaluation in Speech-Language Pathology: content validity. Codas 2024; 36:e20230276. [PMID: 38836832 PMCID: PMC11189150 DOI: 10.1590/2317-1782/20242023276pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/18/2024] [Indexed: 06/06/2024] Open
Abstract
PURPOSE To validate the content of the Speech-Language Pathology Concordance Test called FonoTCS. METHODS This is a content validation study of the instrument. Five speech-language pathologists, all with doctoral degrees and teaching experience, averaging 24.8 years of professional practice, participated in the development of FonoTCS and reached a consensus during the process. Thirty questions and 120 items were created, covering seven areas of speech-language pathology expertise across three domains. For content validation, FonoTCS was electronically sent to 15 evaluators to respond to a questionnaire with five questions, rated on a five-point scale, regarding the criteria of clarity, ethics, and relevance of the questions. The Corrected Content Validity Coefficient was calculated for all statements to analyze the responses. Questions with agreement percentages equal to or less than 80% were revised. RESULTS Thirteen evaluators, all female, with an average age of 39.07 years, including eight with master's degrees and five with doctoral degrees, and an average clinical practice experience of 15.38 years, participated in the analysis. The average Corrected Content Validity Coefficient values for the clarity criterion were 0.93 and 0.95, for the relevance criterion 0.98 and 0.92, and for the ethics criterion 0.99. Two questions received scores of 0.78 and 0.80, both related to the audiology area in the assessment/diagnosis domain, specifically question 2 regarding the relevance criterion. These questions were reviewed and restructured by the judges. CONCLUSION FonoTCS is a valid instrument from a content perspective.
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Affiliation(s)
- Ana Cristina Côrtes Gama
- Departamento de Fonoaudiologia, Faculdade de Medicina, Universidade Federal de Minas Gerais – UFMG - Belo Horizonte (MG), Brasil.
| | - Aline Mansueto Mourão
- Departamento de Fonoaudiologia, Faculdade de Medicina, Universidade Federal de Minas Gerais – UFMG - Belo Horizonte (MG), Brasil.
| | - Adriane Mesquita Medeiros
- Departamento de Fonoaudiologia, Faculdade de Medicina, Universidade Federal de Minas Gerais – UFMG - Belo Horizonte (MG), Brasil.
| | - Patrícia Cotta Mancini
- Departamento de Fonoaudiologia, Faculdade de Medicina, Universidade Federal de Minas Gerais – UFMG - Belo Horizonte (MG), Brasil.
| | - Thais Helena Machado
- Departamento de Fonoaudiologia, Faculdade de Medicina, Universidade Federal de Minas Gerais – UFMG - Belo Horizonte (MG), Brasil.
| | - Lara Gama Santos
- Centro Federal de Educação Tecnológica de Minas Gerais – CEFET - Belo Horizonte (MG), Brasil.
| | - Nayara Ribeiro Gomes
- Programa de Pós-graduação (doutorado) em Ciências Fonoaudiológicas, Departamento de Fonoaudiologia, Faculdade de Medicina, Universidade Federal de Minas Gerais – UFMG - Belo Horizonte (MG), Brasil.
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Kojich L, Miller SA, Axman K, Eacret T, Koontz JA, Smith C. Evaluating clinical reasoning in first year DPT students using a script concordance test. BMC MEDICAL EDUCATION 2024; 24:329. [PMID: 38519915 PMCID: PMC11404025 DOI: 10.1186/s12909-024-05281-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 03/08/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND A script concordance test (SCT) provides a series of clinical vignettes to assess clinical reasoning in uncertainty. Appraised throughout health education literature, SCTs are cognitive assessments of clinical reasoning, though their use in Doctor of Physical Therapy (DPT) entry-level education has not been investigated. The purpose of this study was to develop and explore the reliability and validity of a SCT for first year DPT students. METHODS The SCT was developed and implemented over four phases. During phases one and two, DPT program faculty consulted on course content from the first-year curriculum. Thirty clinical vignettes with three follow-up questions each were constructed. The SCT was pilot tested with five clinicians in phase three to assess question clarity. During phase four, the SCT was administered to students and a reference panel via Qualtrics. First year DPT students (n = 44) and reference panel physical therapists with at least two years of experience and advanced certification (n = 15) completed the SCT. Internal consistency was analyzed using Cronbach's Alpha. Differences between student and reference panel percent-correct scores were analyzed with a t-test. Relationships between student SCT scores and academic records were explored with Spearman's Rho. RESULTS The SCT had an internal consistency of 0.74. A significant difference in scores was found between the students [mean 58.5 (+/-5.31)] and reference panel [65.8 (+/-4.88), p < .01]. No significant correlations between student SCT scores and academic records were found. CONCLUSIONS The developed SCT was reliable and demonstrated satisfactory internal consistency among test items. The SCT successfully differentiated between groups, with the reference panel demonstrating statistically significant higher percent-correct scores compared to students. SCTs may provide means to measure clinical reasoning in DPT students and lead to novel pedagogical approaches to enhance clinical reasoning.
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Affiliation(s)
- Lindsey Kojich
- University of Indianapolis, 1400 E. Hanna Ave, 46227, Indianapolis, IN, USA.
| | - Stephanie A Miller
- University of Indianapolis, 1400 E. Hanna Ave, 46227, Indianapolis, IN, USA
| | - Katelyn Axman
- University of Indianapolis, 1400 E. Hanna Ave, 46227, Indianapolis, IN, USA
| | - Timothy Eacret
- University of Indianapolis, 1400 E. Hanna Ave, 46227, Indianapolis, IN, USA
| | - J Atticus Koontz
- University of Indianapolis, 1400 E. Hanna Ave, 46227, Indianapolis, IN, USA
| | - Caroline Smith
- University of Indianapolis, 1400 E. Hanna Ave, 46227, Indianapolis, IN, USA
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Naylor K, Hislop J, Torres K, Mani ZA, Goniewicz K. The Impact of Script Concordance Testing on Clinical Decision-Making in Paramedic Education. Healthcare (Basel) 2024; 12:282. [PMID: 38275562 PMCID: PMC10815909 DOI: 10.3390/healthcare12020282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/10/2024] [Accepted: 01/15/2024] [Indexed: 01/27/2024] Open
Abstract
This study investigates the effectiveness of the Script Concordance Test (SCT) in enhancing clinical reasoning skills within paramedic education. Focusing on the Medical University of Lublin, we evaluated the SCT's application across two cohorts of paramedic students, aiming to understand its potential to improve decision-making skills in emergency scenarios. Our approach, informed by Van der Vleuten's assessment framework, revealed that while the SCT's correlation with traditional methods like multiple-choice questions (MCQs) was limited, its formative nature significantly contributed to improved performance in summative assessments. These findings suggest that the SCT can be an effective tool in paramedic training, particularly in strengthening cognitive abilities critical for emergency responses. The study underscores the importance of incorporating innovative assessment tools like SCTs in paramedic curricula, not only to enhance clinical reasoning but also to prepare students for effective emergency responses. Our research contributes to the ongoing efforts in refining paramedic education and highlights the need for versatile assessment strategies in preparing future healthcare professionals for diverse clinical challenges.
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Affiliation(s)
- Katarzyna Naylor
- Independent Unit of Emergency Medical Services and Specialist Emergency, Medical University of Lublin, Chodzki 7, 20-059 Lublin, Poland
| | - Jane Hislop
- Clinical Education, Edinburgh Medical School, The University of Edinburgh, Edinburgh EH16 4SB, UK;
| | - Kamil Torres
- Department of Didactics and Medical Simulation, Faculty of Medical Sciences, Medical University of Lublin Poland, Chodźki 7, 20-093 Lublin, Poland;
| | - Zakaria A. Mani
- Nursing College, Jazan University, Jazan 45142, Saudi Arabia;
| | - Krzysztof Goniewicz
- Department of Security Studies, Polish Air Force University, 08-521 Dęblin, Poland;
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Begun YS, Stange LR, Davis CR. Script concordance testing in genetic counseling training: A pilot study. J Genet Couns 2023; 32:1121-1130. [PMID: 37443441 DOI: 10.1002/jgc4.1752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/28/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023]
Abstract
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.
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Affiliation(s)
- Yakira S Begun
- Sarah Lawrence College Joan H. Marks Graduate Program in Human Genetics, Bronxville, New York, USA
| | - Lila R Stange
- Sarah Lawrence College Joan H. Marks Graduate Program in Human Genetics, Bronxville, New York, USA
| | - Claire R Davis
- Sarah Lawrence College Joan H. Marks Graduate Program in Human Genetics, Bronxville, New York, USA
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Naylor K, Chrzanowska-Wąsik M, Okońska P, Kucmin T, Al-Wathinani AM, Goniewicz K. Adapting to a Pandemic: Web-Based Residency Training and Script Concordance Testing in Emergency Medicine During COVID-19. Disaster Med Public Health Prep 2023; 17:e541. [PMID: 38018433 DOI: 10.1017/dmp.2023.195] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
OBJECTIVE The coronavirus disease (COVID-19) pandemic necessitated alternative methods to ensure the continuity of medical education. Our study explores the efficacy and acceptability of a digital continuous medical education initiative for medical residents during this challenging period. METHODS From September to December 2020, 47 out of 60 enrolled trainee doctors participated in this innovative digital Continuous Medical Education (CME) approach. We utilized the Script Concordance Test to bolster clinical reasoning skills. Three simulation scenarios, namely Advanced Trauma Life Support (ATLS), Advanced Life Support (ALS), and European Paediatric Life Support (EPLS), were transformed into interactive online sessions via Zoom™. Participant feedback was also collected through a survey. RESULTS Consistent Script Concordance Testing (SCT) scores among participants indicated the effectiveness of the online training module. Feedback suggested a broad acceptance of this novel training approach. However, discrepancies observed between formative SCT scores, and summative Multiple-Choice Questions (MCQ) assessments highlighted areas for potential refinement. CONCLUSIONS Our findings showcase the resilience and adaptability of medical education amidst challenges like the global pandemic. The success of methodologies such as SCT, endorsed by prestigious bodies like the European Resuscitation Council and the American Heart Association, suggests their potential in preparing health care professionals for emergent situations. This research offers valuable insights for shaping future online CME strategies.
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Affiliation(s)
- Katarzyna Naylor
- Independent Unit of Emergency Medical Services and Specialist Emergency, Medical University of Lublin, Lublin, Poland
| | | | - Patrycja Okońska
- Department of Emergency Medicine, Medical University of Lublin, Lublin, Poland
| | - Tomasz Kucmin
- Department of Didactics and Medical Simulation, Medical University of Lublin, Lublin, Poland
| | - Ahmed M Al-Wathinani
- Department of Emergency Medical Services, Prince Sultan bin Abdulaziz College for Emergency Medical Services, King Saud University, Saudi Arabia
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Charton L, Lahmar A, Hernandez E, Rougerie F, Lorenzo M. Impact of an online learning by concordance program on reflection. BMC MEDICAL EDUCATION 2023; 23:822. [PMID: 37915022 PMCID: PMC10621083 DOI: 10.1186/s12909-023-04799-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/22/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Learning by concordance (LbC) is a recent approach that introduces learners to the complexity and uncertainty of clinical practice. Some data on LbC suggest that it stimulates reflection in future clinicians. We developed an online LbC training program on electrocardiogram (ECG) interpretation in general practice at the University of Strasbourg, France, and conducted an exploratory qualitative study to document the impact of this ECG learning-by-concordance training program on reflection in participants. METHODS We created 18 clinical vignettes on ECG interpretation based on a review of the literature on frequent and serious cardiovascular diseases that can be identified using an ECG in general practice. The training program was delivered online to postgraduate general practice students in two faculties of medicine. We conducted a qualitative study based on thematic analysis of two focus groups and six individual interviews. Inductive and deductive coding were performed. The five major components of reflection in the Nguyen model were used in the deductive coding: (i) thoughts and actions, (ii) attentive, critical, exploratory, and iterative processes (ACEI), (iii) underlying conceptual frame, (iv) change and (v) self. RESULTS Two focus groups and six individual interviews were conducted. The qualitative analysis indicated 203 codes in the focus groups and 206 codes in the individual interviews, which were divided into five groups based on the components of reflection in the Nguyen model: (i) the self; (ii) attentive, critical, exploratory, and iterative interactions with (iii) one's thoughts and actions; and (iv) a view on both the change itself and (v) the underlying conceptual frame. Inductive coding revealed interesting insights into the impact of the identity of the panel members, the absence of a scoring system and the question of uncertainty in ECG reading. CONCLUSIONS This study supports the claim that the use of LbC in the context of ECG interpretation could foster reflection in future general practitioners. We discuss future research avenues on instructional design of LbC and reflection.
