Script Concordance Test in Physiology: Preparation, Scoring, and Student Perceptions – A Mixed Method Study

Background: Although the curriculum has changed, assessment tools are not in alignment with the new types of teaching such as early clinical exposure (ECE) and self-directed learning. Both in summative and formative assessment most commonly used tools for assessment of cognitive domain are written formats including MCQ. However, these assessment tools such as MCQ and written essays cannot assess the higher order thinking skills and clinical reasoning skills. Materials and Methods: The present study was conducted in the department of physiology, in collaboration with medical simulation center, as a part of formative assessment for topics on pathophysiology of shock and obstructive and restrictive lung disorders taught during ECE using case scenarios. Two script concordance tests (SCTs) each on the topic of pathophysiological mechanism of different types of shock and obstructive and restrictive lung disorders each were prepared and administered to the students. Student perception to this assessment tools was obtained. Results: The Cronbach's alpha of the 6-item SCT for respiratory and cardiovascular topic administered to the students (n = 107, 98) was 0.83 and 0.82, respectively. The inter-item correlation was respiratory and cardiovascular topic for 0.71, 0.69 suggesting that they are close and repetitive. Students were of the opinion that SCT are difficult to understand (75.8%), challenging to answer (47.2%), and it tested the clinical content better (71.4%). Conclusions: In our study, students felt though SCT tested the clinical content better when compared to conventionally used MCQ, they still find it challenging to understand and are not in favor of its use in summative and formative assessments. Keywords: Assessment, medical education, physiology, undergraduates