Script Concordance Test
Reasoning under uncertainty
SCT captures how experienced clinicians actually think — by measuring how a new piece of information shifts a working hypothesis. Your responses are compared with an expert panel.
A situation
A short clinical vignette establishing genuine uncertainty.
A hypothesis
“If you were thinking of …” — a plausible diagnosis or action.
New information
“… and then you find …” — decide how it shifts the hypothesis (−2 to +2).
Each item gives a clinical situation, a diagnostic or management hypothesis, and one new finding. Decide how that new finding changes the hypothesis. There is no single "right" answer — your score reflects agreement with an expert panel.
Clinical vignette
A 50-year-old man with 3 months of polyuria and 4 kg weight loss attends the clinic.
If you were thinking of…
you are thinking the diagnosis is Type 2 Diabetes Mellitus
…and then you find
you find his fasting plasma glucose is 148 mg/dL
Effect on hypothesis
This new information on the hypothesis (Type 2 DM) has the effect:
Clinical vignette
The same 50-year-old man is being assessed for the cause of his diabetes.
If you were thinking of…
you are thinking this is Type 1 (not Type 2) Diabetes
…and then you find
you find he is obese with a strong family history and no ketonuria
Effect on hypothesis
This new information on the hypothesis (Type 1 DM) has the effect:
Clinical vignette
A diabetic patient on metformin has an HbA1c of 9.2% after 6 months.
If you were thinking of…
you are thinking of intensifying therapy by adding a second agent
…and then you find
you learn he has been skipping doses and rarely follows dietary advice
Effect on hypothesis
This new information on the hypothesis (add a second drug now) has the effect:
Clinical vignette
A 48-year-old newly diagnosed diabetic has no symptoms other than incidental hyperglycaemia.
If you were thinking of…
you are thinking he already has diabetic retinopathy
…and then you find
you find a normal dilated fundus examination
Effect on hypothesis
This new information on the hypothesis (established retinopathy at diagnosis) has the effect:
Illustrative expert-panel scoring