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首页> 外文期刊>BMC Surgery >Validation of undergraduate medical student script concordance test (SCT) scores on the clinical assessment of the acute abdomen
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Validation of undergraduate medical student script concordance test (SCT) scores on the clinical assessment of the acute abdomen

机译：医科学生剧本一致性测试（SCT）分数在急性腹部临床评估中的验证

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Background Health professionals often manage medical problems in critical situations under time pressure and on the basis of vague information. In recent years, dual process theory has provided a framework of cognitive processes to assist students in developing clinical reasoning skills critical especially in surgery due to the high workload and the elevated stress levels. However, clinical reasoning skills can be observed only indirectly and the corresponding constructs are difficult to measure in order to assess student performance. The script concordance test has been established in this field. A number of studies suggest that the test delivers a valid assessment of clinical reasoning. However, different scoring methods have been suggested. They reflect different interpretations of the underlying construct. In this work we want to shed light on the theoretical framework of script theory and give an idea of script concordance testing. We constructed a script concordance test in the clinical context of “acute abdomen” and compared previously proposed scores with regard to their validity. Methods A test comprising 52 items in 18 clinical scenarios was developed, revised along the guidelines and administered to 56 4th and 5th year medical students at the end of a blended-learning seminar. We scored the answers using five different scoring methods (distance (2×), aggregate (2×), single best answer) and compared the scoring keys, the resulting final scores and Cronbach’s α after normalization of the raw scores. Results All scores except the single best answers calculation achieved acceptable reliability scores (>= 0.75), as measured by Cronbach’s α. Students were clearly distinguishable from the experts, whose results were set to a mean of 80 and SD of 5 by the normalization process. With the two aggregate scoring methods, the students’ means values were between 62.5 (AGGPEN) and 63.9 (AGG) equivalent to about three expert SD below the experts’ mean value (Cronbach’s α : 0.76 (AGGPEN) and 0.75 (AGG)). With the two distance scoring methods the students’ mean was between 62.8 (DMODE) and 66.8 (DMEAN) equivalent to about two expert SD below the experts’ mean value (Cronbach’s α: 0.77 (DMODE) and 0.79 (DMEAN)). In this study the single best answer (SBA) scoring key yielded the worst psychometric results (Cronbach’s α: 0.68). Conclusion Assuming the psychometric properties of the script concordance test scores are valid, then clinical reasoning skills can be measured reliably with different scoring keys in the SCT presented here. Psychometrically, the distance methods seem to be superior, wherein inherent statistical properties of the scales might play a significant role. For methodological reasons, the aggregate methods can also be used. Despite the limitations and complexity of the underlying scoring process and the calculation of reliability, we advocate for SCT because it allows a new perspective on the measurement and teaching of cognitive skills.
机译：背景技术卫生专业人员经常在时间紧迫和信息模糊的基础上处理紧急情况下的医疗问题。近年来，双重过程理论提供了认知过程的框架，以帮助学生发展由于工作量大和压力水平升高而特别在外科手术中至关重要的临床推理技能。但是，临床推理技能只能间接观察到，并且难以评估相应的结构以评估学生的表现。脚本一致性测试已在该领域中建立。大量研究表明，该测试可以对临床推理进行有效评估。但是，已经提出了不同的评分方法。它们反映了对基础结构的不同解释。在这项工作中，我们想阐明脚本理论的理论框架，并给出脚本一致性测试的想法。我们在“急性腹部”的临床情况下构建了脚本一致性测试，并比较了先前提出的分数的有效性。方法制定了一项包含18个临床场景中的52个项目的测试，并按照指南进行了修订，并在混合式学习结束时对56名第4 和第5 年的医学生进行了测试，学习研讨会。我们使用五种不同的评分方法（距离（2倍），合计（2倍），单个最佳答案）对答案进行评分，并比较了评分重点，最终得分和原始得分归一化后的克伦巴赫α。结果除单个最佳答案计算外，所有分数均达到了可接受的可靠性分数（> = 0.75），这由Cronbach的α测得。学生与专家明显区分开来，通过标准化过程将其结果设置为平均值80和标准差5。使用这两种汇总评分方法，学生的均值介于62.5（AGGPEN）和63.9（AGG）之间，大约比专家均值（Cronbach'sα：0.76（AGGPEN）和0.75（AGG））低约三个专家SD。使用两种距离计分方法，学生的均值介于62.8（DMODE）和66.8（DMEAN）之间，大约比专家均值（Cronbach'sα：0.77（DMODE）和0.79（DMEAN））低约两个专家SD。在这项研究中，单一最佳答案（SBA）评分键产生了最差的心理测验结果（Cronbach'sα：0.68）。结论假设脚本一致性测试成绩的心理计量学特性有效，则可以使用此处提供的SCT中的不同评分键可靠地测量临床推理技能。从心理学上讲，距离方法似乎更好，其中尺度的固有统计属性可能起重要作用。由于方法上的原因，也可以使用汇总方法。尽管基础评分过程和可靠性计算存在局限性和复杂性，但我们提倡SCT，因为它为认知技能的度量和教学提供了新的视角。

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