Evaluation of clinical reasoning in urology. Contribution of the Script Concordance Test.

Objective: The Script Concordance test is designed to measure knowledge organization, to allow interpretation of data in clinical decision making. The objective of this study was to assess the value of this new written evaluation instrument to evaluate clinical reasoning in urology. Material and Method: An 80-item examination was completed by a group of medical students (n=15), a group of urology interns (n=11), a group of registrars-assistants (n=7), and a group of experienced urologists (n=10). The scores obtained were compared by analysis of variance. The reliability of the test was studied by calculating Cronbach's coefficient alpha. Results: The mean score was 46.95 +/- 6.80 for students, 56.18 +/- 1.73 for interns, 66.27 +/- 4.92 for registrars and 63.38 +/- 2.19 for urologists. The differences observed between the scores for students, interns and urologists were significant. The reliability coefficient was 0.79 for the entire examination. Conclusions: This test is able to discriminate various levels of experience in urology. It proposes a simple and direct approach to evaluation of knowledge organization. Further studies are necessary to confirm the contribution of this test to the strategy of evaluation of the clinical skills lit urology.