Assessing the Feasibility and Construct Validity of Cross-Cultural Care Competency with the Script Concordance Test (Published 2015)
Apr 06, 2016
Lypson M.L, Ross P.T, Purkiss J.A, Uijtdehaage S, Gomez A and Grum C.M
Script Concordance Test (SCT) is based on a clinical vignette of a patient that presents with clinical complaints and is used to assess clinical reasoning. This study tests the feasibility of using this instrument in an undergraduate medical curriculum.
Background: The University of Michigan tested feasibility and construct validity of a computer-based Script Concordance Test (SCT) in an existing undergraduate medical curriculum to explore the validity of this instrument to assess competence in patient-centered care when various cultural factors are introduced. The SCT is based on a clinical vignette of a patient that presents with clinical complaints and is used to assess clinical reasoning.
Methods: An online version of the SCT consisting of one case and 18 questions was used for this study. Scores were based on proportional agreement of student responses with answers collected from a panel of experts. Descriptive statistics and Pearson correlations were tabulated for three cohorts of M3 students who completed the online SCT and the Diagnostic Pattern Recognition Exam (DPRE) test (N=453 or 84% of all M3 students). SCT scores were also correlated with United States Medical Licensing Examination (USMLE) Step 1 and an Objective Structured Clinical Examination (OSCE) communication skills score.
Results: No significant correlation was found between the SCT and Step 1, or the SCT and the OSCE Communication score. However, the correlation between SCT and Step 2-Clinical Knowledge was statistically significant but weak: Rho=0.097, p=0.040, N=452. The correlation between SCT and DPRE was also statistically significant, though weak: Spearman’s Rho=0.112, p=0.017, N=453.
Conclusion: Given the weak correlations, the SCT may require refinement or may assess a unique domain of clinical reasoning. Although we found evidence of minimal overlap between reasoning assessed by SCT and that assessed by the DPRE, it is also possible that issues related to cross-cultural care allow for a distinctive style of pattern recognition for disease presentation.
Although it is often important to report negative results as much as positive ones, I struggled to find a step forward with this paper other than its strong suggestion of the need for further work.