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Affiliation(s)
- Léa Charton
- Département de Médecine Générale et de la Formation Territoriale, Faculté de Médecine, Maïeutique et Sciences de la Santé, 4 rue Kirschleger, Strasbourg, 67085, France
| | - Abdelkader Lahmar
- Département de Médecine Générale et de la Formation Territoriale, Faculté de Médecine, Maïeutique et Sciences de la Santé, 4 rue Kirschleger, Strasbourg, 67085, France
| | - Elodie Hernandez
- Département de Médecine Générale, Faculté de Médecine, Besançon, France
| | - Fabien Rougerie
- Département de Médecine Générale et de la Formation Territoriale, Faculté de Médecine, Maïeutique et Sciences de la Santé, 4 rue Kirschleger, Strasbourg, 67085, France
| | - Mathieu Lorenzo
- Département de Médecine Générale et de la Formation Territoriale, Faculté de Médecine, Maïeutique et Sciences de la Santé, 4 rue Kirschleger, Strasbourg, 67085, France.
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11
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Deschênes MF, Maheu-Cadotte MA, Fontaine G, Dionne É. Scoring Methods in Script Concordance Tests: An Exploratory Psychometric Study. J Nurs Educ 2023; 62:549-555. [PMID: 37812827 DOI: 10.3928/01484834-20230815-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
BACKGROUND Despite the increasingly popular role of script concordance test (SCT) scoring methods in the evaluation of clinical reasoning, studies examining these methods in nursing are relatively scarce. This study explored the psychometric properties of five SCT scoring methods. METHOD An SCT was administered to 12 experts and 43 learners. Scores were calculated using five methods and descriptive statistics. Differences in scores were assessed with the Mann-Whitney U test, and Spearman correlation coefficients were calculated for the different methods. RESULTS The median scores of both experts and learners differed substantially according to the scoring method used. Learners' scores were statistically different from experts' scores (p < .01) for each method. Spearman coefficients (range, 0.44 to 0.95) were positive for the different methods. CONCLUSION Further research is needed to refine the influence of SCT scoring methods for use in certifying assessment of clinical reasoning in nursing. [J Nurs Educ. 2023;62(10):549-555.].
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Mok SF, Tan TMD, Seow CJ. Modified endocrinology script concordance test: evaluating the reliability and construct validity for assessing clinical reasoning. Singapore Med J 2023:384045. [PMID: 37675672 DOI: 10.4103/singaporemedj.smj-2021-230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Affiliation(s)
- Shao Feng Mok
- Department of Medicine, National University Hospital, Singapore
| | | | - Cherng Jye Seow
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore
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13
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Fong JMN, Hoe RHM, Huang DH, Wong JC, Kee XLJ, Teng KLA, Hong R, Saffari SE, Tan K, Tan NCK. Script concordance test to assess diagnostic and management reasoning in acute medicine. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2023; 52:383-385. [PMID: 38904506 DOI: 10.47102/annals-acadmedsg.202327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
Clinical reasoning, an essential skill for patient care, can be difficult to assess. We created and validated a script concordance test (SCT) to assess clinical reasoning in acute medicine. This tool was used to provide feedback and targeted remediation for Postgraduate-Year-1 (PGY1) doctors, guide teaching and learning, and facilitate programme evaluation.
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Affiliation(s)
| | | | | | | | | | | | - Rilong Hong
- Department of Cardiology, National Heart Centre Singapore
| | - Seyed Ehsan Saffari
- Department of Neurology, National Neuroscience Institute, Singapore
- Health Services & Systems Research, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Kevin Tan
- Department of Neurology, National Neuroscience Institute, Singapore
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14
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Fahim A, Khan RA, Sethi A. Use of situational judgment tests for assessing non-cognitive attributes of final year dental students. J Dent Educ 2023; 87:158-169. [PMID: 36184745 DOI: 10.1002/jdd.13113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 08/26/2022] [Accepted: 09/11/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Situational judgment tests (SJT) have been previously used in the admission process of medical and dental undergraduate programs, but their utilization as an assessment tool is fairly new. The objective of this study was to explore essential non-cognitive attributes of dental graduates. We also aimed to assess the attributes of final year dental students utilizing SJT and later collected participants' reactions on the test. METHODS A mixed-method exploratory sequential study was conducted. One-on-one and group discussions were done with subject matter experts (SMEs) to explore the essential attributes of fresh dental graduates. Based on the thematic analysis, 10 SJT items per domain were constructed by one group of SMEs and expert validated by a different group of SMEs and vice versa. The final dental-SJT was piloted online on final year dental students and their perceptions were collected using a five-point Likert scale questionnaire. Descriptive statistics and Cronbach's alpha were calculated for the test. RESULTS The consultation with SMEs generated three main themes, namely, Conventional skills, Tribal skills, and Occupational skills. The 70-item dental-SJT piloted on 150 final year dental students revealed data were normally distributed. The internal reliability of test was good (0.738). Students scored highest in "management skills" (>70%) and lowest in "professional ethics" (56%) and "diverse experiences" (58%). The overall student perception about the test was good. CONCLUSION SJT is an effective tool to assess non-cognitive attributes of dental students. It has an overall positive perception about perceived predictive validity, perceived fairness, face and content validity.
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Affiliation(s)
- Ayesha Fahim
- Dental Section, University College of Medicine and Dentistry, Lahore, Pakistan
| | - Rehan Ahmed Khan
- Islamic International Medical College, Riphah International University, Rawalpindi, Pakistan
| | - Ahsan Sethi
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
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15
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Ross L, Semaan E, Gosling CM, Fisk B, Shannon B. Clinical reasoning in undergraduate paramedicine: utilisation of a script concordance test. BMC MEDICAL EDUCATION 2023; 23:39. [PMID: 36658560 PMCID: PMC9849838 DOI: 10.1186/s12909-023-04020-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/11/2023] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Clinical reasoning is a complex cognitive and metacognitive process paramount to patient care in paramedic practice. While universally recognised as an essential component of practice, clinical reasoning has been historically difficult to assess in health care professions. Is the Script Concordance Test (SCT) an achievable and reliable option to test clinical reasoning in undergraduate paramedic students? METHODS This was a single institution observational cohort study designed to use the SCT to measure clinical reasoning in paramedic students. Clinical vignettes were constructed across a range of concepts with varying shades of clinical ambiguity. A reference panel mean scores of the test were compared to that of students. Test responses were graded with the aggregate scoring method with scores awarded for both partially and fully correct responses. RESULTS Eighty-three student paramedic participants (mean age: 21.8 (3.5) years, 54 (65%) female, 27 (33%) male and 2 (2%) non-binary) completed the SCT. The difference between the reference group mean score of 80 (5) and student mean of score of 65.6 (8.4) was statistically significant (p < 0.001). DISCUSSION Clinical reasoning skills are not easily acquired as they are a culmination of education, experience and the ability to apply this in the context to a specific patient. The SCT has shown to be reliable and effective in measuring clinical reasoning in undergraduate paramedics as it has in other health professions such as nursing and medicine. More investigation is required to establish effective pedogeological techniques to optimise clinical reasoning in student and novice paramedics who are devoid of experience.
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Affiliation(s)
- Linda Ross
- Department of Paramedicine, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, PO Box 527, Peninsula Campus, McMahons Road, Frankston, Melbourne, Victoria, 3199, Australia.
| | - Eli Semaan
- Ambulance Victoria, Melbourne, Australia
| | - Cameron M Gosling
- Department of Paramedicine, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, PO Box 527, Peninsula Campus, McMahons Road, Frankston, Melbourne, Victoria, 3199, Australia
| | - Benjamin Fisk
- Department of Paramedicine, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, PO Box 527, Peninsula Campus, McMahons Road, Frankston, Melbourne, Victoria, 3199, Australia
- Ambulance Victoria, Melbourne, Australia
| | - Brendan Shannon
- Department of Paramedicine, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, PO Box 527, Peninsula Campus, McMahons Road, Frankston, Melbourne, Victoria, 3199, Australia
- Ambulance Victoria, Melbourne, Australia
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16
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Pusic MV, Cook DA, Friedman JL, Lorin JD, Rosenzweig BP, Tong CK, Smith S, Lineberry M, Hatala R. Modeling Diagnostic Expertise in Cases of Irreducible Uncertainty: The Decision-Aligned Response Model. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:88-97. [PMID: 36576770 PMCID: PMC9780042 DOI: 10.1097/acm.0000000000004918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE Assessing expertise using psychometric models usually yields a measure of ability that is difficult to generalize to the complexity of diagnoses in clinical practice. However, using an item response modeling framework, it is possible to create a decision-aligned response model that captures a clinician's decision-making behavior on a continuous scale that fully represents competing diagnostic possibilities. In this proof-of-concept study, the authors demonstrate the necessary statistical conceptualization of this model using a specific electrocardiogram (ECG) example. METHOD The authors collected a range of ECGs with elevated ST segments due to either ST-elevation myocardial infarction (STEMI) or pericarditis. Based on pilot data, 20 ECGs were chosen to represent a continuum from "definitely STEMI" to "definitely pericarditis," including intermediate cases in which the diagnosis was intentionally unclear. Emergency medicine and cardiology physicians rated these ECGs on a 5-point scale ("definitely STEMI" to "definitely pericarditis"). The authors analyzed these ratings using a graded response model showing the degree to which each participant could separate the ECGs along the diagnostic continuum. The authors compared these metrics with the discharge diagnoses noted on chart review. RESULTS Thirty-seven participants rated the ECGs. As desired, the ECGs represented a range of phenotypes, including cases where participants were uncertain in their diagnosis. The response model showed that participants varied both in their propensity to diagnose one condition over another and in where they placed the thresholds between the 5 diagnostic categories. The most capable participants were able to meaningfully use all categories, with precise thresholds between categories. CONCLUSIONS The authors present a decision-aligned response model that demonstrates the confusability of a particular ECG and the skill with which a clinician can distinguish 2 diagnoses along a continuum of confusability. These results have broad implications for testing and for learning to manage uncertainty in diagnosis.
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Affiliation(s)
- Martin V. Pusic
- M.V. Pusic is associate professor of emergency medicine, Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts; ORCID: https://orcid.org/0000-0001-5236-6598
| | - David A. Cook
- D.A. Cook is professor of medicine and medical education, chair, Mayo Clinic Multidisciplinary Simulation Center Research Committee, and consultant, Division of General Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota; ORCID: https://orcid.org/0000-0003-2383-4633
| | - Julie L. Friedman
- J.L. Friedman is assistant professor of clinical medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Jeffrey D. Lorin
- J.D. Lorin is assistant professor, Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Barry P. Rosenzweig
- B.P. Rosenzweig is associate professor, Department of Medicine, associate director for educational affairs, Leon H. Charney Division of Cardiology, and assistant dean for graduate medical education, NYU Grossman School of Medicine, New York, New York
| | - Calvin K.W. Tong
- C.K.W. Tong is cardiologist and codirector, Heart Failure Services, Surrey Memorial Hospital, Surrey, British Columbia, Canada
| | - Silas Smith
- S. Smith is associate professor of emergency medicine, Department of Emergency Medicine, NYU Grossman School of Medicine, New York, New York
| | - Matthew Lineberry
- M. Lineberry is associate professor of population health, Department of Population Health, University of Kansas Medical Center and Health System, Kansas City, Kansas; ORCID: https://orcid.org/0000-0002-0177-5305
| | - Rose Hatala
- R. Hatala is professor, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; ORCID: https://orcid.org/0000-0003-0521-2590
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Newsom LC, Augustine J, Momary K. Development of a script concordance test to assess clinical reasoning in a pharmacy curriculum. CURRENTS IN PHARMACY TEACHING & LEARNING 2022; 14:1135-1142. [PMID: 36154958 DOI: 10.1016/j.cptl.2022.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 07/01/2022] [Accepted: 07/20/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Clinical reasoning is a vital skill for student pharmacists in the provision of patient-centered care, but these skills are often difficult to assess in the didactic curriculum. A script concordance test (SCT) is an innovative assessment method that can be used to assess clinical reasoning skills. The objective of this study was to develop and refine an SCT to assess clinical reasoning skills of third year student pharmacists (P3s). METHODS An SCT was written and administered to P3s. Pharmacy practice faculty members served as the expert group. The SCT was scored and Rasch analysis was performed. RESULTS The SCT included 20 case vignettes and 60 questions. Test reliability was 0.34 with mean square values for all items between 0.7 and 1.3. Forty-two questions had a difficulty score between 0 and - 1 logits, indicating there were multiple questions with similar difficulty levels. Two case vignettes and 43.3% of questions (n = 26) were revised to enhance clarity and decrease ambiguity. CONCLUSIONS The SCT is a tool to assess clinical reasoning in the didactic curriculum. Faculty can create the SCT and use statistical methods such as Rasch analysis to assess validity and reliability of the SCT.
