An Alternative Scoring Approach to the Script Concordance Test for Evaluating the Effect of Clinical Simulation on Clinical Reasoning in Kinesiology Students: A Pilot Study

INTRODUCTION: Clinical reasoning is fundamental in kinesiology education, but its assessment remains a challenge. The Script Concordance Test (SCT) is a tool for assessing reasoning under conditions of uncertainty. This study assesses the feasibility of using the SCT to evaluate clinical reasoning in kinesiology students and gathers preliminary validity evidence for its application in simulation-based education. METHODS: An observational analytic study with a pretest and posttest design was used. Fifty-two kinesiology students participated in 7 simulated tele-rehabilitation scenarios in neurokinesiology, cardiorespiratory rehabilitation, and musculoskeletal rehabilitation. SCTs were administered before and after the simulations to measure changes in reasoning. The Wilcoxon signed-rank test and Cohen's effect size (d) were used to evaluate differences in scores. RESULTS: Three of the 7 SCTs met reliability criteria (Cronbach's α > 0.7). Postsimulation SCT scores significantly improved (P = 0.021), with a small effect size (Cohen's d = 0.22). A new Script Concordance Simulation Index was developed, showing high discriminatory ability (AUC = 0.989) between student reasoning categories. CONCLUSIONS: The SCT can be utilized as a tool to evaluate clinical reasoning in kinesiology students within simulation-based education. Our study contributes to the generation of evidence supporting the feasibility and potential validity of the SCT in this context. The Simulation Script Concordance Test Index introduces an innovative approach to tracking cognitive trajectories after simulation. Future studies should provide additional evidence to strengthen the validity of the SCT in simulation-based education, and by deepening the understanding of the reasoning that underlies students' decision-making changes.