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Hong Kong Med J. 2015 Oct;21(5):455-61. doi: 10.12809/hkmj154572. Epub 2015 Aug 28.

Using the script concordance test to assess clinical reasoning skills in undergraduate and postgraduate medicine.

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School of Medicine Sydney, University of Notre Dame, 160 Oxford Street, Darlinghurst, NSW 2010, Australia.


The script concordance test is a relatively new format of written assessment that is used to assess higher-order clinical reasoning and data interpretation skills in medicine. Candidates are presented with a clinical scenario, followed by the reveal of a new piece of information. The candidates are then asked to assess whether this additional information increases or decreases the probability or likelihood of a particular diagnostic, investigative, or management decision. To score these questions, the candidate's decision in each question is compared with that of a reference panel of expert clinicians. This review focuses on the development of quality script concordance questions, using expert panellists to score the items and set the passing score standard, and the challenges in the practical implementation (including pitfalls to avoid) of the written assessment.


Clinical competence; Education, medical, undergraduate; Educational measurement/methods

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