# An Ontology-Driven Learning Assessment Using the Script Concordance Test
## 2 Methods and Materials  
### Script Concordance Test  
Script Concordance test is an assessment tool used in measuring assessing reasoning under conditions of uncertainty [8]. The construction of SCT is based on the principles and characteristics of script theory, which states that networks of knowledge, called \"illness scripts\", begin to form during the physician's first encounter with the patient and become refined with experience. In other words, each time a physician meets a new patient with incoming data (symptoms, signs, laboratory data, etc.), illness scripts enable the selection and interpretation of these data. Through time, evolved illness scripts allow medical experts to make accurate decisions promptly, efficiently, and often with minimal conscious effort [6].  
In its traditional written form, the construction of SCT (Table 1) involves two or more experienced physicians who write patient vignettes. These vignettes or clinical scenarios contain a certain amount of uncertainty, in order to simulate the ambiguous conditions that often occur in real life. Vignette is then followed by three mutually independent hypotheses in the form of a diagnostic possibility, an investigative option, or a therapeutic alternative [6]. It is important to note that the hypotheses must all be plausible (i.e., students should feel that the hypotheses are, indeed, reasonable considerations in the context of the given patient vignette) [6]. Each hypothesis is further followed by new information, such as a physical examination sign, an imaging study, laboratory test result, etc. This new information may or may not be relevant for the given hypothesis. The impact of new information on a given hypothesis is captured through a five-point Likert-type scale.  
When the SCT is complete, it is presented to the reference panel of experienced practitioners. Research study shows that the optimal number of experts is 15 [5]. After the reference panel, SCT is presented to students who also make judgments about the impact of new information on a given hypothesis. Each answer can be further measured and compared to those of a reference panel. There are several scoring methods and the aggregation method seems to be mostly used [1]. Here, the credits for each question are  
\begin{table}
\begin{tabular}{c c c} \hline \hline
**Case Description: You Are Evaluating a 35-Year-Old Woman with a Sore Throat, Difficulty Swallowing, and Coughing for 10 Days.** \\ \hline \hline If you were thinking...: & Additionally, then you find...: & Your hypothesis becomes...: \\ \hline \hline Q1. Acute bronchitis & Bronchovesicular breathing without accompanying sounds sounds; lymph nodes of the neck—not palpably enlarged; throat- hyperemia, enlarged tonsils & \(-2\) –\(1\) \(0\) +\(1\) +\(2\) \\ \hline Q2. Acute pharyngitis & lymph nodes of the neck—not palpably enlarged; throat- hyperemia, enlarged tonsils & \(-2\) –\(1\) \(0\) +\(1\) +\(2\) \\ \hline Q3. Acute rhinopharyngealgitis & lymph nodes of the neck—not palpably enlarged; throat- mild hyperemia of the throat & \(-2\) –\(1\) \(0\) +\(1\) +\(2\) \\ \hline \hline \end{tabular}
\begin{tabular}{c c} \hline \hline \end{tabular}
\end{table}
Table 1: Example of SCT.  
derived from the answers given by the panel of experts and divided by the number of panel members. Scores for each question are added up and divided by the total number of questions and divided by 100 to give a percentage score [2]. Several research studies across different medical disciplines support the SCT's construct validity, reliability, and feasibility across a variety of health science disciplines [6]. To achieve the best score reliability, SCT should include about 25 cases, with 3 hypotheses nested within each question, and testing time should be 60-90 min [4].