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Affiliation(s)
- Lydia C Newsom
- Department of Pharmacy Practice, Mercer University College of Pharmacy, 3001 Mercer University Drive, Atlanta, GA 30341-4115, United States.
| | - Jill Augustine
- Department of Pharmacy Practice and the Department of Pharmaceutical Sciences, Mercer University College of Pharmacy, 3001 Mercer University Drive, Atlanta, GA 30341-4115, United States.
| | - Kathryn Momary
- Department of Pharmacy Practice, Mercer University College of Pharmacy, 3001 Mercer University Drive, Atlanta, GA 30341-4115, United States.
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Underman K, Kochunilathil M, McLean L, Vinson AH. Online student culture as site for negotiating assessment in medical education. Soc Sci Med 2022; 310:115270. [PMID: 36030626 DOI: 10.1016/j.socscimed.2022.115270] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 08/01/2022] [Accepted: 08/04/2022] [Indexed: 11/30/2022]
Abstract
Classic studies of medical education have examined how professional socialization reproduces the prevailing professional culture, as well as how students actively negotiate their place in educational processes. However, sociological research has not re-examined student culture in light of structural transformations in medical education, such as the introduction of new assessment types and their use as modes of commensuration. In this paper, we examine data from two studies of online forums where medical trainees and applicants to medical school discuss their experiences preparing for tests of professional skills, including judgment, empathy, and communication. Examining how medical students talk about these tests on such forums allows us to understand the meaning-making processes at work as students negotiate the commensuration processes such tests enable. We examine how these negotiations take place in online forums, where participants confront common challenges, form common perspectives, and share common solutions, all hallmarks of student culture. Through qualitative analysis, we find that online communities are spaces where students grapple with these new forms of commensuration, interrogate the standards and quantifications that underlie them, and collectively negotiate how to approach these assessments. Using the case of online forum communities, our findings advance past work on student culture in medical sociology by theorizing student culture as an extra-organizational phenomenon that spans multiple career stages. In so doing, we highlight the importance of online forum data for studying social processes.
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Affiliation(s)
| | | | - Lauren McLean
- Central Michigan University College of Medicine, USA
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19
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Nafea ET. Does Self-Efficacy Affect Clinical Reasoning in Dental Students? Int Dent J 2022; 72:872-878. [PMID: 35753843 PMCID: PMC9676534 DOI: 10.1016/j.identj.2022.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/13/2022] [Accepted: 05/15/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Individual ability, motivation, age, and gender are all specific learner-related factors that can affect the academic performance of undergraduate dental students. Clinical reasoning and self-efficacy may potentially play crucial roles in this. This research aims to study the effects of clinical reasoning and self-efficacy on academic performance and to determine the relationship between them. Materials and methods This is a cross-sectional quantitative study that was conducted in 2021, and the study participants included 81 (86.19% response rate) final-year dental students who responded to an online questionnaire containing a specially designed clinical reasoning test and a self-efficacy scale. Results Although the levels of clinical reasoning skills and self-efficacy were not directly related, they were positively associated with students’ academic achievements. Furthermore, these 2 factors were considered to be predictors of a student's academic performance. Conclusions High levels of self-efficacy and clinical reasoning skills were associated with high academic achievement in students. However, having high levels of self-efficacy does not necessarily indicate mastery of clinical reasoning skills. This conclusion reflects the complexity of the clinical reasoning process during which an individual is faced with uncertainty. High levels of confidence might make students rush to a conclusion without considering all the conflicting possibilities or alternatives. In all instances, dental educators should follow recommended measures to improve clinical reasoning and self-efficacy abilities due to their importance in improving learning in students.
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Affiliation(s)
- Ebtihaj T Nafea
- Department of Dental Education, Taibah University, Medinah, Saudi Arabia.
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20
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Kün-Darbois JD, Annweiler C, Lerolle N, Lebdai S. Script concordance test acceptability and utility for assessing medical students' clinical reasoning: a user's survey and an institutional prospective evaluation of students' scores. BMC MEDICAL EDUCATION 2022; 22:277. [PMID: 35418078 PMCID: PMC9008989 DOI: 10.1186/s12909-022-03339-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 04/01/2022] [Indexed: 06/14/2023]
Abstract
Script Concordance Testing (SCT) is a method for clinical reasoning assessment in the field of health-care training. Our aim was to assess SCT acceptability and utility with a survey and an institutional prospective evaluation of students' scores.With a user's online survey, we collected the opinions and satisfaction data of all graduate students and teachers involved in the SCT setting. We performed a prospective analysis comparing the scores obtained with SCT to those obtained with the national standard evaluation modality.General opinions about SCT were mostly negative. Students tended to express more negative opinions and perceptions. There was a lower proportion of negative responses in the teachers' satisfaction survey. The proportion of neutral responses was higher for teachers. There was a higher proportion of positive positions towards all questions among teachers. PCC scores significantly increased each year, but SCT scores increased only between the first and second tests. PCC scores were found significantly higher than SCT scores for the second and third tests. Medical students' and teachers' global opinion on SCT was negative. At the beginning SCT scores were found quite similar to PCC scores. There was a higher progression for PCC scores through time.
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Affiliation(s)
- Jean-Daniel Kün-Darbois
- Maxillofacial Surgery Department, University Hospital of Angers, 49933, Angers Cedex, France.
- Faculty for Health Sciences and Medicine, University of Angers, Angers, Angers, France.
| | - Cédric Annweiler
- Faculty for Health Sciences and Medicine, University of Angers, Angers, Angers, France
- Geriatric Department, University Hospital of Angers, Angers, France
| | - Nicolas Lerolle
- Faculty for Health Sciences and Medicine, University of Angers, Angers, Angers, France
- Intensive Care Department, University Hospital of Angers, Angers, France
| | - Souhil Lebdai
- Faculty for Health Sciences and Medicine, University of Angers, Angers, Angers, France
- Urology Department, University Hospital of Angers, Angers, France
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Smith KJ, Childs‐Kean LM, Smith MD. Developing Clinical Reasoning: An Introduction for Pharmacy Preceptors. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kathryn J. Smith
- University of Oklahoma Health Sciences Center College of Pharmacy 1110 N. Stonewall Ave CPB 229 Oklahoma City Oklahoma
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22
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Patel R. General practice trainees’ learning experiences of formative think-aloud script concordance testing. EDUCATION FOR PRIMARY CARE 2022; 33:229-236. [DOI: 10.1080/14739879.2022.2057240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Rajan Patel
- Academic Clinic Fellow, Nuffield Department of Primary Care Health Sciences, University of Oxford Medical Sciences Division, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Oxford, United Kingdom
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Zagury-Orly I, Kamin DS, Krupat E, Charlin B, Fernandez N, Fischer K. The Student-Generated Reasoning Tool (SGRT): Linking medical knowledge and clinical reasoning in preclinical education. MEDICAL TEACHER 2022; 44:158-166. [PMID: 34459337 DOI: 10.1080/0142159x.2021.1967904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION The simultaneous integration of knowledge acquisition and development of clinical reasoning in preclinical medical education remains a challenge. To help address this challenge, the authors developed and implemented the Student-Generated Reasoning Tool (SGRT)-a tool asking students to propose and justify pathophysiological hypotheses, generate findings, and critically appraise information. METHODS In 2019, students in a first-year preclinical course (n = 171; SGRT group) were assigned to one of 20 teams. Students used the SGRT individually, then in teams, and faculty provided feedback. The control group (n = 168) consisted of students from 2018 who did not use SGRT. Outcomes included academic performance, effectiveness of collaborative environments using the SGRT, and student feedback. RESULTS Students were five times more likely to get questions correct if they were in the SGRT group versus control group. Accuracy of pathophysiological hypotheses was significantly lower for individuals than teams. Qualitative analysis indicated students benefited from generating their own data, justifying their reasoning, and working individually as well as in teams. CONCLUSIONS This study introduces the SGRT as a potentially engaging, case-based, and collaborative learning method that may help preclinical medical students become aware of their knowledge gaps and integrate their knowledge in basic and clinical sciences in the context of clinical reasoning.
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Affiliation(s)
- Ivry Zagury-Orly
- Faculty of Medicine, Université de Montréal, Montreal, Canada
- Harvard Medical School, Boston, MA, USA
| | - Daniel S Kamin
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - Edward Krupat
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Bernard Charlin
- Centre for Pedagogy Applied to the Health Sciences, Department of Surgery, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Nicolas Fernandez
- Centre for Pedagogy Applied to the Health Sciences, Department of Surgery, Faculty of Medicine, Université de Montréal, Montreal, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Krisztina Fischer
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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An Ontology-Driven Learning Assessment Using the Script Concordance Test. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12031472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Assessing the level of domain-specific reasoning acquired by students is one of the major challenges in education particularly in medical education. Considering the importance of clinical reasoning in preclinical and clinical practice, it is necessary to evaluate students’ learning achievements accordingly. The traditional way of assessing clinical reasoning includes long-case exams, oral exams, and objective structured clinical examinations. However, the traditional assessment techniques are not enough to answer emerging requirements in the new reality due to limited scalability and difficulty for adoption in online education. In recent decades, the script concordance test (SCT) has emerged as a promising tool for assessment, particularly in medical education. The question is whether the usability of SCT could be raised to a level high enough to match the current education requirements by exploiting opportunities that new technologies provide, particularly semantic knowledge graphs (SCGs) and ontologies. In this paper, an ontology-driven learning assessment is proposed using a novel automated SCT generation platform. SCTonto ontology is adopted for knowledge representation in SCT question generation with the focus on using electronic health records data for medical education. Direct and indirect strategies for generating Likert-type scores of SCT are described in detail as well. The proposed automatic question generation was evaluated against the traditional manually created SCT, and the results showed that the time required for tests creation significantly reduced, which confirms significant scalability improvements with respect to traditional approaches.
