Article Title

Association between candidate total scores and response pattern in script concordance testing of medical students


Introduction: The script concordance test (SCT) aims to test clinical decision making and clinical reasoning. This study is a preliminary attempt to understand an alleged test-taking strategy where students avoid extreme response options, potentially threatening the validity of SCT scores. We investigated whether there is a significant association between the propensity to avoid the extreme response options and candidates’ overall SCT scores.

Methods: The SCT scores of 660 clinical-year medical students (six cohorts from 2013–2015) were analysed for a possible association with candidates’ response pattern. The proportion of middle range response options was calculated. Propensity to avoid extreme response options is defined as a response pattern with 15% or more of middle-range responses compared to those of the expert reference panel. The distribution for candidates with propensity to avoid the extreme options was further investigated using chi-square statistics for possible association with their overall SCT results.

Results: Fifty-five percent of the students from the lowest quartile, compared to 30% from the top quartile, had shown a propensity to avoid the extreme options. The differences were statistically significant (p < 0.001) and were consistent among all six cohorts included in this study.

Conclusions: Students whose SCT scores are in the lowest quartile are more likely to avoid the extreme response options in answering SCT questions. For quality assurance in high stakes summative SCTs, it may be worthwhile to select items with expert reference panel’s modal answers covering the full 5-point response options


medical education, script concordance, clinical reasoning, assessment, test taking strategies

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