Script concordance tests: Guidelines for construction

Background: SCT is used to assess clinical reasoning in ambiguous or uncertain situations. It allows testing on real-life situations that are not adequately measured with current tests. It probes the multiple judgments that are made in the clinical reasoning process. Scoring reflects the degree of concordance of these judgments to those of a panel of reference experts. Method: SCT is an item format that is gaining acceptance in education in the health professions. However, there are no detailed guidelines on item writing, test scoring or test optimization. Results: The item format is described and the steps for preparing and administering reliable and valid SCTs are presented. Conclusion: SCTs probe examinees on a specific clinical reasoning task: data interpretation, a crucial step in the clinical reasoning process. It is inferred that a high degree of concordance corresponds to optimal use of information in the context of these specific tasks and therefore provides an indication of clinical reasoning quality.