Abstract
-
Purpose
Diagnostic errors contribute to patient safety risks, often arising from cognitive failures in clinical reasoning. Preceptorship is thought to improve residents’ clinical reasoning. The aim of this study was to evaluate the effect of a preceptorship program on clinical reasoning among pediatric residents.
-
Methods
This randomized controlled trial was conducted from March 2025 to May 2025 at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. All pediatric residents were randomly allocated into two groups. The intervention group received a scheduled preceptorship program, while the control group continued with standard supervision. After 8 weeks, clinical reasoning skills were assessed using the Script Concordance Test (SCT). Data were analyzed using comparation test. End-of-program questionnaires were also reported.
-
Results
Total 41 residents completed the study. Baseline characteristics did not differ between groups (p>0.05). Mean overall SCT scores ranged from 55% to 90% of the maximum possible score. Among 14 topics, hematology & oncology was the only topic that showed a significant difference in SCT scores between the intervention group (median, 14.28; interquartile range [IQR], 12.78–15.08) and the control group (median, 12.75; IQR, 11.49–13.63). Participants reported that preceptorship made learning more structured and interactive but noted barriers including busy preceptor schedules and lack of standardized teaching materials.
-
Conclusion
The preceptorship program resulted in a significant improvement in only one topic, which may reflect suboptimal implementation of the intervention. Despite this, participants reported positive perceptions, indicating good acceptability. More intensive and consistent preceptorship may be required to achieve measurable improvements in clinical reasoning.
-
Key Words: Clinical reasoning, Medical education, Preceptorship, Resident, Script Concordance Test
Introduction
Diagnostic error is a major concern across medical residents, particularly in high workload and stress settings. Diagnostic errors account for approximately 10% of patient deaths and 17% of adverse events in hospitals [
1]. A study in internal medicine reported that 74% of diagnostic errors were attributable to cognitive errors and 65% were attributable to system errors [
2]. These findings reflect a complex interaction between systemic and cognitive factors, with a large proportion of errors arising from cognitive failures in clinical reasoning [
1,
2].
Medical education plays a crucial role in addressing diagnostic error. Educational approaches that develop clinical reasoning have been proposed to reduce diagnostic mistakes [
3,
4]. Clinical reasoning is a core component of residency training. It enables residents to reach accurate diagnoses and make appropriate management decisions. Therefore, residency curricula and teaching practices should prioritize methods that improve this competency.
Among interventions designed to enhance clinical reasoning, several strategies have been described, including workshops, debriefing programs, preceptorship, and dedicated clinical reasoning curricula [
5,
6]. Increasing preceptor presence in education and training is considered a practical and effective approach because preceptors provide real-time guidance and critical feedback that help residents refine their decision-making in authentic clinical contexts [
7]. Although existing studies demonstrate benefits of preceptorship for professional development and interpersonal relationships, there remains a lack of research specifically examining the effect of preceptor presence on clinical reasoning using standardized, validated assessment methods [
8].
Clinical reasoning can be measured with several methods, including the Script Concordance Test (SCT), Patient Management Problems (PMP), situativity-based approaches, key features, and extended matching items [
9,
10]. The SCT is particularly well suited for assessing how clinicians interpret ambiguous or incomplete information and adapt their illness scripts to complex clinical situations, making it an appropriate tool for evaluating changes in clinical reasoning resulting from educational interventions [
11,
12]. Moreover, the SCT has been used to support both training and evaluation in residency development by providing a valid representation of clinicians’ ability to make appropriate and effective clinical decisions [
13-
15]. Therefore, this study aims to evaluate the effect of preceptor presence on the clinical reasoning of pediatric residents at Dr. Soetomo General Academic Hospital, measured using standardized methods (SCT).
Methods
1. Study design and setting
This study was a single center randomized controlled trial. It aimed to evaluate the impact of a preceptorship program on the clinical reasoning of pediatric residents. The trial was conducted from March 2025 to May 2025 at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. Standard clinical supervision practices remained in place for both groups throughout the study; the intervention consisted solely of adding a dedicated preceptor for the intervention group without altering existing supervisory methods.
