Digital Script Concordance Test for Clinical Reasoning

The Master of Advanced Nursing Practice (MANP) programme in the Netherlands is the professional training for the nursing specialist. The field of MANP is in flux; taking independent medical action and prescribing medication are among the principle aspects of this. Consequently clinical reasoning is an important part of the curriculum and makes great demands on the level of medical and nursing knowledge. At the moment the clinical reasoning capabilities of students are tested by means of two methods (assessment, case-history papers) that are frequently very labor-intensive for the teachers in regard to both developing questions and evaluation. The case-history papers also have a low inter-assessor validity, which is undesirable. The digital test is not suitable for this method of examination. In addition, the field of work is not involved in either the development of the questions or their validation.

Three Universities of Applied Sciences (Rotterdam, Fontys, Zuyd), along with the Learning Station Care Foundation initiated this project. The question was whether there was a suitable type of question to assess digitally the clinical reasoning capabilities of the trainee nursing specialist. The aim was greater possibilities for the teacher and trainee nursing specialist to support learning and to establish and pursue the desired level of knowledge. Based on a literature study it was jointly decided that the question type Script Concordance Test (SCT) could be used for this. The SCT type is in English and has been in use for 15-20 years. The starting point is the generic knowledge of the MANP trainee (medical and nursing) that is necessary for clinical reasoning. As the MANP programme is practice oriented it has the added value that in constructing SCT questions experts (medical and nursing specialists) working in the field have an essential role in validating the questions. Accordingly, this project will investigate whether there are digital test systems that can support this process and improve the quality of the tests.

In this project the SCT question type is digitalized, and digital tests have been developed for the complex practice of clinical reasoning for the MANP programme. The SCT question type has been included in the system of the Learning Station Care Foundation especially for this project. The conclusion is that the digital training and testing with the SCT type offers new possibilities for education and retraining. It must be noted that construction of the question type is labor-intensive and recruiting experts for the validation process is time-consuming. An expected result of the project is that the question type supports the learning process of clinical reasoning and teachers are enthusiastic about the various possibilities. The SCT question type can make an important contribution to the development and maintenance of clinical reasoning skills in (trainee) nursing specialists.