Assessing clinical reasoning in optometry using the script concordance test

Abstract

Background

Clinical reasoning is central to any health profession but its development among learners is difficult to assess. Over the last few decades, the script concordance test (SCT) has been developed to solve this dilemma and has been used in many health professions; however, no study has been published on the use of the script concordance test in optometry. The purpose of this study was to develop and validate a script concordance test for the field of optometry.

Methods

A 101‐question script concordance test (27 short clinical scenarios) was developed and administered online to a convenience sample of 23-second‐year and 19 fourth‐year students of optometry. It was also administered to a reference panel of 12 experienced optometrists to develop the scoring key. An item‐total correlation was calculated for each question. Cronbach's alpha coefficient was used to evaluate the script concordance test reliability and a t‐test compared the two groups.

Results

A final 77‐question script concordance test was created by eliminating questions with low item‐total correlation. Cronbach's alpha for this optimised 77‐question script concordance test was 0.80. A group comparison revealed that the second‐year students' scores (n = 23; mean score = 66.4 ± 7.87 per cent) were statistically lower (t = ‐4.141; p < 0.001) than those of the fourth‐year students (n = 19; mean score = 75.5 ± 5.97 per cent).

Conclusion

The online script concordance test developed for this study was found to be both reliable and capable of discriminating between second‐ and fourth‐year optometric students. These results demonstrate that the script concordance test may be considered as a new tool in the optometric educators' assessment arsenal. Further studies will be needed to cover additional levels of professional development.

Key words:

• assessment
• clinical reasoning
• education
• optometry
• script concordance test

Acknowledgments

The authors wish to thank Driss Kazitani for his technical assistance.

This study was funded by the Canadian Optometric Education Trust Fund (MPDG, GL and CF).