2. Participants
The target population were pediatric resident at Dr. Soetomo General Academic Hospital. Inclusion criteria were: (1) enrollment as a junior & intermediate level pediatric resident, and (2) voluntary consent to participate. Residents were excluded if they were repeating a rotation or on academic or personal leave during the study period. All eligible residents meeting these criteria were invited to participate (total sampling).
Baseline characteristics of participants showed similar distributions of training level (intermediate vs. junior), sex, semester, age, and number of publications between groups (p>0.05) (
Table 1). Approximately one-third of participants were at the intermediate level (26.8% in the control group vs. 24.4% in the intervention group), and the majority of participants were female (31.7% in the control group vs. 39.0% in the intervention group).
The sample size was calculated for an unpaired two-sample t-test using previously reported data [
16]. Based on Lubarsky et al. [
17], standard deviations (SDs) of 9.4 and 7.0 for the two groups and a minimum meaningful difference of 7.238 were assumed. The calculation indicated a requirement of 16 participants per group. Allowing for up to a 10% dropout rate, the target enrollment was increased to 18 residents in each group.
After enrollment, participants were randomized into the intervention or control group. Randomization was performed using a computerized random number generator in IBM SPSS Statistics ver. 23.0 (IBM Corp., Armonk, USA). A stratified randomization process with additional blocking was applied to ensure balanced distribution of baseline characteristics: training level (junior vs. intermediate) and clinical rotation (14 pediatric divisions: allergy & immunology, endocrinology, pediatric emergency & intensive care, gastroenterology, hematology & oncology, hepatology, tropical & infectious diseases, cardiology, nephrology, neonatology, neurology, nutrition & metabolism, respirology, growth & development). Training level refers to the stage within the postgraduate specialist training program. Junior residents are in the early phase of training, focusing on basic knowledge and supervised clinical exposure, whereas Intermediate residents are in more advanced stages with greater clinical responsibility and experience. Within each stratum-block, residents were randomly assigned in a 1:1 ratio to intervention or control. The allocation sequence was concealed in SPSS until assignment. Blinding of participants and preceptors was not feasible due to the visible nature of the intervention. Participants were considered dropouts if they failed to complete the assigned intervention, took a leave of absence, or voluntarily withdrew from the study after randomization.
5. Interventions
1) Intervention group (resident-preceptor match)
Residents in the intervention group participated in a structured preceptorship program based on the resident–preceptor match model described by Sobel et al. [
7]. Thirteen experienced pediatricians (preceptors) were recruited, each responsible for supervising one or two residents. Preceptors were certified pediatric specialists (or sub-specialists) with at least 3 years of clinical experience.
To encourage consistency across preceptors, all preceptors received prior training in the cognitive apprenticeship model from medical education experts. This training covered the six instructional methods (modeling, coaching, scaffolding, articulation, reflection, exploration) as described by Collins et al. [
18] and Stalmeijer et al. [
19]. A written guide for preceptors was developed and refined by experts before the study. The guide specified the core structure of each session, including case discussion, prompting of clinical reasoning, real-time feedback, and formulation of management plans.
Topics and discussions were grounded in real patient cases encountered by residents on the same day of each session. Although the patient cases discussed varied according to residents’ daily clinical encounters, preceptors were asked to apply the same instructional principles throughout the program. Feedback was provided verbally and in real time, with a focus on residents’ clinical reasoning processes, diagnostic considerations, and management decisions, in accordance with the cognitive apprenticeship framework.
The preceptorship lasted 8 weeks for each group of matched residents. During this period, each preceptor scheduled to meet with their assigned residents 2 times per week for at least 30 minutes per meeting session. Residents maintained a meeting logbook, which helped monitor the frequency and content of sessions. The study team periodically reviewed the logbooks and clarified any questions to maintain uniform implementation. After the 8-week preceptorship, intervention group residents completed an anonymous evaluation questionnaire about their experience.
2) Control group (standard supervision)
Throughout the intervention, standard clinical supervisors at the hospital continued their regular duties for all residents (both intervention and control group). The intervention did not reduce the control group’s learning opportunities. The residents in control group continued their usual rotations with standard supervision. Supervisors focused on ensuring adherence to clinical standards and provided general feedback, rotating among services daily. Supervisors provided general teaching and feedback as part of routine training.
