Script concordance test examinations: Student perception and study approaches

Introduction:  Script concordance test questions (SCTs) are a style of question that has been developed based upon the script theory of information storage and retrieval. SCTs use script theory to examine a clinical reasoning construct purported to be different from that assessed by multiple-choice questions (MCQs). Evidence regarding the construct validity of SCT is somewhat limited, but generally supportive.  Methods:  This project involved a content-matched MCQ and SCT practice examination delivered to senior medical students (n = 211) from a single institution with an accompanying survey regarding educational consequences of SCT and MCQ examinations.  Results: Students’ responses differed significantly between how they would prepare for an MCQ examination as compared to an SCT examination. These differences were present in a number of areas, including greater focus on textbooks and use of websites for MCQ examination preparation (p < 0.001). Students reported that for an SCT examination they would benefit most from in-person teaching from local consultants involved in the process of SCT generation. Students felt that they would also benefit from further instruction regarding key elements of SCT technique, and from opportunities to provide written explanations of their reasoning during the exam.  Conclusions: The results suggest that SCTs have educational consequences different from MCQs. Further research into the educational consequences of SCTs, and how these consequences may differ from that of other methods of assessment, is warranted.