gms | German Medical Science

Research in Medical Education – Chances and Challenges International Conference

20.05. - 22.05.2009, Heidelberg

New methods in assessing clinical reasoning: the script concordance test

Meeting Abstract

Research in Medical Education - Chances and Challenges 2009. Heidelberg, 20.-22.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. Doc09rmeE9

doi: 10.3205/09rme29, urn:nbn:de:0183-09rme293

Published: May 5, 2009

© 2009 Hoeffe et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Introduction: Clinical reasoning is a central competence of professional practice. The script concordance test (SCT) has been developed to assess examinees in their ability to use their knowledge in clinical situations. Short vignettes with typical clinical situations are presented, followed by related test items. Examinees are asked to evaluate diagnostic, investigative, or therapeutic decisions when confronted with new information. Scoring is based on comparison of examinees' results with those of a panel of experts.

Aim of this study was to develop an SCT in pediatrics' undergraduate education and to evaluate its value in this context.

Methods: Following learning objectives in pediatrics, and based on a blue print, more than 150 items were written and reviewed, and new items are written on a regular basis. 120 items are published to students to discuss in clinical pediatric training with tutors. The expert panel of our SCT consists of 30 experienced pediatricians. After one week of intensive pediatric training, students finish with a SCT of 45 questions.

Results: The test is well accepted by both students and tutors, and evaluation in general is good. It is considered neither too easy nor too difficult. Reliability in general is good (Cronbach’s alpha 0,77).

Conclusion: SCT is a promising instrument to assess competence in clinical reasoning. It is designed for undergraduate as well as postgraduate assessment. Crucial for quality of the test are quality of test items and formation of expert panel [1], [2], [3].


Charlin B, Van der Vleuten C. Standardized assessment of reasoning in the context of uncertainty: The script concordance approach. Eval Health Prof. 2004;27(3):304-319. DOI: 10.1177/0163278704267043. External link
Brailovsky C, Charlin B, Beausoleil S, Coté S, Van der Vleuten C. Measurement of clinical reflective capacity early in training as a predictor of clinical reasoning performance at the end of residency. Med Educ. 2001;35(5):430-436. DOI: 10.1046/j.1365-2923.2001.00911.x. External link
Carrière B, Gagnon R, Charlin B, Downing S, Bordage G. Assessing Clinical Reasoning in Pediatric Emergency Medicine: Validity Evidence for a Script Concordance Test. Ann Emerg Med. 2008;21. [Epub ahead of print]