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Misganaw E, Yigzaw T, Tezera R, Gelitew A, Gedamu S. The Promise of the New Educational Strategy for Curriculum Development (SPICES) Model on the Development of Students' Clinical Reasoning Ability. A Comparative Cross-Sectional Study. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2022; 13:71-79. [PMID: 35068943 PMCID: PMC8769052 DOI: 10.2147/amep.s344933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/07/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Clinical reasoning skills are a core competency that must be taught at all levels of health-care education. In the last decade, several health professional education curricula in Ethiopia have been redesigned with the goal of improving student competence in key health-care delivery skills. Despite the fact that some academic programs followed the conventional educational strategy, a significant number of academic programs adopted a new educational strategy for curriculum development: Student-centered, Problem-based, Integrated, Community-based, Elective, and Systematic (SPICES) model. More empirical evidence, however, is required to determine whether the new curricular approach is effective in improving students' clinical reasoning. The purpose of this study is to determine whether the new educational strategy for curriculum development improves the clinical reasoning ability of midwifery students when compared to a peer institution that follows a traditional curriculum. METHODS A comparative cross-sectional study was conducted to compare the clinical reasoning skills of midwifery students who completed the new curricular approach versus students who completed a traditional curriculum. A Script Concordance Test (SCT) was used to collect data. The mean SCT score and an independent two-sample t-test were calculated to see if the two groups differed significantly in terms of clinical reasoning skills in managing Post-Partum hemorrhage (PPH). RESULTS A total of 77 final-year midwifery students participated (38 from the new and 39 from the traditional curriculum approach). Midwifery students who completed the new and conventional curriculum approaches had mean clinical reasoning SCT scores of 0.7 (SD = 0.35) and 0.53 (SD = 0.37), respectively. There was a statistically significant difference in the overall mean SCT score between the two study groups in terms of clinical reasoning skills (p = 0.008). CONCLUSION Our study found that the new SPICES model curricular approach is promising in fostering the development of clinical reasoning skills of Midwifery students in managing PPH.
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Affiliation(s)
- Equlinet Misganaw
- CIH Center for International Health, University Hospital, LMU Munich, Munich, Germany
| | | | - Robel Tezera
- Addis Ababa University, College of Medicine and Health Science, Addis Ababa, Ethiopia
| | - Awoke Gelitew
- Debre-Tabor University, College of Medicine and Health Science, Debre-Tabor, Ethiopia
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Kelkar A, Bhandary S, Chacko T. Addressing the need to develop critical thinking skills in the new competency-based medical education post graduate curriculum in pathology: Experience-sharing of the process of development and validation of script concordance test. ARCHIVES OF MEDICINE AND HEALTH SCIENCES 2022. [DOI: 10.4103/amhs.amhs_227_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Nomura O, Itoh T, Mori T, Ihara T, Tsuji S, Inoue N, Carrière B. Creating Clinical Reasoning Assessment Tools in Different Languages: Adaptation of the Pediatric Emergency Medicine Script Concordance Test to Japanese. Front Med (Lausanne) 2021; 8:765489. [PMID: 34950681 PMCID: PMC8688734 DOI: 10.3389/fmed.2021.765489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/12/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: Clinical reasoning is a crucial skill in the practice of pediatric emergency medicine and a vital element of the various competencies achieved during the clinical training of resident doctors. Pediatric emergency physicians are often required to stabilize patients and make correct diagnoses with limited clinical information, time and resources. The Pediatric Emergency Medicine Script Concordance Test (PEM-SCT) has been developed specifically for assessing physician's reasoning skills in the context of the uncertainties in pediatric emergency practice. In this study, we developed the Japanese version of the PEM-SCT (Jpem-SCT) and confirmed its validity by collecting relevant evidence. Methods: The Jpem-SCT was developed by translating the PEM-SCT into Japanese using the Translation, Review, Adjudication, Pretest, Documentation team translation model, which follows cross-cultural survey guidelines for proper translation and cross-cultural and linguistic equivalences between the English and Japanese version of the survey. First, 15 experienced pediatricians participated in the pre-test session, serving as a reference panel for modifying the test descriptions, incorporating Japanese context, and establishing the basis for the scoring process. Then, a 1-h test containing 60 questions was administered to 75 trainees from three academic institutions. Following data collection, we calculated the item-total correlations of the scores to optimize selection of the best items in the final version of the Jpem-SCT. The reliability of the finalized Jpem-SCT was calculated using Cronbach's α coefficient for ensuring generalizability of the evidence. We also conducted multiple regression analysis of the test score to collect evidence on validity of the extrapolation. Results: The final version of the test, based on item-total correlation data analysis, contained 45 questions. The participant's specialties were as follows: Transitional interns 12.0%, pediatric residents 56.0%, emergency medicine residents 25.3%, and PEM fellows 6.7%. The mean score of the final version of the Jpem-SCT was 68.6 (SD 9.8). The reliability of the optimized test (Cronbach's α) was 0.70. Multiple regression analysis showed that being a transitional intern was a negative predictor of test scores, indicating that clinical experience relates to performance on the Jpem-SCT. Conclusion: This pediatric emergency medicine Script Concordance Test was reliable and valid for assessing the development of clinical reasoning by trainee doctors during residency training.
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Affiliation(s)
- Osamu Nomura
- Department of Emergency and Disaster Medicine, Hirosaki University, Hirosaki, Aomori, Japan
| | - Taichi Itoh
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States.,Department of Medical Education, University of Illinois at Chicago, Chicago, IL, United States
| | - Takaaki Mori
- Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore, Singapore.,Division of Pediatric Emergency Medicine, Tokyo Children's Medical Center, Fuchu, Tokyo, Japan
| | - Takateru Ihara
- Division of Pediatric Emergency Medicine, Tokyo Children's Medical Center, Fuchu, Tokyo, Japan
| | - Satoshi Tsuji
- National Center for Child Health and Development, Setagaya, Tokyo, Japan
| | - Nobuaki Inoue
- Department of Human Resources Development, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Shinjuku, Tokyo, Japan
| | - Benoit Carrière
- Department of Pediatrics, Section of Pediatric Emergency Medicine, Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC, Canada
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Deschênes MF, Charlin B, Phan V, Grégoire G, Riendeau T, Henri M, Fehlmann A, Moussa A. Educators and practitioners' perspectives in the development of a learning by concordance tool for medical clerkship in the context of the COVID pandemic. CANADIAN MEDICAL EDUCATION JOURNAL 2021; 12:43-54. [PMID: 35003430 PMCID: PMC8740256 DOI: 10.36834/cmej.72461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND The COVID-19 pandemic has forced medical schools to create educational material to palliate the anticipated and observed decrease in clinical experiences during clerkships. An online learning by concordance (LbC) tool was developed to overcome the limitation of students' experiences with clinical cases. However, knowledge about the instructional design of an LbC tool is scarce, especially the perspectives of collaborators involved in its design: 1- educators who wrote the vignettes' questions and 2- practitioners who constitute the reference panel by answering the LbC questions. The aim of this study was to describe the key elements that supported the pedagogical design of an LbC tool from the perspectives of educators and practitioners. METHODS A descriptive qualitative research design has been used. Online questionnaires were used, and descriptive analysis was conducted. RESULTS Six educators and 19 practitioners participated in the study. Important to the educators in designing the LbC tool were prevalent or high-stake situations, theoretical knowledge, professional situations experienced and perceived difficulties among students, and that the previous workshop promoted peer discussion and helped solidify the writing process. Important for practitioners was standards of practice and consensus among experts. However, they were uncertain of the educational value of their feedback, considering the ambiguity of the situations included in the LbC tool. CONCLUSIONS The LbC tool is a relatively new training tool in medical education. Further research is needed to refine our understanding of the design of such a tool and ensure its content validity to meet the pedagogical objectives of the clerkship.
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Affiliation(s)
- Marie-France Deschênes
- Centre d’innovation en formation infirmière (CIFI) – Center for Innovation in Nursing Education, Université de Montréal, Quebec, Canada
| | | | - Véronique Phan
- Faculté de Médecine, Université de Montréal, Quebec, Canada
| | | | - Tania Riendeau
- Faculté de Médecine, Université de Montréal, Quebec, Canada
| | - Margaret Henri
- Faculté de Médecine, Université de Montréal, Quebec, Canada
| | - Aurore Fehlmann
- Department of Paediatrics, Gynecology and Obstetrics, Geneva University Hospitals, Switzerland
| | - Ahmed Moussa
- Faculté de Médecine, Université de Montréal, Quebec, Canada
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Ong KY, Ng CWQ, Tan NCK, Tan K. Differential effects of team-based learning on clinical reasoning. CLINICAL TEACHER 2021; 19:17-23. [PMID: 34747568 DOI: 10.1111/tct.13436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 09/06/2021] [Accepted: 10/22/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Clinical reasoning (CR) is the ability to integrate information, knowledge and contextual factors for patient care. Few studies have explored effects of team-based learning (TBL) on neurological CR. This study compared simplified TBL (sTBL) against interactive lectures (IL) for teaching CR in neuroanatomical localisation (NL) and neurological emergencies (NE), assessed using a validated Script Concordance Test (SCT). METHODS A crossover study was conducted with third- and fifth-year undergraduates, randomly assigned to two groups, from the Yong Loo Lin School of Medicine in Singapore. Group 1 was taught NE with sTBL and NL with IL, whereas Group 2 was taught NL with sTBL and NE with IL. Teaching was conducted sequentially over 3 h followed immediately by the SCT. The primary outcome was the difference in mean SCT scores of NE and NL taught with sTBL versus IL. FINDINGS A total of 179 students (Group 1, n = 81; Group 2, n = 98) participated. Mean NL SCT scores for students taught with sTBL were significantly higher compared with IL (64.8% vs. 61.7%, mean difference 3.1%, 95% confidence interval [CI] 0.6%-5.5%, p = 0.013); effect size was 0.38. Mean NE SCT scores were similar between students taught with sTBL or IL (66.6% vs. 67.0%, mean difference -0.4%, 95% CI -2.2% to 3.1%, p = 0.75). CONCLUSIONS sTBL was superior to IL for teaching NL, whereas both methods were comparable for teaching NE. TBL may be suitable for teaching more complex neurological topics involving diagnostic reasoning through development of problem representation, hypothesis generation and illness script selection.
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Affiliation(s)
| | - Cherie W Q Ng
- Department of Diagnostic Imaging, National University Health System, Singapore
| | - Nigel C K Tan
- Office of Neurological Education, Department of Neurology, National Neuroscience Institute, Singapore
| | - Kevin Tan
- Office of Neurological Education, Department of Neurology, National Neuroscience Institute, Singapore
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Leenhardt R, Koulaouzidis A, McNamara D, Keuchel M, Sidhu R, McAlindon ME, Saurin JC, Eliakim R, Fernandez-Urien Sainz I, Plevris JN, Rahmi G, Rondonotti E, Rosa B, Spada C, Toth E, Houdeville C, Li C, Robaszkiewicz M, Marteau P, Dray X. A guide for assessing the clinical relevance of findings in small bowel capsule endoscopy: analysis of 8064 answers of international experts to an illustrated script questionnaire. Clin Res Hepatol Gastroenterol 2021; 45:101637. [PMID: 33662785 DOI: 10.1016/j.clinre.2021.101637] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/10/2020] [Accepted: 09/10/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIM Although recommended, the P-score used for assessing the pertinence / relevance of findings seen in small bowel (SB) capsule endoscopy (CE) is based on a low level of knowledge. The aim of this study was to evaluate the clinical relevance of the most frequent SBCE findings through an illustrated script questionnaire. MATERIALS AND METHODS Sixteen types of SBCE findings were illustrated four times each in three different settings (occult and overt obscure gastrointestinal bleeding and suspected Crohn's disease), and with a variable number (n = 1/n = 2-5/n ≥ 6), thus providing a questionnaire with 192 scenarios and 576 illustrated questions. Fifteen international experts were asked to rate the finding's relevance for each question as very unlikely (-2) / unlikely (-1) / doubtful (0) / likely (+1) / very likely (+2). The median score (≤-0.75, between -0.75 and 0.75, or ≥0.75) obtained for each scenario determined a low (P0), intermediate (P1) or high (P2) relevance, respectively. RESULTS 8064 answers were analyzed. Participation and completion rates were 93% and 100%, respectively. In overt or occult OGIB, resultant P2 findings were 'typical angiectasia', 'deep ulceration', 'stenosis', and'blood', whatever their numbers, and 'superficial ulcerations' when multiple. While in suspected CD, consensus P2 lesions were 'deep ulceration' and 'stenosis' whatever their numbers, and 'aphthoid erosions' and 'superficial ulcerations' when multiple. CONCLUSION This study establishes a guide for the evaluation of relevance of SBCE findings. It represents a step forward for SB-CE interpretation and is intended to be used as a tool for teaching and academic research.
