Skip to main content

Advertisement

SpringerLink
Log in

Development and Validation of a Script Concordance Test (SCT) to Evaluate Ethical Reasoning Ability Among First and Fifth Year Students in a Medical School

  • Published:
Journal of Academic Ethics Aims and scope Submit manuscript

Abstract

A script concordance test (SCT) was developed as an innovative tool for assessing ethical reasoning ability. An SCT of 12 medical ethical vignettes were constructed from the UNESCO Casebook on Human Dignity and Human Rights. The vignettes were reviewed by a panel of 15 medical experts before administration to a panel of 18 clinicians. The clinician’s answers were used to constitute the scoring key. The SCT was then administered to first and final year medical students. Data were analysed using SPSS. Internal consistency was assessed using Cronbach’s alpha. SCT performance was tested for association with sex, year of study and race by comparing the mean SCT scores between categories within each variable. Internal consistency as measured by Cronbach’s alpha values, ranging from 0.597 to 0.902, indicated high intra-vignette reliability for 10 of the vignettes. Inter-vignette reliability was high at 0.797. Mean SCT scores were not significantly different between students of different gender, year of study and ethnicity. However, each vignette was able to distinguish between overall poor and good test performers. The SCT was able to differentiate between students with varying degrees of ethical reasoning ability.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Akabayashi, A., Slingsby, B. T., Kai, I., Nishimura, T., & Yamagishi, A. (2004). The development of a brief and objective method for evaluating moral sensitivity and reasoning in medical students. BMC Medical Ethics, 5(1), E1.

    Article  Google Scholar 

  • Boulouffe, C., Doucet, B., Muschart, X., Charlin, B., & Vanpee, D. (2014). Assessing clinical reasoning using a script concordance test with electrocardiogram in an emergency medicine clerkship rotation. Emergency Medicine Journal, 31(4), 313–316.

    Article  Google Scholar 

  • Bursztejn, A. C., Cuny, J. F., Adam, J. L., Sido, L., Schmutz, J. L., de Korwin, J. D., Latarche, C., Braun, M., & Barbaud, A. (2011). Usefulness of the script concordance test in dermatology. Journal of the European Academy of Dermatology and Venereology, 25(12), 1471–1475.

    Article  Google Scholar 

  • Candee, D., & Puka, B. (1984). An analytic approach to resolving problems in medical ethics. Journal of Medical Ethics, 10(2), 61–70.

    Article  Google Scholar 

  • Carrese, J. A., Malek, J., Watson, K., Lehmann, L. S., Green, M. J., McCullough, L. B., Geller, G., Braddock, C. H., III, & Doukas, D. J. (2015). The essential role of medical ethics education in achieving professionalism: the Romanell report. Academic Medicine, 90(6), 744–752.

    Article  Google Scholar 

  • Cobb, K. A., Brown, G., Hammond, R., & Mossop, L. H. (2015). Students' perceptions of the script concordance test and its impact on their learning behavior: a mixed methods study. Journal of Veterinary Medical Education, 42(1), 45–52.

    Article  Google Scholar 

  • Cohen, C. J., Chen, Y., Orbach, H., Freier-Dror, Y., Auslander, G., & Breuer, G. S. (2015). Social values as an independent factor affecting end of life medical decision making. Medicine, Health Care and Philosophy, 18(1), 71–80.

    Article  Google Scholar 

  • Deschenes, M. F., Charlin, B., Gagnon, R., & Goudreau, J. (2011). Use of a script concordance test to assess development of clinical reasoning in nursing students. The Journal of Nursing Education, 50(7), 381–387.

    Article  Google Scholar 

  • Ducos, G., Lejus, C., Sztark, F., Nathan, N., Fourcade, O., Tack, I., Asehnoune, K., Kurrek, M., Charlin, B., & Minville, V. (2015). The script concordance test in anesthesiology: validation of a new tool for assessing clinical reasoning. Anaesthesia Critical Care & Pain Medicine, 34(1), 11–15.