6. Data collection
1) Clinical reasoning assessment (Script Concordance Test)
The primary quantitative outcome was clinical reasoning skill, measured by a SCT. The SCT was a case-based assessment in which participants make decisions under uncertainty and their answers are compared to a panel of expert responses [
20]. An SCT for pediatric clinical reasoning was developed following established procedures (
Supplement 1) [
21]. The SCT scoring used the aggregate method. A panel of 12 pediatric experts provided their answers to each SCT item. For each response option selected by a participant, a score was assigned based on the proportion of panelists choosing that option (
Supplement 2). Each participant’s raw score was the sum of these weighted values across all items.
Validation of the aggregate scoring system was performed using intraclass correlation coefficient analysis. The validation of SCT items was carried out through bivariate Pearson correlation analysis and Cronbach’s α reliability testing. Given the limited population size, a pilot test could not be conducted. Instead, validation was performed using a data-driven item reduction method, in which non-valid items were eliminated until the questionnaire met the required statistical criteria [
22]. The SCT were administered to all participants after the 8-week period.
SCT development and aggregate scoring procedures demonstrated high inter-rater reliability across topics. Inter-rater reliability of the panelists’ responses by topic was high: intraclass correlation coefficients (average measures) ranged from good to excellent (0.75–0.95) and the F test for each topic was significant (p<0.001). Initial pilot testing of participant responses revealed low reliability for the 30-item draft per topic. Items were reduced iteratively to remove items that negatively affected reliability. The final instrument comprised 20 items per topic with Cronbach’s α values ranges from 0.60 to 0.85. These findings support the SCT as a valid and reliable instrument for assessing clinical reasoning [
23-
26].
2) End-of-program questionnaire
At the end of the 8-week intervention, participants in the preceptorship group completed a feedback questionnaire. The questionnaire had two sections. Section 1 consisted of three open-ended questions asking residents to describe (1) the impact of the preceptorship on their learning process, (2) perceived strengths, and (3) perceived limitations of the preceptorship system. Section 2 contained 12 statements rated on a 5-point Likert scale assessing aspects of the cognitive apprenticeship model (
Supplement 3). This section was adapted from cognitive apprenticeship literature to evaluate the fidelity of the intervention. The validation of cognitive apprenticeship questionnaire was carried out through bivariate Pearson correlation analysis and Cronbach’s α reliability testing.
Data were analyzed using IBM SPSS Statistics ver. 23.0 (IBM Corp.). Continuous variables were summarized as mean±SD if normally distributed, or median and interquartile range (IQR) if not. Categorical variables were summarized as counts and percentages. The primary comparison of SCT scores between the intervention and control groups were tested using an independent-samples t-test or Mann-Whitney U test. A two-sided p-value <0.05 was considered statistically significant.
Qualitative data from feedback questionnaire responses were analyzed descriptively and using an inductive thematic approach. Two researchers independently coded the transcripts to identify emerging themes. Discrepancies were resolved through discussion. Major themes reflecting aspects of perceptions were identified. The number of participants expressing each theme was counted and presented descriptively.
8. Ethical considerations
Participation in the study was voluntary. Written informed consent was obtained from all residents prior to enrollment. Residents were informed that participation or non-participation would not affect their academic evaluation, clinical grading, or progression in the training program. Ethical approval for this study was obtained from the Institutional Review Board (IRB) at Dr. Soetomo General Academic Hospital (IRB approval no. 1216/KEPK/I/2025). All procedures conformed to institutional guidelines for research with human subjects and the ethical principles of the Declaration of Helsinki.
Results
1. Randomization and group allocation
A total of 42 pediatric residents participated in this study (
Fig. 1). One participant (2.38%) withdrew from the study because of educational leave. Therefore, data from 41 participants were available for analysis (21 in the intervention group and 20 in the control group).
Comparative analysis of SCT results across the 14 topics showed a statistically significant between-group difference only for the hematology & oncology topic (
Table 2). For hematology & oncology topic, the intervention group recorded a median SCT score of 14.28 (IQR, 12.78–15.08) compared with a median of 12.75 (IQR, 11.49–13.63) in the control group (p=0.037).
