Construcción de una estrategia para evaluar el razonamiento clínico de residentes de medicina interna mediante el uso de Script Concordance Test más Written Think Aloud

Purpose: Clinical reasoning (CR) is a competency that should be taught and assessed. The Script Concordance Test (SCT) assesses CR under conditions of uncertainty, and its validity has been demonstrated. The Written Think Aloud (WTA) is complementary to understanding CR. This study describes the development and application of the SCT-WTA in internal medicine residents at a university in Bogotá, D.C., Colombia. Methods Mixed instrumental case study. During the development, application, and scoring of the SCT-WTA, the researchers kept field diaries where they recorded their perceptions, observations and experiences. The SCT-WTA was applied to 11 experts and 11 residents. Qualitative information and basic statistics were coded and categorized for the quantitative results. Results For the construction of the cases and questions of the SCT, it was crucial to have expected learning outcomes and disease scripts and to resort to cases of daily practice. The time investment in elaboration, response, and scoring was high; however, experts and residents considered that the SCT allowed evaluation content, organization, and use of information. Responses between residents and experts were similar. Conclusions The SCT format is attractive to experts and residents, who consider it an excellent tool to evaluate CR, a fundamental competence for the internist and which does not have a specific chair or evaluation. The SCT-WTA was perceived as complementary and valuable as a formative assessment.