Self-assessment for neurosurgery residents by script concordance test (SCT). The process of test elaboration

The script concordance test (SCT) is a new tool to assess clinical reasoning in a context of uncertainty. It was chosen for computer-based self-assessment training for neurosurgery residents. The aim of this work is to describe the construction of a first series of questions and provide teachers practical information needed to build a SCT. The theorical background of the SCT is explained. We review the steps we followed when writing of a series of more than two hundred questions. We present the different steps of our work, including writing clinical cases, validation of questions and elaboration of scoring systems. We explain the main difficulties we encountered. The script concordance test is an interesting easy-to-construct assessment tool useful for evaluating clinical competence. This work summarizes our experience in building a SCT, which should be helpful for teachers interested in this new assessment tool, especially in neurosurgery.