Most participants (61.9%) reported session durations of 30 minutes or more; 38.1% reported sessions shorter than 30 minutes. The majority (71.4%) experienced fewer than two meetings per week. The cognitive apprenticeship questionnaire demonstrated excellent internal consistency (Cronbach’s α=0.935). The mean total score was 51.6±6.9 (
Table 3).
The most frequently reported effect was that preceptorship made learning more structured and focused (23.8%), as illustrated by “Learners receive structured explanations and can ask freely, resulting in good feedback” (Participant 3). Another 23.8% reported direct gains in knowledge, skills, and professional experience from the preceptor: “Preceptorship made my learning not only about knowledge and skills, but also about the real-world experience of a pediatrician” (Participant 14). Nineteen percent indicated improved clinical reasoning and problem-solving, and 19% reported increased motivation (
Table 4).
Participants identified several advantages (
Supplement 4). The most common (23.8%) was a more comfortable discussion environment: “Discussions became more compact; juniors often hesitate to ask questions. Preceptorship made it easier for juniors to discuss” (Participant 21). Other reported strengths included intensive learning with constructive feedback (19.0%) and better linkage between theory and clinical practice (14.3%). Participants noted that “Preceptorship enabled direct guidance from experienced pediatric specialists and opportunities to learn from real cases and clinical approaches” (Participant 14).
The major constraint (71.4%) was limited time and irregular schedules for preceptorship sessions (Supplement 5). Participants commented: “Preceptors usually have busy schedules, so limited time can reduce mentorship quality, especially when teaching occurs only between clinical duties” (Participant 4) and “Time constraints and many activities make it difficult to find opportunities” (Participant 6). Two participants (9.5%) recommended a clearer teaching curriculum or structure for the program: “There is no clear material or curriculum stating what the preceptor should teach to trainees and what should be tested at the end” (Participant 1).
Discussion
1. Assessment of clinical reasoning with the SCT
This randomized trial evaluated the effect of increased preceptor presence on residents’ clinical reasoning across pediatric subspecialty topics. The main finding was a significant improvement in the hematology & oncology topic, with higher median SCT scores in the intervention group compared with the control group (14.28 vs. 12.75, p=0.037). This finding is consistent with previous resident-matched preceptor models that have demonstrated improvements in residents’ clinical reasoning [
7,
27].
One plausible explanation is that the hematology & oncology domain involves a relatively bounded set of competencies, with clinical reasoning often supported by objective laboratory results and well-defined diagnostic algorithms [
28]. Therefore, even small gains in residents’ clinical reasoning may have been sufficient to produce measurable improvement in SCT performance. Preceptorship may have been especially effective in helping residents interpret laboratory findings and link them to management decisions, even over a short period.
At the same time, this result should be interpreted cautiously, because similar improvements were not observed consistently across the other topics. This may suggest that the educational effect of preceptorship was more topic-specific rather than uniformly distributed. Furthermore, the aggregate scoring method used in SCTs may be susceptible to score inflation from guessing and should therefore be interpreted carefully [
29].
The SCT results did not show consistent benefits across topics, possibly because of suboptimal implementation of the preceptorship program. Implementation data showed that most preceptorship meetings were relatively short (61.9% of sessions lasted ≥30 minutes) and infrequent (28.6% of participants received ≥2 meetings per week). Time and frequency are important because intensive contact between preceptor and trainee underpins effective clinical learning. Short or infrequent teaching has been associated with poorer learning outcomes [
30].
Despite limited contact time, the mean cognitive apprenticeship questionnaire score was 51.6 out of 60 (SD=6.9), indicating good adherence to cognitive apprenticeship principles. Cognitive apprenticeship emphasizes progressive support, so learners gradually construct their own clinical reasoning [
31]. However, although the instructional framework was applied appropriately, limited session duration and frequency likely reduced opportunities to fully apply all cognitive-apprenticeship techniques.
The feedback questionnaire reported positive perception from most participants. The dominant theme was that learning became more structured and focused, consistent with evidence that active dialogue and guided coaching improve trainee understanding [
30]. Nearly one quarter of participants reported direct gains in knowledge, skills, and clinical experience obtained from working with preceptors, findings that align with previous reports of preceptorship improving clinical competence in health professions [
32]. About 19.0% of participants reported improved clinical reasoning and problem solving. Preceptorship also helped bridge theory and practice by exposing trainees to real cases under expert supervision [
31].
