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.
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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.
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.
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.
Candee, D., & Puka, B. (1984). An analytic approach to resolving problems in medical ethics. Journal of Medical Ethics, 10(2), 61–70.
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.
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.
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.
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.
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.
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.
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.
Fournier, J. P., Demeester, A., & Charlin, B. (2008). Script concordance tests: guidelines for construction. BMC Medical Informatics and Decision Making, 8, 18.
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.
Hafferty, F. W. (1998). Beyond curriculum reform: confronting medicine's hidden curriculum. Academic Medicine, 73(40), 403–407.
Hattab, A. S. (2004). Current trends in teaching ethics of healthcare practices. Developing World Bioethics, 4(2), 160–172.
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.
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.
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.
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.
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.
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.
Murrell, V. S. (2014). The failure of medical education to develop moral reasoning in medical students. International Journal of Medical Education, 5, 219–225.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
UNESCO. (2011). Casebook on human dignity and human rights, bioethics Core curriculum. Casebook series, no. 1. Paris: UNESCO.
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.
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.
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.
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.
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This study was funded by International Medical University (grant number IMU279/2013).
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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
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DOI: https://doi.org/10.1007/s10805-019-09327-3