OBJECTIVE:To assess the validity and reliability of a neurological script concordance test (SCT) in Neurology and Emergency departments (EDs) in 2 hospitals.BACKGROUND:Clinical reasoning (CR) varies with medical and socio-cultural contexts. This implies assessments of CR must demonstrate reliability across disciplines and institutions. SCTs are validated assessment tools of CR. We previously designed and validated a SCT for neurological emergencies and localisation . Since neurologists and emergency physicians frequently manage neurological emergencies and perform neurological localization, we aimed to validate the SCT on neurologists and emergency physicians in 2 hospitals.DESIGN/METHODS:The SCT was administered to faculty, residents and 4th year medical undergraduates in Neurology and EDs of 2 tertiary care centres in Singapore. These constituted National University Hospital Neurology Department (NUHNL, National University Hospital ED (NUHED), Tan Tock Seng Hospital ED (TTSHED) and National Neuroscience Institute-Tan Tock Seng Hospital NNI-TTSH).RESULTS:N= 289 (104 from NNI-TTSH, 36 from NUHNL, 95 from NUHED and 54 from TTSHED), consisting 60 experts, 151 residents and 78 undergraduates assigned to NNI-TTSH and NUHED. At each site, scores were derived from the departmental expert panel. All scores reported as mean± SEM. Respective scores for experts in NNI-TTSH; NUHNL; TTSHED; NUHED were 76.6± 1.1; 79.4± 1.2; 79.1± 1.0; 77.3± 0.6. Equivalent scores for residents were 68.3± 1.1; 69.6± 0.8; 66.8± 0.9; 67.0± 0.7. Undergraduates in NNI-TTSH and NUHED scored 61.0± 0.9 and 68.6± 0.5 respectively. Experts scored better than residents and undergraduates (p<0.05 in all centres and disciplines). Residents scored better than undergraduates in NNI-TTSH (p<0.05), but not NUHED. Test reliability was acceptable in all settings, Cronbach's alpha ranging from 0.72 to 0.81.CONCLUSIONS:Across disciplines and institutions, the SCT showed acceptable construct validity and reliability. The SCT can be used in differing disciplines and institutions with appropriate selection of expert panelsStudy Supported by:National University Health System NICE (New innovations in clinical education) Fund
Disclosure: Dr. Soon has nothing to disclose. Dr Nigel Tan holds stock and/or stock options in Pfizer Inc. and Stryker. Dr. Heng has nothing to disclose. Dr. Chiu has nothing to disclose. Dr. Madhevan has nothing to disclose. Dr. Manauis has nothing to disclose. Dr. Phua has nothing to disclose. Dr. Ponnamperuma has nothing to disclose.
Original Article: http://www.neurology.org/cgi/content/short/82/10_Supplement/P1.327?rss=1
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