These positive participant perceptions are consistent with recent evidence on structured preceptorship and mentoring programs in clinical settings. Research on preceptor feedback indicates that preceptors employ a wide range of conceptual frameworks when responding to learners’ cases, which is associated with richer and more diverse feedback [
33]. In addition, studies of mentorship, preceptorship, and debriefing report improvements in perceived program quality, clinical skills, and learner confidence [
6]. Surveys of learners further show that trainees value engaged preceptors who explicitly discuss their clinical reasoning and provide timely, case-based feedback in environments with sufficient patient volume and case variety [
34].
The main barriers were limited time and irregular preceptor schedules: 71.4% of participants reported schedule-related constraints. This linear to prior studies showing that when preceptors cannot dedicate sufficient time (e.g., teaching only between routine duties), the quality of mentorship declines [
30]. Other issues included lack of a clear teaching curriculum and variable teaching skills among preceptors, which may produce uneven learning quality [
35,
36].
This randomized controlled trial successfully collect adequate sample. The SCT with aggregate scoring added objectivity to outcome measurement. However, several limitations exist. First, the suboptimal delivered intervention could affect the results. Second, prior rotation exposure varied between residents, so baseline domain exposure was not uniform and may have influenced topic-specific scores. Third, preceptor teaching quality was not measured before the intervention, limiting assessment of intervention fidelity. Fourth, blinding was not feasible, introducing potential performance bias. Fifth, despite ethical safeguards, the hierarchical relationship between preceptors and residents may have influenced residents’ willingness to provide open feedback. Sixth, inter-preceptor variability in mentoring style may have influenced outcomes; we did not formally assess consistency, which limits ability to separate program effects from individual preceptor effects. Seventh, no pre-intervention assessment of clinical reasoning was performed. Without baseline SCT data, post-intervention differences may reflect pre-existing variation rather than effects of the preceptorship.
Future studies should prioritize incorporating baseline and longitudinal assessments of clinical reasoning, including pre-intervention SCT measurements, to attribute observed effects to the preceptorship program. In addition, longer and more integrated preceptorship models should be implemented, accompanied by formal assessment of preceptor consistency and quality, as well as a clearly defined preceptorship syllabus. Expanding outcome measures to include OSCEs, focused qualitative interviews, and objective clinical performance metrics would further strengthen the robustness and interpretability of findings.
5. Conclusion
The preceptorship program resulted in a statistically significant improvement in clinical reasoning in only one subspecialty topic, suggesting a limited and domain-specific effect. This modest impact is likely attributable to suboptimal implementation of the intervention, particularly in terms of session frequency and duration. Despite the limited quantitative improvement, qualitative feedback indicated that residents perceived the preceptorship program positively and reported more structured and focused learning experiences. These findings suggest that short-term preceptorship is acceptable and valued by residents. More consistent and intensive implementation of preceptorship, along with complementary outcome measures, is likely required to demonstrate a meaningful and generalizable improvement in clinical reasoning performance.
Supplementary materials
Acknowledgements
The authors acknowledge the Director of Dr Soetomo General Academic Hospital for granting permission and providing the facilities necessary to carry out this study. We also thank the pediatric residents and staff of the Department of Child Health at Dr Soetomo General Academic Hospital for their participation and invaluable contributions to this research.
Funding
No external funding was received for this study.
Conflicts of interest
No potential conflict of interest relevant to this article was reported.
Author contributions
Conception or design of the work: RAS, APS, HEH, NMR. Data collection: RAS, APS, NMR. Data analysis and interpretation: RAS, APS, HEH, NMR. Drafting the article: RAS, APS. Critical revision of the article: HEH, NMR. Final approval of the version to be published: RAS, APS, HEH, NMR.
Fig. 1.Participant flow diagram.