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Affiliation(s)
- R Leenhardt
- Sorbonne Université, Endoscopy Unit, Hôpital Saint-Antoine, APHP, Paris, France
| | - A Koulaouzidis
- The Royal Infirmary of Edinburgh, Centre For Liver & Digestive Disorders, Edinburgh, United Kingdom
| | - D McNamara
- TAGG Research Centre, Department of Clinical Medicine Tallaght Hospital, Trinity College Dublin, Ireland
| | - M Keuchel
- Bethesda Krankenhaus Bergedorf, Klinik für Innere Medizin, Hamburg, Germany
| | - R Sidhu
- Dept. of Gastroenterology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - M E McAlindon
- Dept. of Gastroenterology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - J C Saurin
- Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Lyon, France
| | - R Eliakim
- Dept. of Gastroenterology, Sheba Medical Center, Ramat Gan, and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - J N Plevris
- The Royal Infirmary of Edinburgh, Centre For Liver & Digestive Disorders, Edinburgh, United Kingdom
| | - G Rahmi
- Université de Paris, Department of Gastroenterology and Digestive Endoscopy, Georges-Pompidou European Hospital, Paris, France
| | - E Rondonotti
- Gastroenterology Unit, Valduce Hospital, Como, Italy
| | - B Rosa
- Universidade do Minho, Hospital Senhora da Oliveira, Departamento de Gastroenterologia, Guimarães, Portugal
| | - C Spada
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy; Digestive Endoscopy Unit, Universita Cattolica del Sacro Cuore, Roma, Italy
| | - E Toth
- Department of Gastroenterology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - C Houdeville
- Sorbonne Université, Endoscopy Unit, Hôpital Saint-Antoine, APHP, Paris, France
| | - C Li
- Sorbonne Université, Endoscopy Unit, Hôpital Saint-Antoine, APHP, Paris, France; Drexel University, College of Arts & Sciences, Philadelphia, USA
| | - M Robaszkiewicz
- La Cavale Blanche University Hospital, Endoscopy Unit, Brest, France
| | - P Marteau
- Sorbonne Université, Endoscopy Unit, Hôpital Saint-Antoine, APHP, Paris, France
| | - X Dray
- Sorbonne Université, Endoscopy Unit, Hôpital Saint-Antoine, APHP, Paris, France.
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Vital S, Wulfman C, Girard F, Tamimi F, Charlin B, Ducret M. Script concordance tests: A call for action in dental education. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2021; 25:705-710. [PMID: 33486880 DOI: 10.1111/eje.12649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/23/2020] [Accepted: 12/13/2020] [Indexed: 06/12/2023]
Abstract
The Script Concordance Test (SCT) is an educational tool that aims to assess the ability to interpret medical information under conditions of uncertainty. It is widely used and validated in health education, but almost unknown in dentistry. Based on authentic clinical problem-solving situations, it allows to assess clinical reasoning that experienced health workers develop over the years. A specific scoring system, dedicated to SCT, considers the variability of responses of practitioners in the same clinical situations. Finally, the scores generated by SCT reflect the respondents' ability to interpret clinical data compared to experienced clinicians. This article aims to familiarise the dental educators' community with SCT construction, optimisation and its possible applications.
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Affiliation(s)
- Sibylle Vital
- UFR Odontologie, UR 2496, Université de Paris, Paris, France
- Hôpital Louis Mourier, Service de Médecine Bucco-Dentaire, DMU ESPRIT, AP-HP, Colombes, France
| | - Claudine Wulfman
- Université de Paris, URB2I, UR 4462, F-92049, Montrouge, Université Sorbonne Paris Nord, F- 93000, Bobigny, France
- AP-HP, Hôpitaux Universitaires Henri Mondor, Service de Médecine Bucco-Dentaire, F-94010, Créteil, France
| | - Félix Girard
- Faculty of Dentistry, Université de Montréal, Montréal, QC, Canada
| | - Faleh Tamimi
- Faculty of Dentistry, McGill University, Montreal, QC, Canada
- College of Dental Medicine, Qatar University, Doha, Qatar
| | - Bernard Charlin
- Faculté de médecine, Université de Montréal, Montréal, QC, Canada
- Centre de pédagogie appliquée aux sciences de la santé (CPASS), Université de Montréal, Montréal, QC, Canada
| | - Maxime Ducret
- Faculty of Dentistry, McGill University, Montreal, QC, Canada
- Faculté d'Odontologie, Université Claude Bernard Lyon 1, Lyon, France
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Abstract
BACKGROUND The script concordance approach aims at triggering judgments in simulated contexts of uncertainty. PROBLEM Nursing students need to be prepared to manage the uncertainty of clinical practice. APPROACH The purpose of this article is to describe the theoretical foundation and the pedagogical use of the script concordance approach, as well as to present the current state of nursing evidence on the subject. The script concordance approach includes (1) script concordance testing, which is a quantitative examination that evaluates clinical reasoning; (2) a face-to-face script concordance activity; and (3) a digital educational strategy based on script concordance delivered via an online teaching/learning platform that aims to support clinical reasoning development. CONCLUSIONS Relying on questioning and experts' modeling, the script concordance offers an innovative pedagogical approach that approximates the uncertainty of clinical practice.
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Bryant GA, Dy-Boarman EA, Herring MS, Witry MJ. Use of a script concordance test to evaluate the impact of a targeted educational strategy on clinical reasoning in advanced pharmacy practice experiential students. CURRENTS IN PHARMACY TEACHING & LEARNING 2021; 13:1024-1031. [PMID: 34294243 DOI: 10.1016/j.cptl.2021.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 01/27/2021] [Accepted: 06/09/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND PURPOSE It is unclear how clinical reasoning is impacted by a single advanced pharmacy practice experience (APPE) and how preceptors can further develop these skills. EDUCATIONAL ACTIVITY AND SETTING Students completing an APPE within four sites were invited to participate. To assess clinical reasoning skills, students completed a 30 item script concordance test (SCT) during week 1 and week 5 of a rotation. Students were divided into control and intervention groups. The intervention group participated in a clinical reasoning discussion, during which students presented a case and led a discussion on how to reason through treatment options. FINDINGS Change in mean SCT scores between week 1 and week 5 were 0.84 (2.8%) and 1.23 (4.1%) in the control (n = 15) and intervention groups (n = 28), respectively. There was no significant change in scores in the control group (P = .07, CI -0.34, 2.01). The change in scores was statistically significant in the intervention group (P = .02, CI 0.23, 2.23). An independent samples t-test comparing the SCT score change for the control and intervention group showed no significant difference (P = .62, CI -1.18, 1.96). SUMMARY This study demonstrated the feasibility of implementing a SCT in experiential education. SCT scores did not significantly improve beyond the standard APPE in response to the focused educational intervention, but investigators found that the discussion facilitated rich conversations about patient cases and was valuable for assessing a student's thinking pattern.
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Affiliation(s)
- Ginelle A Bryant
- Department of Clinical Sciences, Drake University College of Pharmacy and Health Sciences, 2507 University Avenue, Des Moines, IA 50311-4505, United States.
| | - Eliza A Dy-Boarman
- Department of Clinical Sciences, Drake University College of Pharmacy and Health Sciences, 2507 University Avenue, Des Moines, IA 50311-4505, United States.
| | - Morgan S Herring
- Department of Pharmacy Practice and Science, Division of Applied Clinical Sciences, University of Iowa College of Pharmacy, 180 South Grand Avenue, Iowa City, Iowa 52242, United States.
| | - Matthew J Witry
- Department of Pharmacy Practice and Science, Division of Health Services Research, University of Iowa College of Pharmacy, 180 South Grand Avenue 342 CPB, Iowa City, Iowa 52242, United States.
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Charlin B, Deschênes MF, Fernandez N. Learning by concordance (LbC) to develop professional reasoning skills: AMEE Guide No. 141. MEDICAL TEACHER 2021; 43:614-621. [PMID: 33779476 DOI: 10.1080/0142159x.2021.1900554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Developing effective clinical reasoning is central to health professions education. Learning by concordance (LbC) is an on-line educational strategy that makes learners practice reasoning competency in case-based clinical situations. The questions asked are similar to those professionals ask themselves in their practice and participant answers are compared to those of a reference panel. When participants answer the questions, they receive an automated feedback that is two-fold as they see (1) how the panelists respond and (2) justifications each panelist gives for their answer. This provides rich contextual knowledge about the situation, supplemented by a synthesis summarizing crucial points. As many educators in the health sciences are engaging in introducing innovative approaches, many consider building LbC learning modules. Elaborating, designing and implementing a LbC tool remain a challenge. This AMEE Guide describes the steps and elements to be considered when designing a LbC tool, drawing on examples from distinct health professions: medicine, nursing, physiotherapy, and dentistry. Specifically, the following elements will be discussed: (1) LbC theoretical underpinnings; (2) principles of LbC questioning; (3) goals of the concordance-based activity; (4) nature of reasoning tasks; (5) content/levels of complexity; (6) reference panel; (7) feedback/synthesis messages; (8) on-line learning platforms.
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Affiliation(s)
- Bernard Charlin
- Faculté de médecine, Université de Montréal, Montréal, Canada
- Centre de pédagogie appliquée aux sciences de la santé (CPASS), Université de Montréal, Montréal, Canada
| | - Marie-France Deschênes
- Faculté des sciences infirmières, Université de Montréal, Montréal, Canada
- Centre d'innovation en formation infirmière (CIFI), Université de Montréal, Montréal, Canada
| | - Nicolas Fernandez
- Faculté de médecine, Université de Montréal, Montréal, Canada
- Centre de pédagogie appliquée aux sciences de la santé (CPASS), Université de Montréal, Montréal, Canada
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Leclerc AA, Nguyen LH, Charlin B, Lubarsky S, Ayad T. Assessing the acceptability of script concordance testing: a nationwide study in otolaryngology. Can J Surg 2021; 64:E317-E323. [PMID: 34038060 PMCID: PMC8327993 DOI: 10.1503/cjs.014919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background Script concordance testing (SCT) is an objective method to evaluate clinical reasoning that assesses the ability to interpret medical information under conditions of uncertainty. Many studies have supported its validity as a tool to assess higher levels of learning, but little is known about its acceptability to major stakeholders. The aim of this study was to determine the acceptability of SCT to residents in otolaryngology – head and neck surgery (OTL-HNS) and a reference group of experts. Methods In 2013 and 2016, a set of SCT questions, as well a post-test exit survey, were included in the National In-Training Examination (NITE) for OTL-HNS. This examination is administered to all OTL-HNS residents across Canada who are in the second to fifth year of residency. The same SCT questions and survey were then sent to a group of OTL-HNS surgeons from 4 Canadian universities. Results For 64.4% of faculty and residents, the study was their first exposure to SCT. Overall, residents found it difficult to adapt to this form of testing, thought that the clinical scenarios were not clear and believed that SCT was not useful for assessing clinical reasoning. In contrast, the vast majority of experts felt that the test questions reflected real-life clinical situations and would recommend SCT as an evaluation method in OTL-HNS. Conclusion Views about the acceptability of SCT as an assessment tool for clinical reasoning differed between OTL-HNS residents and experts. Education about SCT and increased exposure to this testing method are necessary to improve residents’ perceptions of SCT.
