Script concordance testing to understand the hypothesis processes of undergraduate nursing students : multiple case study

Abstract

Background: Albeit essential to clinical reasoning (CR), strategies for generating student nursing clinical hypotheses at the time of transition to professional practice are underdeveloped. While script concordance testing (SCT) has been shown to be a valid and reliable assessment tool for CR in nursing education, the thought processes including the hypothesis processes involved in choosing an answer is not examined.

Methods: A multiple case study was used to understand the complex phenomenon of students’ hypothesis activation and confrontation with the combined use of SCT questions and the think-aloud method. Structured individual interviews were conducted. Results: A total of 18 students, nine first-year and nine third-year students participated in the study. The results show that the students demonstrate certain CR cognitive processes, including early representation of a clinical situation, semantic transformation of data, and hypothesis comparison. Conclusions: Results suggest promoting knowledge articulation aloud and the frequent use of micro-judgments to compare and differentiate hypotheses involving the uncertainty of clinical practice, which underpin learning in successive layers.