LAUSR

ABSTRACT General practitioners (GPs) make timely and accurate clinical decisions, often in the contexts of complexity and uncertainty. However, structured approaches to facilitate development of these complex decision-making skills remain largely unexplored. Here, the educational use of formative script concordance testing (SCT), a written assessment format originally designed to test clinical reasoning, is evaluated in this context through an in-depth qualitative exploration of the learning experiences of participating GP trainees. A ‘think-aloud’ approach to SCT is used, which requires question responses to be justified with a short clinical rationale. Eleven 1st-year GP trainees in Oxford (United Kingdom) completed the formative SCT activity, before taking part in individual semi-structured interviews. Data exploring their learning experiences was transcribed and analysed using reflexive thematic analysis. Thirty-seven codes were generated, and schematically organised into six sub-themes, that provide a descriptive summary of the data and insights into the practical educational utility of the SCT format. Three overarching themes were subsequently produced that relate specifically to aim of exploring in-depth the learning experiences of GP trainees to formative think-aloud SCT: 1) developing complex decision-making skills; 2) opportunity for self-evaluation and awareness; and 3) promoting community and professional identity. The development of complex clinical decision-making and reasoning skills is proposed to occur through guided reflection on performance, facilitated by the think-aloud approach to questioning. Together, this suggests a potential role for think-aloud SCT as a distinctive, structured learning activity to complement trainees’ professional development.