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Affiliation(s)
- Andrée-Anne Leclerc
- From the Department of Otolaryngology – Head and Neck Surgery, Université de Montréal, Montreal, Que. (Leclerc, Charlin, Ayad); the Department of Otolaryngology – Head and Neck Surgery, McGill University, Montréal, Que. (Nguyen); the Centre for Medical Education, Université de Montréal, Montreal, Que. (Charlin); the Centre for Medical Education, McGill University, Montreal, Que. (Lubarsky); and the Department of Neurology, McGill University, Montreal, Que. (Lubarsky)
| | - Lily H.P. Nguyen
- From the Department of Otolaryngology – Head and Neck Surgery, Université de Montréal, Montreal, Que. (Leclerc, Charlin, Ayad); the Department of Otolaryngology – Head and Neck Surgery, McGill University, Montréal, Que. (Nguyen); the Centre for Medical Education, Université de Montréal, Montreal, Que. (Charlin); the Centre for Medical Education, McGill University, Montreal, Que. (Lubarsky); and the Department of Neurology, McGill University, Montreal, Que. (Lubarsky)
| | - Bernard Charlin
- From the Department of Otolaryngology – Head and Neck Surgery, Université de Montréal, Montreal, Que. (Leclerc, Charlin, Ayad); the Department of Otolaryngology – Head and Neck Surgery, McGill University, Montréal, Que. (Nguyen); the Centre for Medical Education, Université de Montréal, Montreal, Que. (Charlin); the Centre for Medical Education, McGill University, Montreal, Que. (Lubarsky); and the Department of Neurology, McGill University, Montreal, Que. (Lubarsky)
| | - Stuart Lubarsky
- From the Department of Otolaryngology – Head and Neck Surgery, Université de Montréal, Montreal, Que. (Leclerc, Charlin, Ayad); the Department of Otolaryngology – Head and Neck Surgery, McGill University, Montréal, Que. (Nguyen); the Centre for Medical Education, Université de Montréal, Montreal, Que. (Charlin); the Centre for Medical Education, McGill University, Montreal, Que. (Lubarsky); and the Department of Neurology, McGill University, Montreal, Que. (Lubarsky)
| | - Tareck Ayad
- From the Department of Otolaryngology – Head and Neck Surgery, Université de Montréal, Montreal, Que. (Leclerc, Charlin, Ayad); the Department of Otolaryngology – Head and Neck Surgery, McGill University, Montréal, Que. (Nguyen); the Centre for Medical Education, Université de Montréal, Montreal, Que. (Charlin); the Centre for Medical Education, McGill University, Montreal, Que. (Lubarsky); and the Department of Neurology, McGill University, Montreal, Que. (Lubarsky)
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Ottolini MC, Chua I, Campbell J, Ottolini M, Goldman E. Pediatric Hospitalists' Performance and Perceptions of Script Concordance Testing for Self-Assessment. Acad Pediatr 2021; 21:252-258. [PMID: 33065290 DOI: 10.1016/j.acap.2020.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/25/2020] [Accepted: 10/10/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The cognitive expertise of Pediatric Hospitalists (PH) lies not in standard knowledge but in making decisions under conditions of uncertainty. To maintain expertise, PH should engage in deliberate practice via self-assessments that promote higher-level cognitive processes necessary to address problems with missing or ambiguous information. Higher levels of cognition are purported with Script Concordance Test (SCT) questions compared to Multiple Choice Questions (MCQ). To determine if PH use higher levels of cognition when answering SCT versus MCQ questions and to analyze participants' perceptions of the utility of using SCT self-assessment for deliberate practice in addressing clinical problems encountered in daily practice. METHODS This is a mixed methods study comparing the cognitive level expressed according to Bloom's Taxonomy by PH answering MCQ versus SCT questions using a "think aloud" (TA) exercise, followed by qualitative analysis of interviews conducted afterward. RESULTS A significantly greater percentage of comments were coded as higher cognitive processes (apply, analyze, evaluate, and create) for SCT versus MCQ (74% vs 19%) compared with lower order (remember, understand); chi-square P < .00001. Analysis of interviews revealed 6 themes. CONCLUSION SCT questions elicited higher level cognition essential to clinical reasoning compared to MCQ questions. PH-indicated MCQ questions measure standard knowledge, while SCT questions better measure decision-making under conditions of uncertainty. PH-perceived SCT could be useful for deliberate practice in Pediatric Hospital Medicine decision-making if they could compare their rationale in answering questions with that of experts.
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Affiliation(s)
- Mary C Ottolini
- Department of Pediatrics, The Barbara Bush Children's Hospital at Maine Medical Center (MC Ottolini), Portland, Maine.
| | - Ian Chua
- Department of Pediatrics, Children's National Medical Center, George Washington University School of Medicine and Health Sciences (I Chua and J Campbell), Washington, DC
| | - Joyce Campbell
- Department of Pediatrics, Children's National Medical Center, George Washington University School of Medicine and Health Sciences (I Chua and J Campbell), Washington, DC
| | - Martin Ottolini
- Department of Pediatrics, Uniformed Services University of the Health Sciences (M Ottolini), Bethesda, Md
| | - Ellen Goldman
- George Washington University Graduate School of Education and Human Development, George Washington University School of Medicine and Health Sciences (E Goldman), Washington, DC
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Moghadami M, Amini M, Moghadami M, Dalal B, Charlin B. Teaching clinical reasoning to undergraduate medical students by illness script method: a randomized controlled trial. BMC MEDICAL EDUCATION 2021; 21:87. [PMID: 33531017 PMCID: PMC7856771 DOI: 10.1186/s12909-021-02522-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 01/27/2021] [Indexed: 05/29/2023]
Abstract
BACKGROUND The illness script method employs a theoretical outline (e.g., epidemiology, pathophysiology, signs and symptoms, diagnostic tests, interventions) to clarify how clinicians organized medical knowledge for clinical reasoning in the diagnosis domain. We hypothesized that an educational intervention based on the illness script method would improve medical students' clinical reasoning skills in the diagnosis domain. METHODS This study is a randomized controlled trial involving 100 fourth-year medical students in Shiraz Medical School, Iran. Fifty students were randomized to the intervention group, who were taught clinical reasoning skills based on the illness script method for three diseases during one clinical scenario. Another 50 students were randomized to the control group, who were taught the clinical presentation based on signs and symptoms of the same three diseases as the intervention group. The outcomes of interest were learner satisfaction with the intervention and posttest scores on both an internally developed knowledge test and a Script Concordance Test (SCT). RESULTS Of the hundred participating fourth-year medical students, 47 (47%) were male, and 53 (53%) were female. On the knowledge test, there was no difference in pretest scores between the intervention and control group, which suggested a similar baseline knowledge in both groups; however, posttest scores in the intervention group were (15.74 ± 2.47 out of 20) statistically significantly higher than the control group (14.38 ± 2.59 out of 20, P = 0.009). On the SCT, the mean score for the intervention group (6.12 ± 1.95 out of 10) was significantly higher than the control group (4.54 ± 1.56 out of 10; P = 0.0001). Learner satisfaction data indicated that the intervention was well-received by students. CONCLUSION Teaching with the illness script method was an effective way to improve students' clinical reasoning skills in the diagnosis domain suggested by posttest and SCT scores for specific clinical scenarios. Whether this approach translates to improved generalized clinical reasoning skills in real clinical settings merits further study.
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Affiliation(s)
- Mana Moghadami
- Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mitra Amini
- Clinical Education Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
- Foundation for Advancement of International Medical Education and Research (FAIMER), Philadelphia, USA.
| | - Mohsen Moghadami
- Noncommunicable Disease Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Bhavin Dalal
- Foundation for Advancement of International Medical Education and Research (FAIMER), Philadelphia, USA
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
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Piquette D, Goffi A, Lee C, Brydges R, Walsh CM, Mema B, Parshuram C. Resident competencies before and after short intensive care unit rotations: a multicentre pilot observational study. Can J Anaesth 2021; 68:235-244. [PMID: 33174164 DOI: 10.1007/s12630-020-01850-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 08/19/2020] [Accepted: 08/22/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE Residency programs need to understand the competencies developed by residents during an intensive care unit (ICU) rotation, so that curricula and assessments maximize residents' learning. The primary study objective was to evaluate the feasibility for training programs and acceptability by residents of conducting a multi-competency assessment during a four-week ICU rotation. METHODS We conducted a prospective, multicentre observational pilot study in three ICUs. During weeks 1 and 4 of an ICU rotation, we conducted repeated standardized assessments of non-critical care specialty residents' competencies in cognitive reasoning (script concordance test [SCT]), procedural skills (objective structured assessment of technical skills [OSATS]-global rating scale], and communication skills through a written test, two procedural simulations, and a simulated encounter with a "family member". The feasibility outcomes included program costs, the proportion of enrolled residents able to complete at least one three-station assessment during their four-week ICU rotation, and acceptability of the assessment for the trainees. RESULTS We enrolled 63 (69%) of 91 eligible residents, with 58 (92%) completing at least one assessment. The total cost to conduct 90 assessments was CAD 33,800. The majority of participants agreed that the assessment was fair and that it measured important clinical abilities. For the 32 residents who completed two assessments, the mean (standard deviation) cognitive reasoning and procedural skill scores increased between weeks 1 and 4 [SCT difference, 3.1 (6.5), P = 0.01; OSATS difference for bag-mask ventilation and central line insertion, 0.4 (0.5) and 0.6 (0.8), respectively; both P ≤ 0.001]. Nevertheless, the communication scores did not change significantly. CONCLUSIONS A monthly multi-competency assessment for specialty residents rotating in the ICU is likely feasible for most programs with appropriate resources, and generally acceptable for residents. Specialty residents' cognitive reasoning and procedural skills may improve during a four-week ICU rotation, whereas communication skills may not.
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Affiliation(s)
- Dominique Piquette
- Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Room D108, Toronto, ON, M4N3M5, Canada.
| | - Alberto Goffi
- St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Christie Lee
- Mt. Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Ryan Brydges
- The Wilson Centre, University of Toronto, Toronto, ON, Canada
| | - Catharine M Walsh
- The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Briseida Mema
- The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Chris Parshuram
- The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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Hamzeh H, Madi M. Using the diagnostic thinking inventory in musculoskeletal physiotherapy: a validity and reliability study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2021; 26:e1895. [PMID: 33464675 DOI: 10.1002/pri.1895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 11/20/2020] [Accepted: 12/25/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Development of clinical reasoning is an essential aspect in musculoskeletal physiotherapy practice that is linked to better outcomes. The measurement of clinical reasoning has placed an emphasis on diagnostic reasoning using different types of examinations. The Diagnostic Thinking Inventory (DTI) is a self-assessment tool developed to measure two aspects of diagnostic reasoning: flexibility in thinking (FT) and structure in memory (SM). DTI is valid and reliable that has been used extensively in medical field. OBJECTIVE To investigate the validity and reliability of DTI in musculoskeletal physiotherapy practice. METHODS Two groups of musculoskeletal physiotherapists completed DTI. Expert musculoskeletal physiotherapists assessed face and content validity. Data from the second group of musculoskeletal physiotherapists were used to assess test-retest reliability. Internal consistency was calculated using Cronbach's alpha. Construct validity was assessed by comparing both groups. Data were analyzed using the IBM SPSS statistics 25.0 version. RESULTS The experts agreed that DTI measures diagnostic reasoning. For test-retest reliability, average intraclass correlation coefficient was 0.91, 0.92 and 0.90 (p < 0.001) for DTI, FT and SM scores, respectively. Cronbach's alpha was 0.909, 0.919 and 0.897 (p < 0.001) for DTI, FT and SM, respectively. The independent samples t-test demonstrated that the experts group achieved higher and statistically significant score (p < 0.001). CONCLUSION DTI is valid and reliable in measuring diagnostic reasoning in the context of musculoskeletal physiotherapy practice. It can be used to assess the impact of continuing education on musculoskeletal physiotherapists' diagnostic reasoning.
