Twelve tips for the construction of ethical dilemma case-based assessment

Abstract

Ethical dilemma case-based examination (ethics Script Concordance Test, eSCT) is a written examination that can be delivered to a large group of examinees for the purpose of measuring high-level thinking. As it accommodates for diverse responses from experts, ethics SCT allows partial credits. The framework of ethics SCT includes a vignette with an ethical dilemma and a leading question, which asks the examinee to “agree” or “disagree”, plus the shifts of prior decision by adding new information. In this article, the following tips for constructing this type of examination are provided: use “true” dilemmas, select an appropriate ethical issue, target high-level cognitive tasks, list key components, keep a single central theme, device quality scoring system, be important and plausible, be clear, select quality experts, validate, know the limitation, and be familiar with test materials. The use of eSCT to measure ethical reasoning ability appears to be both viable and desirable.

Glossary

Ethics reasoning: The ability to identify, assess, and develop arguments on resolving ethical problems, which represents interplay among: medical and ethical knowledge, problem-solving skills, and the justification for the use of appropriate principles, laws or values to rationalize a decision or to modify actions.

Tsai TC, Harasym PH. 2010. A medical ethical reasoning model and its contributions to medical education. Med Educ. 44:864–873.

High-level thinking (cognition): The cognitive processes that presuppose not only the recall of factual knowledge but also its application, such as, comparison, logic reasoning, planning, and decision-making.

https://cogsci.uni-osnabrueck.de/∼NBP/PDFs_Publications/AWH_MSatRoC_2013_PK_KUK_TCK.pdf

Acknowledgements

I would like to thank Professor Bernard Charlin for commending on improving the test framework, Professor Lambert Schuwirth and Professor Pawel Kindler for improving this article. I also want to acknowledge Dr Ching-Ju Shen, Nan-chieh Chen, and Dr William Fu-Hsiung Su for inviting participants.

Disclosure statement

The author reports no conflicts of interest. The author alone is responsible for the content and writing of the article.

Funding

This work was supported by Ministry of Science and Technology in Taiwan [NSC 102-2511-S-214-003].

Notes on contributor

Tsuen-Chiuan Tsai, MD, PhD, is now an Associate Dean and Professor, Kaohsiung Medical University, College of Medicine, Kaohsiung City, Taiwan.