Preliminary Factor Analyses Raise Concerns about Script Concordance Test Utility: Exploring SCT constructs

Adam B. Wilson, Gary R. Pike, Aloysius J. Humbert

Research output: Contribution to journalArticle

4 Scopus citations


Purpose: Script concordance tests (SCTs) are assessments purported to measure one’s ability to interpret clinical data, a key component of the clinical diagnostic reasoning process. The aim of this research was to directly examine the construct validity/dimensionality of SCTs using factor analysis. Method: At Indiana University School of Medicine, a confirmatory factor analysis was conducted on three SCT datasets to assess whether SCT scores represented a single dimension of clinical reasoning. Exploratory factor analyses were also performed to determine if the SCTs represented multiple dimensions and to examine the effects of various SCT scoring methods on test dimensionality. Results: Results of the confirmatory factor analysis revealed that the SCTs did not have a unidimensional factor structure. Subsequent exploratory factor analyses of six different scoring methods confirmed these results. Factor loadings were weak and the factors explained only a small portion of the total variance in SCT scores. Conclusions: The results of this study challenge the assertion that SCTs measure one dimension of clinical reasoning. Because the outcomes of this study raise questions about the latent constructs SCTs measure, recommendations concerning the utility of SCT scores are also presented.

Original languageEnglish (US)
Pages (from-to)51-58
Number of pages8
JournalMedical Science Educator
Issue number1
StatePublished - Mar 1 2014


  • Clinical reasoning
  • Factor analysis
  • Scoring
  • Script concordance test

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Education

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