Table 1.Baseline Characteristics of Study Participants
Table 1.
|
Characteristic |
Control group (n=20) |
Intervention group (n=21) |
p-valuea)
|
|
Education level |
|
|
1.000 |
|
Intermediate |
11 (26.8) |
10 (24.4) |
|
|
Junior |
9 (22.0) |
11 (26.8) |
|
|
Sex |
|
|
0.734 |
|
Male |
7 (17.1) |
5 (12.2) |
|
|
Female |
13 (31.7) |
16 (39.0) |
|
|
Age (yr) |
|
|
0.536 |
|
≥30 |
13 (31.7) |
10 (24.4) |
|
|
<30 |
7 (17.1) |
11 (26.8) |
|
Table 2.SCT Score Comparation between Groups
Table 2.
|
Topic |
Control group |
Intervention group |
p-valuea)
|
|
Respirology |
16.09 (15.50–17.18) |
16.38 (14.37–17.10) |
0.896 |
|
Allergy & immunology |
16.38 (14.77–17.60) |
16.50 (14.73–17.82) |
0.990 |
|
Hematology & oncology |
12.75 (11.49–13.63) |
14.28 (12.78–15.08) |
0.037*
|
|
Nephrology |
17.91 (16.29–18.98) |
16.02 (13.99–18.79) |
0.095 |
|
Endocrinology |
16.42 (15.53–17.96) |
16.92 (13.70–18.51) |
0.754 |
|
Gastroenterology |
18.09 (16.28–19.06) |
17.77 (16.16–18.90) |
0.705 |
|
Hepatology |
14.58 (11.97–16.47) |
14.58 (12.85–16.11) |
0.825 |
|
Tropical & infectious diseases |
11.75 (10.22–14.23) |
11.80 (9.95–15.52) |
0.620 |
|
Cardiology |
17.89 (14.59–19.11) |
18.23 (15.89–19.54) |
0.638 |
|
Nutrition & metabolism |
13.42 (10.95–14.69) |
11.87 (10.23–16.01) |
0.639 |
|
Neonatology |
12.93 (11.56–14.30) |
12.63 (9.95–15.83) |
0.696 |
|
Pediatric emergency & intensive care |
17.68 (15.81–19.64) |
18.54 (16.26–19.71) |
0.916 |
|
Neurology |
18.62 (16.19–19.49) |
17.93 (16.05–19.30) |
0.325 |
|
Growth & development |
11.35 (8.28–12.96) |
11.08 (8.32–14.15) |
1.000 |
Table 3.Characteristics of the Preceptorship Program
Table 3.
|
Variable |
Value |
|
Duration per session (min) |
|
|
≥30 |
13 (61.9) |
|
<30 |
8 (38.1) |
|
No. of sessions per week (times) |
|
|
≥2 |
6 (28.6) |
|
<2 |
15 (71.4) |
|
Cognitive apprenticeship questionnaire scorea)
|
51.6±6.9 |
Table 4.Perceived Impacts of the Preceptorship Program
Table 4.
|
Theme |
No. (%) |
|
Structured and directed learning |
5 (23.8) |
|
Acquisition of knowledge, skills, and experience |
5 (23.8) |
|
Improved clinical reasoning & problem solving |
4 (19.0) |
|
Increased motivation to learn |
4 (19.0) |
|
Receiving feedback |
1 (4.8) |
|
Not specific answer |
2 (9.5) |
|
Total |
21 (100.0) |
References
- 1. Schaye V, Eliasz KL, Janjigian M, Stern DT. Theory-guided teaching: Implementation of a clinical reasoning curriculum in residents. Med Teach. 2019;41(10):1192-1199. https://doi.org/10.1080/0142159X.2019.1626977
- 2. Graber ML, Franklin N, Gordon R. Diagnostic error in internal medicine. Arch Intern Med. 2005;165(13):1493-1499. https://doi.org/10.1001/archinte.165.13.1493
- 3. Lambe KA, O'Reilly G, Kelly BD, Curristan S. Dual-process cognitive interventions to enhance diagnostic reasoning: a systematic review. BMJ Qual Saf. 2016;25(10):808-820. https://doi.org/10.1136/bmjqs-2015-004417
- 4. Lubarsky S, Dory V, Audétat MC, Custers E, Charlin B. Using script theory to cultivate illness script formation and clinical reasoning in health professions education. Can Med Educ J. 2015;6(2):e61-e70. https://doi.org/10.36834/cmej.36631