    Article  Google Scholar 

  • Eckles, R. E., Meslin, E. M., Gaffney, M., & Helft, P. R. (2005). Medical ethics education: where are we? Where should we be going? A review. Academic Medicine, 80(12), 1143–1152.

    Article  Google Scholar 

  • Eva, K. W., Reiter, H. I., Rosenfeld, J., Trinh, K., Wood, T. J., & Norman, G. R. (2012). Association between a medical school admission process using the multiple mini-interview and national licensing examination scores. JAMA : The Journal of the American Medical Association, 308(21), 2233–2240.

    Article  Google Scholar 

  • Fournier, J. P., Demeester, A., & Charlin, B. (2008). Script concordance tests: guidelines for construction. BMC Medical Informatics and Decision Making, 8, 18.

    Article  Google Scholar 

  • Greene, D. (1997). The use of service learning in client environments to enhance ethical reasoning in students. American Journal of Occupational Therapy, 51(10), 844–852.

    Article  Google Scholar 

  • Hafferty, F. W. (1998). Beyond curriculum reform: confronting medicine's hidden curriculum. Academic Medicine, 73(40), 403–407.

    Article  Google Scholar 

  • Hattab, A. S. (2004). Current trends in teaching ethics of healthcare practices. Developing World Bioethics, 4(2), 160–172.

    Article  Google Scholar 

  • Henning, M. A., Ram, S., Malpas, P., Shulruf, B., Kelly, F., & Hawken, S. J. (2013). Academic dishonesty and ethical reasoning: pharmacy and medical school students in New Zealand. Medical Teacher, 35(6), e1211–e1217.

    Article  Google Scholar 

  • Hinkka, H., Kosunen, E., Metsanoja, R., Lammi, U. K., & Kellokumpu-Lehtinen, P. (2002). Factors affecting physicians' decisions to forgo life-sustaining treatments in terminal care. Journal of Medical Ethics, 28(2), 109–114.

    Article  Google Scholar 

  • Humbert, A. J., Johnson, M. T., Miech, E., Friedberg, F., Grackin, J. A., & Seidman, P. A. (2011). Assessment of clinical reasoning: a script concordance test designed for pre-clinical medical students. Medical Teacher, 33(6), 472–477.

    Article  Google Scholar 

  • Lubarsky, S., Dory, V., Duggan, P., Gagnon, R., & Charlin, B. (2013). Script concordance testing: From theory to practice: AMEE guide no. 75. Medical Teacher, 35(3), 184–193.

    Article  Google Scholar 

  • Merrick, A., Green, R., Cunningham, T. V., Eisenberg, L. R., & Hester, D. M. (2016). Introducing the medical ethics bowl. Cambridge Quarterly of Healthcare Ethics, 25(1), 141–149.

    Article  Google Scholar 

  • Moon, M., Taylor, H. A., McDonald, E. L., Hughes, M. T., Beach, M. C., & Carrese, J. A. (2013). Analyzing reflective narratives to assess the ethical reasoning of pediatric residents. Narrative Inquiry in Bioethics, 3(2), 165–174.

    Article  Google Scholar 

  • Murrell, V. S. (2014). The failure of medical education to develop moral reasoning in medical students. International Journal of Medical Education, 5, 219–225.

    Article  Google Scholar 

  • Myser, C., Kerridge, I. H., & Mitchell, K. R. (1995). Ethical reasoning and decision-making in the clinical setting: assessing the process. Medical Education, 29(1), 29–33.

    Article  Google Scholar 

  • Nolan, P. W., & Smith, J. (1995). Ethical awareness among first year medical, dental and nursing students. International Journal of Nursing Studies, 32(5), 506–517.

    Article  Google Scholar 

  • Self, D. J., Wolinsky, F. D., & Baldwin, D. C., Jr. (1989). The effect of teaching medical ethics on medical students' moral reasoning. Academic Medicine, 64(12), 755–759.

