Feasibility of Script Concordance Test Development: A Qualitative Study of Medical Educators’ Experiences

Script Concordance Tests (SCTs) assess clinical reasoning under uncertainty. While construction guidelines exist, the feasibility of collaborative development approaches and educators’ real-time experiences remain underreported. This feasibility study explores how medical educators construct SCTs collaboratively and their perceptions of the process. Four UK-based medical educators developed SCTs for prescribing in older adults during a three-hour workshop involving observation with a think-aloud approach, followed by a post-workshop focus group. Data were analysed using Braun and Clarke’s thematic analysis, Tuckman’s group development informed observation analysis, and an inductive approach for the focus group. Educators created seven vignettes (30 items) in 127 min, averaging 18 min per vignette. Observation revealed small-team role specification (lead, scribe, challenger) and three themes: content development, quality checks, and team dynamics. The team progressed rapidly through Tuckman’s stages, spending most of the time in the performing stage. Focus group analysis revealed four themes: design features, perceived utility, group dynamics and best-practice recommendations. This study demonstrates the feasibility of collaborative SCT development through structured teamwork. Educators perceived SCTs as practical, as valuing effective team dynamics and clear role distribution. Findings can provide practical insights for institutions implementing SCT development, emphasising practice sessions and appropriately sized collaborative teams.