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Affiliation(s)
- Hayat Hamzeh
- Department of Physiotherapy, School of Rehabilitation Sciences, The University of Jordan, Amman, Jordan
| | - Mohammad Madi
- Department of Physiotherapy and Occupational Therapy, School of Applied Medical Sciences, The Hashemite University, Zarqa, Jordan
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Cohen Aubart F, Roux D. [Reform of the second cycle of medical studies in France: Risk or opportunity?]. Rev Med Interne 2021; 42:149-153. [PMID: 33455834 DOI: 10.1016/j.revmed.2020.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 12/27/2020] [Indexed: 10/22/2022]
Affiliation(s)
- F Cohen Aubart
- Service de médecine interne 2, Sorbonne université, hôpital de la Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - D Roux
- Médecine intensive réanimation, hôpital Louis-Mourier, Assistance publique-Hôpitaux de Paris, 92700 Colombes, France; Inserm, 75018 Paris, UMR1137 IAME, université de Paris, Paris, France
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Guillou P, Pelaccia T, Bacqué MF, Lorenzo M. Does burnout affect clinical reasoning? An observational study among residents in general practice. BMC MEDICAL EDUCATION 2021; 21:35. [PMID: 33413369 PMCID: PMC7792007 DOI: 10.1186/s12909-020-02457-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/11/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Burnout results from excessive demands at work. Caregivers suffering from burnout show a state of emotional exhaustion, leading them to distance themselves from their patients and to become less efficient in their work. While some studies have shown a negative impact of burnout on physicians' clinical reasoning, others have failed to demonstrate any such impacts. To better understand the link between clinical reasoning and burnout, we carried out a study looking for an association between burnout and clinical reasoning in a population of general practice residents. METHODS We conducted a cross-sectional observational study among residents in general practice in 2017 and 2019. Clinical reasoning performance was assessed using a script concordance test (SCT). The Maslach Burnout Inventory for Human Services Survey (MBI-HSS) was used to determine burnout status in both original standards of Maslach's burnout inventory manual (conventional approach) and when individuals reported high emotional exhaustion in combination with high depersonalization or low personal accomplishment compared to a norm group ("emotional exhaustion +1" approach). RESULTS One hundred ninety-nine residents were included. The participants' mean SCT score was 76.44% (95% CI: 75.77-77.10). In the conventional approach, 126 residents (63.31%) had no burnout, 37 (18.59%) had mild burnout, 23 (11.56%) had moderate burnout, and 13 (6.53%) had severe burnout. In the "exhaustion + 1" approach, 38 residents had a burnout status (19.10%). We found no significant correlation between burnout status and SCT scores either for conventional or "exhaustion + 1" approaches. CONCLUSIONS Our data seem to indicate that burnout status has no significant impact on clinical reasoning. However, one speculation is that SCT mostly examines the clinical reasoning process's analytical dimension, whereas emotions are conventionally associated with the intuitive dimension. We think future research might aim to explore the impact of burnout on intuitive clinical reasoning processes.
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Affiliation(s)
- Philippe Guillou
- Departement of General Practice, Medicine Campus, University of Strasbourg, 4, rue Kirschleger, 67085, Strasbourg Cedex, France
| | - Thierry Pelaccia
- Center for Training and Research in Health Sciences Education, Medicine Campus, University of Strasbourg, 4, rue Kirschleger, 67085, Strasbourg Cedex, France
- Prehospital Emergency Care Service, Strasbourg University Hospital, University of Strasbourg, 1, place de l'hôpital, BP 426, 67091, Strasbourg Cedex, France
| | - Marie-Frédérique Bacqué
- EA3071, Psychology Faculty, University of Strasbourg, 12, rue Goethe, 67000, Strasbourg, France
| | - Mathieu Lorenzo
- Departement of General Practice, Medicine Campus, University of Strasbourg, 4, rue Kirschleger, 67085, Strasbourg Cedex, France.
- Center for Training and Research in Health Sciences Education, Medicine Campus, University of Strasbourg, 4, rue Kirschleger, 67085, Strasbourg Cedex, France.
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Shrivastava S, Shrivastava P. Using script concordance tests for assessing clinical reasoning skills of medical students. JOURNAL OF THE SCIENTIFIC SOCIETY 2021. [DOI: 10.4103/jss.jss_24_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Cohen Aubart F, Papo T, Hertig A, Renaud MC, Steichen O, Amoura Z, Braun M, Palombi O, Duguet A, Roux D. Are script concordance tests suitable for the assessment of undergraduate students? A multicenter comparative study. Rev Med Interne 2020; 42:243-250. [PMID: 33288231 DOI: 10.1016/j.revmed.2020.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 10/04/2020] [Accepted: 11/08/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Script concordance tests (SCTs) have been developed to assess clinical reasoning in uncertain situations. Their reliability for the evaluation of undergraduate medical students has not been evaluated. METHODS Twenty internal medicine SCT cases were implemented in undergraduate students of two programs. The results obtained on the SCTs were compared to those obtained by the same students on clinical-based classical multiple-choice questions (MCQs). RESULTS A total of 551/883 students (62%) answered the SCTs. The mean aggregate score (based on a total 20 points) was 11.54 (3.29). The success rate and mean score for each question did not differ depending on the modal response but the discrimination rate did. The results obtained by the students on the SCT test correlated with their scores on the MCQ tests. Among students, 446/517 (86%) considered the SCTs to be more difficult than classical MCQs, although the mean score did not differ between the SCT and MCQ tests. CONCLUSION The use of SCTs is a feasible option for the evaluation of undergraduate students. The SCT scores correlated with those obtained on classical MCQ tests.
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Affiliation(s)
- F Cohen Aubart
- Service de médecine interne 2, Centre national de référence maladies systémiques rares et histiocytoses, hôpital Pitié-Salpêtrière, Sorbonne université, Assistance publique-Hôpitaux de Paris, 75013 Paris, France.
| | - T Papo
- Département de médecine interne, hôpital Bichat, université de Paris, Assistance publique-Hôpitaux de Paris, 75018 Paris, France
| | - A Hertig
- Service de néphrologie et transplantation rénale, hôpital Pitié-Salpêtrière, Sorbonne université, Assistance publique-Hôpitaux de Paris, 75013 Paris, France
| | - M-C Renaud
- Faculté de médecine, Sorbonne université, 75013 Paris, France
| | - O Steichen
- Service de médecine interne, hôpital Tenon, Sorbonne université, Assistance publique-Hôpitaux de Paris, 75020 Paris, France
| | - Z Amoura
- Service de médecine interne 2, Centre national de référence maladies systémiques rares et histiocytoses, hôpital Pitié-Salpêtrière, Sorbonne université, Assistance publique-Hôpitaux de Paris, 75013 Paris, France
| | - M Braun
- Service de neuroradiologie, université de Lorraine, CHRU de Nancy, 54035 Nancy, France
| | - O Palombi
- Service de neurochirurgie, université Grenoble Alpes, CHU de Grenoble, 38000 Grenoble, France
| | - A Duguet
- Service de Pneumologie, hôpital Pitié-Salpêtrière, Sorbonne université, Assistance publique-Hôpitaux de Paris, 75013 Paris, France
| | - D Roux
- Service de médecine intensive réanimation, hôpital Louis-Mourier, université de Paris, Assistance publique-Hôpitaux de Paris, 92700 Colombes, France; Inserm, IAME, UMR-1137, 75018 Paris, France
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Deschênes MF, Goudreau J. L’apprentissage du raisonnement clinique infirmier dans le cadre d’un dispositif éducatif numérique basé sur la concordance de scripts. ACTA ACUST UNITED AC 2020. [DOI: 10.1051/pmed/2020041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Contexte : Un des défis actuels des responsables de la formation des futurs infirmiers est de concevoir des stratégies éducatives pour favoriser le développement optimal du raisonnement clinique infirmier (RCI).But : L’étude visait à développer, mettre à l’essai et évaluer un dispositif éducatif numérique basé sur la concordance de scripts auprès d’étudiants en sciences infirmières. Méthodes : Un devis de recherche-développement a permis de soutenir les étapes de réalisation du dispositif éducatif. Une validation de contenu a été intégrée au devis à l’aide d’une technique Delphi modifiée. Les choix de réponses des étudiants et des experts aux questions du dispositif ont été compilés. Un questionnaire en ligne et des entrevues de groupe focalisées ont été utilisés auprès d’étudiants afin d’évaluer l’acceptabilité et l’utilisabilité du dispositif éducatif. Résultats : Cinq experts-collaborateurs ont validé le contenu du dispositif éducatif. La version finale comptait 81 questions liées à 22 vignettes. Douze experts-panélistes et quarante-cinq étudiants ont répondu aux questions du dispositif éducatif. Les indices alpha (α) de Cronbach ont oscillé entre 0,87 et 0,90. Globalement, les étudiants ont apprécié l’utilisation du dispositif éducatif, dont la rétroaction variée et formative d’experts à des situations apparentées à la vie professionnelle. Conclusion : Le dispositif éducatif repose sur l’utilisation d’un test de concordance de scripts numérisé auquel des rétroactions d’experts sont intégrées à des fins d’apprentissage du RCI. Essentiel, l’engagement des experts-panélistes inscrit la conception d’un tel dispositif éducatif dans une démarche de co-construction et de validation du matériel pédagogique.
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Resende KA, Cavaco AM, Luna-Leite MD, Acacio BR, Pinto NN, Neta MD, Melo AC. Training and standardization of simulated patients for multicentre studies in clinical pharmacy education. Pharm Pract (Granada) 2020; 18:2038. [PMID: 33224323 PMCID: PMC7672484 DOI: 10.18549/pharmpract.2020.4.2038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/25/2020] [Indexed: 11/25/2022] Open
Abstract
Objective: To evaluate the training and standardization methods of multiple simulated
patients (SPs) performing a single scenario in a multicenter study. Methods: A prospective quasi-experimental study, using a multicenter approach,
evaluated the performance of five different individuals with the same
biotype during a simulation session in a high-fidelity environment. The SPs
training and standardization process consisted of four steps and six web or
face-to-face mediated: Step 1: simulation scenario design and pilot test.
Step 2: SPs selection, recruitment and beginning training (Session 1:
performance instructions and memorization request.) Session 2: check the
SPs’ performances and adjustments). Step 3 and session 3: training
role-play and performance’s evaluation. Step 4: SPs’
standardization and performances’ evaluation (Sessions 4 and 5: first
and second rounds of SPs’ standardization assessment. Session 6:
Global training and standardization evaluation. SPs performance consistency
was estimated using Cronbach’s alpha and ICC. Results: In the evaluation of training results, the Maastricht Simulated Patient
Assessment dimensions of SPs performances “It seems
authentic”, “Can be a real patient” and
“Answered questions naturally”, presented “moderate or
complete agreement” of all evaluators. The dimensions “Seems
to retain information unnecessarily”, “Remains in his/her role
all the time”, “Challenges/tests the student”, and
“Simulates physical complaints in an unrealistic way”
presented “moderate or complete disagreement” in all
evaluations. The SPs “Appearance fits the role” showed
“moderate or complete agreement” in most evaluations. In the
second round of evaluations, the SPs had better performance than the first
ones. This could indicate the training process’s had good influence
on SPs performances. The Cronbach’s alpha in the second assessment
was better than the first (varied from 0.699 to 0.978). The same improvement
occurred in the second round of intraclass correlation coefficient that was
between 0.424 and 0.978. The SPs were satisfied with the training method and
standardization process. They could perceive improvement on their role-play
authenticity. Conclusions: The SPs training and standardization process revealed good SPs reliability
and simulation reproducibility, demonstrating to be a feasible method for
SPs standardization in multicenter studies. The Maastricht Simulated Patient
Assessment was regarded as missing the assessment of the information
consistency between the simulation script and the SPs provision.
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Affiliation(s)
- Karina A Resende
- MSc. Federal University of São João Del-Rei. Divinópolis, MG (Brazil).
| | - Afonso M Cavaco
- PhD. Associate Professor in Social Pharmacy. Faculty of Pharmacy, University of Lisbon. Lisbon (Portugal).
| | - Márcia D Luna-Leite
- PhD. Foundation for Scientific and Technological Development in Health (FIOTEC). Rio de Janeiro, RJ (Brasil).
| | - Bianca R Acacio
- MSc. Federal University of Mato Grosso do Sul. Pioneiros, MS (Brasil).
| | - Núbia N Pinto
- Federal University of São João Del-Rei. Divinópolis, MG (Brazil).
| | - Maria D Neta
- MSc. Federal University of Piauí. Teresina, PI (Brasil)
| | - Angelita C Melo
- PhD. Associate Professor in Clinical Pharmacy. Federal University of São João Del-Rei. Divinópolis, MG (Brazil).
