The Script Concordance approach to testing clinical reasoning was developed in Montreal a number of years ago. (www.cpass.umontreal.ca/sct.html) It is based on the premise that experts follow pre-built mental scripts in solving problems. The testing aspect compares a learner’s performance on a series of decisions to see how concordant they are with the decisions made by a panel of experts.

The approach is well developed with very good evidence behind it but not yet widely used. We are exploring some key factors around this and whether our OpenLabyrinth virtual patients might be adapted to a Script Concordance approach. One of the key points in decision making is that all the choices should be reasonable options. This is in contrast with the classic MCQ style best-of-five where only one choice is right, and the question writer has to create credible distractors that are still not correct. In SCT, all choices are potentially correct.

This aligns nicely with the style that we use in our more effective cases. Create a case where all the branch options are reasonable and realistic. So now we are looking at improving some of the interactive tools available within OpenLabyrinth in order to better support the Script Concordance approach to learning and assessment.

We are part way into a project where the learning designs will be based on SCT. We are also exploring what could be done in extending this approach, afforded by the increased flexibility in how we present data and ask for decisions and rankings.

More on this to come soon.