    Article  Google Scholar 

  • Sheehan, S., Robbins, A., Porter, T., & Manley, J. (2015). Why does moral reasoning not improve in medical students? International Journal of Medical Education, 6, 101–102.

    Article  Google Scholar 

  • Sibert, L., Charlin, B., Corcos, J., Gagnon, R., Grise, P., & van der Vleuten, C. (2002). Stability of clinical reasoning assessment results with the script concordance test across two different linguistic, cultural and learning environments. Medical Teacher, 24(5), 522–527.

    Article  Google Scholar 

  • Singer, P. A., Robb, A., Cohen, R., Norman, G., & Turnbull, J. (1996). Performance-based assessment of clinical ethics using an objective structured clinical examination. Academic Medicine, 71(5), 495–498.

    Article  Google Scholar 

  • Sommer, C., Boos, M., Conradi, E., Biller-Andorno, N., & Wiesemann, C. (2011). Care and justice arguments in the ethical reasoning of medical students. Ramon Llull Journal of Applied Ethics, 1(2), 9–32.

    Google Scholar 

  • Tan, K., Tan, N. C., Kandiah, N., Samarasekera, D., & Ponnamperuma, G. (2014). Validating a script concordance test for assessing neurological localization and emergencies. European Journal of Neurology, 21(11), 1419–1422.

    Article  Google Scholar 

  • Tsai, T. C., Peter, H. H., Coderre, S., McLaughlin, K., & Donnon, T. (2009). Assessing ethical problem solving by reasoning rather than decision making. Medical Education, 43(12), 1188–1197.

    Article  Google Scholar 

  • Tsai, T. C., Chen, D. F., & Lei, S. M. (2012). The ethics script concordance test in assessing ethical reasoning. Medical Education, 46(5), 527–527.

    Article  Google Scholar 

  • UNESCO. (2011). Casebook on human dignity and human rights, bioethics Core curriculum. Casebook series, no. 1. Paris: UNESCO.

    Google Scholar 

  • Wan, S. H. (2015). Using the script concordance test to assess clinical reasoning skills in undergraduate and postgraduate medicine. Hong Kong Medical Journal, 21(5), 455–461.

    Google Scholar 

  • Wilkinson, T. J., Wade, W. B., & Knock, L. D. (2009). A blueprint to assess professionalism: results of a systematic review. Academic Medicine, 84(5), 551–558.

    Article  Google Scholar 

  • Wilson, F. L. (1995). The effects of age, gender, and ethnic/cultural background on moral reasoning. Journal of Social Behavior and Personality, 10(1), 67–78.

    Google Scholar 

  • Wolf, T. M., Balson, P. M., Faucett, J. M., & Randall, H. M. (1989). A retrospective study of attitude change during medical education. Medical Education, 23(1), 19–23.

    Article  Google Scholar 

Download references

Funding

This study was funded by International Medical University (grant number IMU279/2013).

Author information

Authors and Affiliations

  1. International Medical University, 57000, Kuala Lumpur, Malaysia

    Allan Pau, Saraswathy Thangarajoo, Vijaya Paul Samuel, Lai Chun Wong, Pak Fong Wong, Patricia Matizha, Sivalingam Nalliah & Vishna Devi Nadarajah

Authors
  1. Allan Pau
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Saraswathy Thangarajoo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vijaya Paul Samuel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lai Chun Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Pak Fong Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Patricia Matizha
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sivalingam Nalliah
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Vishna Devi Nadarajah
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Allan Pau.

Ethics declarations

Conflicts of Interest

No authors have financial disclosures or potential conflicts of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pau, A., Thangarajoo, S., Samuel, V.P. et al. Development and Validation of a Script Concordance Test (SCT) to Evaluate Ethical Reasoning Ability Among First and Fifth Year Students in a Medical School. J Acad Ethics 17, 193–204 (2019). https://doi.org/10.1007/s10805-019-09327-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10805-019-09327-3

Keywords

Search

Navigation