Reliability and validity of the script concordance test for postgraduate students of general practice

Figures & data

Table 1. Sample of an SCT question.

Case 1: Cindy, 28 years old, complained of nausea and faintness, for one week. On request, she signals slight breast pain and mild epigastric pain.
And if your assumption was…	And you discover that…	The hypothesis becomes…
1. Early pregnancy	She has an IUD and her last period was two weeks ago	–2	–1	0	+1	+2
2. Gastroenteritis	She presented with two episodes of profuse diarrhoea during the week	–2	–1	0	+1	+2
3. Latent anxiety	She has a history of depression and anorexia	–2	–1	0	+1	+2
–2: Much less likely diagnostic hypothesis (assumption virtually eliminated) –1: A less likely hypothesis	0: No effect on the diagnostic hypothesis	1: A more likely diagnostic hypothesis 2: A much more likely hypothesis (almost certainly correct)

Table 2. Numbers of questions in the SCT, by field and pathology.

	Pathology	Number of questions
Diagnosis	1-Gynaecology	10
	2-Gastroenterology	5
	3-Psychiatry	3
	4-Orthopaedics	11
	5-Pneumology	5
	6-Cardiovascular	8
	7-Neurology	3
	8-Ophthalmology	1
	9-Infectious	9
	10-Urology	4
	11-Oncology	2
	12-ORL	2
Investigation	1-Neurology	3
	2-Rheumatology	9
	3-Oncology	7
	4-Infectious	9
	5-Endocrinology	4
	6-Psychiatry	1
	7-Cardiovascular	1
	8-Gastroenterology	2
Treatment	1-Rheumatology	6
	2-Infectious	14
	3-Gastroenterology	1
	4-Pneumology	6
	5-Gynaecology	6
	6-Oncology	3

Figure 1. Students’ means scores and their 95%CI at each session of the test.

Table 3. Students’ results on the overall test (n = 90).

Sessions (S)	Means (SD)	95%CI sample	Range	SEM	95%CI individual	Cronbach’s α
S0^a	71.1 (4.5)	70.2–72.0	54.2–79.4	2.66	5.2	0.65
S1^a	71.4 (5.7)	70.2–72.6	43.3–80.4	2.85	5.6	0.74
S2^a	72.1 (5.0)	71.1–73.1	53.2–82.6	2.87	5.6	0.67
S3^a	72.6 (5.9)	71.4–73.8	47.3–81.4	2.76	5.4	0.78
S4^a	68.9 (7.0)	67.5–70.3	47.6–79.6	2.88	5.6	0.83
S5^a	70.7 (6.4)	69.4–72.0	52.4–85.6	2.63	5.2	0.83
S6^a	73.1 (6.3)	71.8–74.4	48.6–85.4	2.81	5.5	0.80

^a t-Test using the expert mean = 76.7; p value <.000.

Table 4. Students’ average improvement between semesters on the global test.

Sessions (S)^a	Average improvement (SD)	95%CI	Min–max
S0–S3	1.5 (5.1)	0.5–2.0	–15.3 to 10.3
S3–S6	0.5 (6.1)	–0.75–1.75	–25.0 to 27.0
S0–S6	2.0 (6.3)	0.7–3.3	–26.1 to 14.4

^a Wilcoxon: S0 versus S3: p value <.003; S3 versus S6: p value <.12; S0 versus S6: p value <.0001.