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Peyrony O, Hutin A, Truchot J, Borie R, Calvet D, Albaladejo A, Baadj Y, Cailleaux PE, Flamant M, Martin C, Messika J, Meunier A, Mirabel M, Tea V, Treton X, Chevret S, Lebeaux D, Roux D. Impact of panelists' experience on script concordance test scores of medical students. BMC MEDICAL EDUCATION 2020; 20:313. [PMID: 32943030 PMCID: PMC7499961 DOI: 10.1186/s12909-020-02243-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 09/10/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The evaluation process of French medical students will evolve in the next few years in order to improve assessment validity. Script concordance testing (SCT) offers the possibility to assess medical knowledge alongside clinical reasoning under conditions of uncertainty. In this study, we aimed at comparing the SCT scores of a large cohort of undergraduate medical students, according to the experience level of the reference panel. METHODS In 2019, the authors developed a 30-item SCT and sent it to experts with varying levels of experience. Data analysis included score comparisons with paired Wilcoxon rank sum tests and concordance analysis with Bland & Altman plots. RESULTS A panel of 75 experts was divided into three groups: 31 residents, 21 non-experienced physicians (NEP) and 23 experienced physicians (EP). Among each group, random samples of N = 20, 15 and 10 were selected. A total of 985 students from nine different medical schools participated in the SCT examination. No matter the size of the panel (N = 20, 15 or 10), students' SCT scores were lower with the NEP group when compared to the resident panel (median score 67.1 vs 69.1, p < 0.0001 if N = 20; 67.2 vs 70.1, p < 0.0001 if N = 15 and 67.7 vs 68.4, p < 0.0001 if N = 10) and with EP compared to NEP (65.4 vs 67.1, p < 0.0001 if N = 20; 66.0 vs 67.2, p < 0.0001 if N = 15 and 62.5 vs 67.7, p < 0.0001 if N = 10). Bland & Altman plots showed good concordances between students' SCT scores, whatever the experience level of the expert panel. CONCLUSIONS Even though student SCT scores differed statistically according to the expert panels, these differences were rather weak. These results open the possibility of including less-experienced experts in panels for the evaluation of medical students.
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Affiliation(s)
- Olivier Peyrony
- Department of Emergency Medicine, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, 1 avenue Claude Vellefaux, 75010 Paris, France
| | - Alice Hutin
- SAMU de Paris, SMUR Necker, Necker Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jennifer Truchot
- Department of Emergency Medicine, SMUR, Lariboisère University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Paris Diderot University, Paris, France
| | - Raphaël Borie
- Department of Pneumology, Reference Center for Rare Pulmonary Diseases, Bichat University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM, UMR 1152, Paris Diderot University, Paris, France
| | - David Calvet
- Department of Neurology and Stroke Unit, Sainte-Anne University Hospital, Paris, France
- INSERM, UMR 1266, Psychiatry and Neurosciences Institute of Paris, Paris-Descartes University, Paris, France
| | | | | | - Pierre-Emmanuel Cailleaux
- Department of Getriatric Medicine, Louis-Mourier University Hospital, Assistance Publique-Hôpitaux de Paris, F-92700 Colombes, France
- INSERM, UMR 1132, BiOsCar, University of Paris, Paris, France
| | - Martin Flamant
- Department of Kidney Physiology, Bichat University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM, UMR 1149, Inflammatory Research Center, Paris, France
- University of Paris, Paris, France
| | - Clémence Martin
- Department of Respiratory Medicine, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Cochin Institute, UMR 1016. Paris-Descartes University, Paris, France
| | - Jonathan Messika
- University of Paris, Paris, France
- Pulmonology and Lung Transplant Unit, Bichat University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Physiopathology and Epidemiology of Respiratory Diseases (PHERE), INSERM, UMR 1152, and Paris Transplant Group, Paris, France
| | | | - Mariana Mirabel
- University of Paris, Paris, France
- Department of Cardio-oncology, Georges Pompidou European University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM, UMR 970, Paris Cardiovascular Research Center PARCC, Paris, France
| | - Victoria Tea
- Department of Cardiology, Georges Pompidou European University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Xavier Treton
- University of Paris, Paris, France
- Department of Gastroenterology, Inflammatory Bowel Disease, and Nutritive Assistance, Beaujon University Hospital, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - Sylvie Chevret
- Department of Biostatistics and Medical Information, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Centre of Research in Epidemiology and StatisticS (CRESS), INSERM, UMR 1153, Epidemiology and Clinical Statistics for Tumor, Respiratory, and Resuscitation Assessments (ECSTRRA) Team, University of Paris, Paris, France
| | - David Lebeaux
- University of Paris, Paris, France
- Department of Microbiology, Mobile Infectiology Unit, Georges Pompidou European University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Damien Roux
- University of Paris, Paris, France
- Department of Intensive Care, Louis Mourier University Hospital, Assistance Publique-Hôpitaux de Paris, F-92700 Colombes, France
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Schuwirth LWT, Durning SJ, King SM. Assessment of clinical reasoning: three evolutions of thought. Diagnosis (Berl) 2020; 7:191-196. [PMID: 32182208 DOI: 10.1515/dx-2019-0096] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 02/12/2020] [Indexed: 02/17/2024]
Abstract
Although assessing clinical reasoning is almost universally considered central to medical education it is not a straightforward issue. In the past decades, our insights into clinical reasoning as a phenomenon, and consequently the best ways to assess it, have undergone significant changes. In this article, we describe how the interplay between fundamental research, practical applications, and evaluative research has pushed the evolution of our thinking and our practices in assessing clinical reasoning.
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Affiliation(s)
- Lambert W T Schuwirth
- Prideaux Centre for Research in Health Professions Education, Flinders University, Adelaide, South Australia, Australia
| | | | - Svetlana M King
- Prideaux Centre for Research in Health Professions Education, Flinders University, Adelaide, South Australia, Australia
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Covin Y, Longo P, Wick N, Gavinski K, Wagner J. Empirical comparison of three assessment instruments of clinical reasoning capability in 230 medical students. BMC MEDICAL EDUCATION 2020; 20:264. [PMID: 32787953 PMCID: PMC7425135 DOI: 10.1186/s12909-020-02185-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/04/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Several instruments intend to measure clinical reasoning capability, yet we lack evidence contextualizing their scores. The authors compared three clinical reasoning instruments [Clinical Reasoning Task (CRT), Patient Note Scoring rubric (PNS), and Summary Statement Assessment Rubric (SSAR)] using Messick's convergent validity framework in pre-clinical medical students. Scores were compared to a validated clinical reasoning instrument, Clinical Data Interpretation (CDI). METHOD Authors administered CDI and the first clinical case to 235 students. Sixteen randomly selected students (four from each CDI quartile) wrote a note on a second clinical case. Each note was scored with CRT, PNS, and SSAR. Final scores were compared to CDI. RESULTS CDI scores did not significantly correlate with any other instrument. A large, significant correlation between PNS and CRT was seen (r = 0.71; p = 0.002). CONCLUSIONS None of the tested instruments outperformed the others when using CDI as a standard measure of clinical reasoning. Differing strengths of association between clinical reasoning instruments suggest they each measure different components of the clinical reasoning construct. The large correlation between CRT and PNS scoring suggests areas of novice clinical reasoning capability, which may not be yet captured in CDI or SSAR, which are weighted toward knowledge synthesis and hypothesis testing.
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Affiliation(s)
- Yvonne Covin
- Department of Internal Medicine, Division of General and Hospital Medicine, UT Health San Antonio, 7703 Floyd Curl Drive, MC 7982, San Antonio, TX, 78229, USA.
| | - Palma Longo
- Department of Healthcare Sciences, UT Southwestern Medical Center, Dallas, TX, USA
| | - Neda Wick
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Katherine Gavinski
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - James Wagner
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
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Garraud O, Vuk T, Brand A, de Angelis V, Politis C, Haddad A, Vlaar APJ, Lozano M, Ertuğrul Örüç N, Laspina S, Tissot JD. Medical student education in transfusion medicine, part II: Moving forward to building up a "Know How" education program in transfusion medicine for under-graduate medical students. Transfus Apher Sci 2020; 59:102879. [PMID: 32718832 DOI: 10.1016/j.transci.2020.102879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/09/2020] [Accepted: 07/13/2020] [Indexed: 01/24/2023]
Abstract
There is a general trend in changing paradigm in teaching medicine; the emerging concept relies on a competence-based approach. Transfusion is either a discipline or a subsidiary of others depending on the countries and systems; this variability can be explained because transfusion is a medical care that is transdisciplinary. As a collective of professionals in both transfusion medicine practice and education, authors aim to propose a revision of the way education in transfusion medicine is delivered in this era of the 'global competency approach'. They advocate in favor of a Know How on 5 key issues: Diagnosing the patient condition in line with the Patient Blood Management principles; Facing acute blood loss; Addressing compatibility and avoiding immunization; Seeking for maximized benefits and dampening complications; and Inlaying competence within global health care issues, also comprising od economy. The methods used would be those developed for medical education at large, such as assessment tools. The global objective is to deliver the necessary competence to manage patients by an intern/resident. At the end of the curriculum, students should be able to self-evaluate the following items: 1) Do I know why my patient is anemic, thrombocytopenic, bleeding….? 2) Do I know the best approach to treat anemia, thrombocytopenia, bleeding (including the "no treatment" option)? 3) Do I know whether a transfusion approach is appropriate for my patients? 4) Do I know how to evaluate and anticipate benefits from blood transfusion and to avoid side-effects in the patient? 5) Do I know how to avoid unnecessary use of the products?
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Affiliation(s)
- Olivier Garraud
- Faculty of Medicine of Saint-Etienne, University of Lyon, Saint-Etienne, France; Institut National De La Transfusion Sanguine, Paris, France; Palliative Care Unit, Ruffec Hospital, Ruffec, France.
| | - Tomislav Vuk
- Croatian Institute of Transfusion Medicine, Zagreb, Croatia; Josip Juraj Strossmayer University of Osijek - Faculty of Medicine, Osijek, Croatia
| | - Anneke Brand
- Transfusion Medicine, Leiden University Medical Center, Leiden University, the Netherlands
| | | | - Constantina Politis
- Coordinating Haemovigilance Centre (SKAE), Hellenic Centre for Disease Control and Prevention, Athens, Greece
| | - Antoine Haddad
- Faculty of Medicine of Saint-Etienne, University of Lyon, Saint-Etienne, France; Department of Clinical Pathology and Blood Bank, Sacre-Coeur Hospital, Lebanese University, Beirut, Lebanon
| | - Alexander P J Vlaar
- Department of Intensive Care Medicine, Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
| | - Miquel Lozano
- Clinic University Hospital Barcelona, University of Barcelona, Spain
| | - Nigar Ertuğrul Örüç
- Health Sciences University Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
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Wan MSH, Tor E, Hudson JN. Examining response process validity of script concordance testing: a think-aloud approach. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2020; 11:127-135. [PMID: 32581143 PMCID: PMC7870454 DOI: 10.5116/ijme.5eb6.7be2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 05/09/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES This study investigated whether medical student responses to Script Concordance Testing (SCT) items represent valid clinical reasoning. Using a think-aloud approach students provided written explanations of the reasoning that underpinned their responses, and these were reviewed for concordance with an expert reference panel. METHODS A set of 12, 11 and 15 SCT items were administered online to Year 3 (2018), Year 4 (2018) and Year 3 (2019) medical students respectively. Students' free-text descriptions of the reasoning supporting each item response were analysed, and compared with those of the expert panel. Response process validity was quantified as the rate of true positives (percentage of full and partial credit responses derived through correct clinical reasoning); and true negatives (percentage of responses with no credit derived through faulty clinical reasoning). RESULTS Two hundred and nine students completed the online tests (response rate = 68.3%). The majority of students who had chosen the response which attracted full or partial credit also provided justifications which were concordant with the experts (true positive rate of 99.6% for full credit; 99.4% for partial credit responses). Most responses that attracted no credit were based on faulty clinical reasoning (true negative of 99.0%). CONCLUSIONS The findings provide support for the response process validity of SCT scores in the setting of undergraduate medicine. The additional written think-aloud component, to assess clinical reasoning, provided useful information to inform student learning. However, SCT scores should be validated on each testing occasion, and in other contexts.
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Affiliation(s)
| | - Elina Tor
- School of Medicine, The University of Notre Dame Australia, Australia
| | - Judith N. Hudson
- Faculty of Health and Medical Sciences, University of Adelaide, Australia
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