L’évaluation du raisonnement clinique des résidents en hématologie par l’approche de concordance de script
The practice of hematology, like any other profession, requires the acquisition of adequate judgment. Based on cognitive psychology theory, the script concordance test (SCT) has been developed and validated as an instrument capable of evaluation clinical judgement in various medical specialties. The goal of this study was to examine the usefulness and the psychometric qualities of the SCT in hematology. We constructed a SCT composed of 60 questions and we administered it to 15 junior residents (R1 to R3 in internal medicine), 46 senior residents (R4, R5 and R6) and 17 hematologists from across Canada. After item optimization, the test comprised 51 questions. Its internal consistency measured by Cronbach alpha was 0.83. The test was able to discriminate between residents according to their year of training. Questions containing an image (n=10) seemed to offer a stronger discriminative potential. Scores obtained by the senior residents correlated moderately with those obtained on a conventional hematology exam made of multiple choice questions and short-answers (Pearson r: 0.42; p=0.02). The SCT was completed in an average of 36 minutes and was well received by participants. The SCT is a useful and valid evaluation instrument in hematology. It may be used during training to monitor resident progression. It may also be combined to other evaluation tools and used for summative purposes or in continuing medical education.
Evaluation Clinical reasoning Clinical judgment Residents Hematology Morphology Script concordance test