THE SCRIPT CONCORDANCE TEST: A NEW TOOL TO EVALUATE CONTINUING PROFESSIONAL DEVELOPMENT TRAINING IN SHARED DECISION MAKING FOR THE USE OF ANTIBIOTICS FOR ACUTE RESPIRATORY INFECTIONS

Purpose: To explore the usefulness of a new Script Concordance Test (SCT) to evaluate clinical reasoning of primary care physicians trained in shared decision making for the use of antibiotics for acute respiratory infections (ARI).

Method: We developed a SCT with 22 clinical scenarios on ARI in primary care, each including one to five questions. The scenarios were designed to reflect the uncertainty of diagnosis (11 scenarios) and treatment of ARI (9 scenarios), and to place participants in situations favourable to shared decision making (2 scenarios). The SCT was administered to 38 primary care physicians from five Family Medicine Groups from the province of Quebec (Canada), before and after an educational program on shared decision making for the optimal use of antibiotics for ARI. Participants' responses were compared to the aggregate responses of an expert panel (8 primary care physicians, 7 paediatricians, 5 pulmonologists, 7 ENT specialists, 2 ethical experts), with the scores representing the distance between participants and experts' responses. Participants' and experts' responses were also compared to responses based on the recommendations of six clinical guidelines on the management of ARI. We explored the feasibility of using the shared decision-making scenarios to assess physicians' intention to offer some decisional responsibility to patients.

Result: Experts' ratings varied markedly depending on their specialty, with paediatrician and primary care physicians scoring the closest to clinical guidelines recommendations, and ethical experts' responses displaying a wide variability (CV = 40%). Participants' clinical reasoning on diagnosis was not significantly changed following the educational program (decrease in score of 3%; P = 0.3) whereas their clinical reasoning on the choice of a treatment was improved (increase in score of 6%; P <0.01). Primary care physicians' responses to the shared decision-making scenarios showed that they had the intention to offer 36% of the decisional responsibility to patients before the educational program, and that this proportion increased to 43% after the program.

Conclusion: The SCT proved useful for assessing clinical reasoning relative to diagnosis, treatment and shared decision making in the context of a continuing professional development program on shared decision making for the use of antibiotics for ARI.