- 5. Iyer S, Goss E, Browder C, Paccione G, Arnsten J. Development and evaluation of a clinical reasoning curriculum as part of an Internal Medicine Residency Program. Diagnosis (Berl). 2019;6(2):115-119. https://doi.org/10.1515/dx-2018-0093
- 6. Van Patten RR, Bartone AS. The impact of mentorship, preceptors, and debriefing on the quality of program experiences. Nurse Educ Pract. 2019;35:63-68. https://doi.org/10.1016/j.nepr.2019.01.007
- 7. Sobel HG, Swigris R, Chacko KM, et al. Resident and preceptor perceptions of preceptor integration into resident clinic scheduling templates. J Grad Med Educ. 2017;9(4):497-502. https://doi.org/10.4300/JGME-D-16-00609.1
- 8. Merbaum A, Kulasegaram K, Stoller R, Fernando O, Freeman R. The system, the resident, and the preceptor: a curricular approach to continuity of care training. Perspect Med Educ. 2022;11(5):295-299. https://doi.org/10.1007/s40037-021-00671-y
- 9. Audétat MC, Laurin S, Dory V, Charlin B, Nendaz MR. Diagnosis and management of clinical reasoning difficulties: Part I. Clinical reasoning supervision and educational diagnosis. Med Teach. 2017;39(8):792-796. https://doi.org/10.1080/0142159X.2017.1331033
- 10. Grunewald ST, Lucchetti AL, Grunewald T, et al. One-minute preceptor, SNAPPS, and traditional teaching in the acquisition of clinical reasoning skills by medical students. Med Sci Educ. 2024;35(2):823-835. https://doi.org/10.1007/s40670-024-02241-3
- 11. Kün-Darbois JD, Annweiler C, Lerolle N, Lebdai S. Script Concordance Test acceptability and utility for assessing medical students’ clinical reasoning: a user’s survey and an institutional prospective evaluation of students’ scores. BMC Med Educ. 2022;22(1):277. https://doi.org/10.1186/s12909-022-03339-1
- 12. Kojich L, Miller SA, Axman K, Eacret T, Koontz JA, Smith C. Evaluating clinical reasoning in first year DPT students using a script Concordance Test. BMC Med Educ. 2024;24(1):329. https://doi.org/10.1186/s12909-024-05281-w
- 13. Newsom LC, Augustine J, Momary K. Development of a Script Concordance Test to assess clinical reasoning in a pharmacy curriculum. Curr Pharm Teach Learn. 2022;14(9):1135-1142. https://doi.org/10.1016/j.cptl.2022.07.028
- 14. Ganesan S, Bhandary S, Thulasingam M, et al. Developing Script Concordance Test items in otolaryngology to improve clinical reasoning skills: validation using consensus analysis and psychometrics. Int J Appl Basic Med Res. 2023;13(2):64-69. https://doi.org/10.4103/ijabmr.ijabmr_604_22
- 15. Omega A, Wijaya Ramlan AA, Soenarto RF, Heriwardito A, Sugiarto A. Assessing clinical reasoning in airway related cases among anesthesiology fellow residents using Script Concordance Test (SCT). Med Educ Online. 2022;27(1):2135421. https://doi.org/10.1080/10872981.2022.2135421
- 16. Dahlan M. Sample size and sampling method. Jakarta, Indonesia: Salemba Medika; 2010.
- 17. Lubarsky S, Chalk C, Kazitani D, Gagnon R, Charlin B. The Script Concordance Test: a new tool assessing clinical judgement in neurology. Can J Neurol Sci. 2009;36(3):326-331. https://doi.org/10.1017/s031716710000706x
- 18. Collins A, Brown JS, Newman SE. Cognitive apprenticeship: teaching the crafts of reading, writing, and mathematics. In: Resnick LB, ed. Knowing, Learning, and Instruction: Essays in Honor of Robert Glaser. Hillsdale, USA: Lawrence Erlbaum Associates; 1989: 453-494.
