LAUSR

INTRODUCTION The cognitive expertise of Pediatric Hospitalists (PH) lies not in standard knowledge but in making decisions under conditions of uncertainty. To maintain expertise, PH should engage in deliberate practice via self-assessments that promote higher-level cognitive processes necessary to address problems with missing or ambiguous information. Higher levels of cognition are purported with Script Concordance Test (SCT) questions compared to Multiple Choice Questions (MCQ). AIMS To determine if PH use higher levels of cognition when answering SCT vs MCQ questions and to analyze participants' perceptions of the utility of using SCT self-assessment for deliberate practice in addressing clinical problems encountered in daily practice. RESEARCH METHODS This is a mixed methods study comparing the cognitive level expressed according to Blooms' Taxonomy by PH answering MCQ vs SCT questions using a "think aloud" (TA) exercise, followed by qualitative analysis of interviews conducted afterward. RESULTS A significantly greater percentage of comments were coded as higher cognitive processes (apply (AP), analyze (AN), evaluate (E), create (C)) for SCT vs MCQ (74% vs 19%) compared with lower order (remember (R), understand (U)); Chi sq p<.00001. Analysis of interviews revealed six themes. CONCLUSION SCT questions elicited higher-level cognition essential to clinical reasoning compared to MCQ questions. PH indicated MCQ questions measure standard knowledge, while SCT questions better measure decision-making under conditions of uncertainty. PH perceived SCT could be useful for deliberate practice in PHM decision making if they could compare their rationale in answering questions with that of experts.