UNASSIGNED: 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.
UNASSIGNED: This evaluation describes the barriers to the development of SCT for Bachelor\'s nursing students and the lessons learned regarding construct validity.
UNASSIGNED: 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).
UNASSIGNED: 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\'.
UNASSIGNED: 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.

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.

SaNuRN is a five-year project by the University of Rouen Normandy (URN) and the Côte d’Azur University (CAU) consortium to optimize digital health education for medical and paramedical students, professionals, and administrators. The project includes a skills framework, training modules, and teaching resources. In 2027, SaNuRN is expected to train a significant portion of the 400,000 health and paramedical professions students at the French national level. Our purpose is to give a synopsis of the SaNuRN initiative, emphasizing its novel educational methods and how they will enhance the delivery of digital health education. Our goals include showcasing SaNuRN as a comprehensive program consisting of a proficiency framework, instructional modules, and educational materials and explaining how SaNuRN is implemented in the participating academic institutions. SaNuRN is a project aimed at educating and training health-related and paramedics students in digital health. The project results from a cooperative effort between URN and CAU, covering four French departments. The project is based on the French National Referential on Digital Health (FNRDH), which defines the skills and competencies to be acquired and validated by every student in the health, paramedical, and social professions curricula. The SaNuRN team is currently adapting the existing URN and CAU syllabi to FNRDH and developing short-duration video capsules of 20 to 30 minutes to teach all the relevant material. The project aims to ensure that the largest student population earns the necessary skills, and it has developed a two-tier system involving facilitators who will enable the efficient expansion of the project’s educational outreach and support the students in learning the needed material efficiently. With a focus on real-world scenarios and innovative teaching activities integrating telemedicine devices and virtual professionals, SaNuRN is committed to enabling continuous learning for healthcare professionals in clinical practice. The SaNuRN team introduced new ways of evaluating healthcare professionals by shifting from a knowledge-based to a competencies-based evaluation, aligning with the Miller teaching pyramid and using the Objective Structured Clinical Examination and Script Concordance Test in digital health education. Drawing on the expertise of URN, CAU, and their public health and digital research laboratories and partners, the SaNuRN project represents a platform for continuous innovation, including telemedicine training and living labs with virtual and interactive professional activities. The SaNuRN project provides a comprehensive, personalized 30-hour training package for health and paramedical students, addressing all 70 FNRDH competencies. The program is enhanced using AI and NLP to create virtual patients and professionals for digital healthcare simulation. SaNuRN teaching materials are open-access. The project collaborates with academic institutions worldwide to develop educational material in digital health in English and multilingual formats. SaNuRN offers a practical and persuasive training approach to meet the current digital health education requirements.

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.

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.

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.

In the assessment of basic medical knowledge, the composition of the reference panel between specialists and primary care (PC) physicians is a contentious issue. We assessed the effect of panel composition on the scores of undergraduate medical students in a script concordance test (SCT).
The scale of an SCT on basic nephrology knowledge was set by a panel of nephrologists or a mixed panel of nephrologists and PC physicians. The results of the SCTs were compared with ANOVA for repeated measurements. Concordance was assessed with Bland and Altman plots.
Forty-five students completed the SCT. Their scores differed according to panel composition: 65.6 ± 9.73/100 points for nephrologists, and 70.27 ± 8.82 for the mixed panel, p < 0.001. Concordance between the scores was low with a bias of -4.27 ± 2.19 and a 95% limit of agreement of -8.96 to -0.38. Panel composition led to a change in the ranking of 71% of students (mean 3.6 ± 2.6 places).
The composition of the reference panel, either specialist or mixed, for SCT assessment of basic knowledge has an impact on test results and student rankings.

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.

Laparoscopic suturing (LS) is a challenging laparoscopic skill to teach. Its complexity and nuances are not modeled or measured in current simulation and assessment platforms.The script concordance test (SCT) is used to assess clinical reasoning.The purpose of this study is to provide evidence for validity of this novel SCT based online assessment for LS skills.
We designed a video-based online SCT for LS using a cognitive task analysis and expert panelists.The CTA yielded 4 LS domains: needle handling (NH), tissue handling (TH), knot tying techniques (KT) and operative ergonomics (OE). Five-point scales with anchoring descriptors from -2 to +2 were used. Scoring was based on a modified SCT methodology.
The test was administrated to 37 subjects (18 experts and 19 novices). There was no time limit given. A different expert group from the minimal invasive surgery (MIS) panelist were recruited. Experts were defined as surgeons and fellows with LS experience of >25 cases annually. Validity was assessed by comparing SCT scores of experienced and inexperienced surgeons. Cronbach\'s alpha was used to assess the internal consistency of the test.
The survey started off with 47 questions in each of the following domains: 13 NH, 4 TH, 20 KT and 10 OE. Thirty-seven surgeons (18 experts and 19 inexperienced surgeons). Questions that demonstrated a large discrepancy among experts and panelists with a weighted score difference more than 40 were discarded (n = 20). One question was discarded because it received a 100% score from all participants. This yielded 26 remaining questions in the following domains: 8 NH, 2 TH, 11 KT and 5 OE. The test reliability level (Cronbach a) was 0.80. The mean score was 72 ± 9% and 63 ± 15% (p = 0.02) for experts and inexperienced surgeons, respectively. The mean time to complete the test was 21 minutes.
This study provides validity evidence for a novel intraoperative LS assessment. The variability of responses between experts and panelists suggests that SCT may capture the clinical differences/surgeon preferences in performing LS intraoperatively.

BACKGROUND: Each year, new pediatric residents begin their shifts in the pediatric emergency room. While technical skills are often acquired during workshops, non-technical skills such as communication, professionalism, situational awareness, or decision-making are rarely tested. Simulation enables non-technical skills to be developed in situations frequently encountered in pediatric emergencies. Adopting an innovative approach, we combined two pedagogical methods: the Script Concordance Test (SCT) and simulation to improve clinical reasoning and non-technical skills of first-year pediatric residents in dealing with clinical situations involving febrile seizures. The aim of this work is to report the feasibility of such a combined training.
METHODS: The first-year pediatric residents participated in a training session on how to manage a child attending the emergency department with a febrile seizure. At the beginning of the session, the trainees had to complete the SCT (seven clinical situations) and then participated in three simulation scenarios. Student satisfaction was assessed by means of a questionnaire at the end of the session.
RESULTS: In this pilot study, 20 residents participated in the training. The SCT scores for the first-year pediatric residents were lower and more widely distributed than those of the experts with better concordance for diagnostic items compared to investigation or treatment items. All were satisfied with the teaching methods employed. Further sessions on additional topics relating to the management of pediatric emergency cases were requested.
CONCLUSIONS: Although limited by the small size of our study, this combination of teaching methods was possible and seemed promising for the development of non-technical skills of pediatric residents. These methods are in line with the changes being made to the third cycle of medical studies in France and can be adapted to other situations and other specialties.