- 19. Stalmeijer RE, Dolmans DH, Wolfhagen IH, Scherpbier AJ. Cognitive apprenticeship in clinical practice: can it stimulate learning in the opinion of students? Adv Health Sci Educ Theory Pract. 2009;14(4):535-546. https://doi.org/10.1007/s10459-008-9136-0
- 20. Patel R. General practice trainees’ learning experiences of formative think-aloud script concordance testing. Educ Prim Care. 2022;33(4):229-236. https://doi.org/10.1080/14739879.2022.2057240
- 21. Prihatanto FS. Script Concordance Test for assessing physicians’ clinical reasoning: how to develop test items based on the Indonesian doctors’ competency standards? Indones J Med Educ. 2012;1(3):159-167. https://doi.org/10.22146/jpki.25100
- 22. Staffini A, Fujita K, Svensson AK, Chung UI, Svensson T. Statistical methods for item reduction in a representative lifestyle questionnaire: pilot questionnaire study. Interact J Med Res. 2022;11(1):e28692. https://doi.org/10.2196/28692
- 23. Nazim SM, Talati JJ, Pinjani S, Biyabani SR, Ather MH, Norcini JJ. Assessing clinical reasoning skills using Script Concordance Test (SCT) and extended matching questions (EMQs): a pilot for urology trainees. J Adv Med Educ Prof. 2019;7(1):7-13. https://doi.org/10.30476/JAMP.2019.41038
- 24. Subra J, Chicoulaa B, Stillmunkès A, Mesthé P, Oustric S, Rougé Bugat ME. Reliability and validity of the Script Concordance Test for postgraduate students of general practice. Eur J Gen Pract. 2017;23(1):208-213. https://doi.org/10.1080/13814788.2017.1358709
- 25. Iravani K, Amini M, Doostkam A, Dehbozorgian M. The validity and reliability of Script Concordance Test in otolaryngology residency training. J Adv Med Educ Prof. 2016;4(2):93-96.
- 26. Wan SH. Using the Script Concordance Test to assess clinical reasoning skills in undergraduate and postgraduate medicine. Hong Kong Med J. 2015;21(5):455-461. https://doi.org/10.12809/hkmj154572
- 27. Jagannath AD, Dreicer JJ, Penner JC, Dhaliwal G. The cognitive apprenticeship: advancing reasoning education by thinking aloud. Diagnosis (Berl). 2022;10(1):9-12. https://doi.org/10.1515/dx-2022-0043
- 28. Indonesian College of Pediatrics. National Standards for Pediatric Specialist Education. Jakarta, Indonesia: Indonesian Pediatric Society; 2018
- 29. Lineberry M, Kreiter CD, Bordage G. Threats to validity in the use and interpretation of Script Concordance Test scores. Med Educ. 2013;47(12):1175-1183. https://doi.org/10.1111/medu.12283
- 30. McSharry E, Lathlean J. Clinical teaching and learning within a preceptorship model in an acute care hospital in Ireland; a qualitative study. Nurse Educ Today. 2017;51:73-80. https://doi.org/10.1016/j.nedt.2017.01.007
- 31. Merritt C, Daniel M, Munzer BW, Nocera M, Ross JC, Santen SA. A cognitive apprenticeship-based faculty development intervention for emergency medicine educators. West J Emerg Med. 2018;19(1):198-204. https://doi.org/10.5811/westjem.2017.11.36429
- 32. Qodir A, Christiana A. Effectiveness of the preceptorship method in nursing students. J Ilm Kesehat Media Husada. 2018;7(2):83-88. https://doi.org/10.33475/jikmh.v8i1.191
- 33. Côté L, Bordage G. Content and conceptual frameworks of preceptor feedback related to residents’ educational needs. Acad Med. 2012;87(9):1274-1281. https://doi.org/10.1097/ACM.0b013e3182623073
- 34. Schultz KW, Kirby J, Delva D, et al. Medical Students’ and residents’ preferred site characteristics and preceptor behaviours for learning in the ambulatory setting: a cross-sectional survey. BMC Med Educ. 2004;4:12. https://doi.org/10.1186/1472-6920-4-12
- 35. Nash DD, Flowers M. Key elements to developing a preceptor program. J Contin Educ Nurs. 2017;48(11):508-511. https://doi.org/10.3928/00220124-20171017-08
- 36. Weber RA. The Perfect Preceptor. J Craniofac Surg. 2015;26(8):2257-2260. https://doi.org/10.1097/SCS.0000000000002211
