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Evaluation & the Health Professions
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Standardized Assessment of Reasoning in Contexts of Uncertainty

The Script Concordance Approach

Bernard Charlin

University of Montreal

Cees van der Vleuten

Maastricht University

Current written tools of assessment are mostly measuring the capacity to solve well-defined problems by the application of rules and principles, while the essence of expertise in the professions lies in the capacity to solve illdefined problems, that is, reasoning in contexts of uncertainty. The purpose of this study is to describe an approach that allows assessing ill-defined problems and to present and discuss research findings related to this approach. The tool has been used up to now mainly in medicine, however it can be applied in all health professions. The approach is based on three principles: (a) examinees are faced with a challenging authenticsituation in which several options are relevant; (b) the response format is a Likert-type scale that reflects the way information is processed in problem-solving situations, according to the script theory; and (c) scoring is based on the aggregate scoring method to take into account the variability of reasoning processes among experts. Research findings suggest that the approach permits one to reliably discriminate examinees across their level of experience, and so in very different domains. It makes it possible to measure skills or domains that were up to now difficult to measure.

Key Words: assessment of reasoning • uncertainty • health professions • medicine • ill-defined problems • script concordance approach

Evaluation & the Health Professions, Vol. 27, No. 3, 304-319 (2004)
DOI: 10.1177/0163278704267043
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