The main observation of the current study is that SCT/TBL approach can be appropriate for teaching and on training site assessment of the clinical practice. TBL and SCT showed a mutual beneficial relationship, in which, each method helped the students to benefit from the other’s advantages and added new advantages. The SCT equipped the approach with a valid and authentic way for assessing and teaching clinical reasoning in uncertainty. Endorsing the TBL approach gives the SCT an interactive nature and fosters active learning, student engagement, teamwork, and collaborative learning.
In the current study, a significance difference existed between the students and experts whole test scores and most of vignettes. This is because the SCT can differentiate between the different level of experience. However, when the test was solved in teams, 9 out of 17 vignettes scores showed non-significant differences when compared to experts. This points to an improvement in students’ scores, despite being non-significant, when they work in teams. Thus, the use of this approach as a teaching tool may help in narrowing the gap between the clinical reasoning of the students and experts. However, this insignificance can be explained as the students were experiencing the SCT for the first time and they were still not familiar with it.
The TBL/SCT allows each student to expose to a real life uncertain clinical case, evaluate the hypothesis, select one hypothesis, discuss this hypothesis, modify the wrong concepts, and reinforce the correct one. These steps are encouraged by the instructor’s discussion that address any misconceptions, answer student questions, and provide immediate, corrective feedback. Moreover, the group SCT provides the opportunity for peer teaching [18]. In which, students can listen to their peers’ line of reasoning, hypotheses, and explanation. All these steps will help the students to develop their own script that in turn will guide them to use the expert line of reasoning and foster the pattern recognition. As indicated by the students that group discussion helped them to correct their mistakes and they found the group discussion as a useful learning activity. Hence, the TBL/SCT approach helped in individualization of learning despite the group size. As it can be considered as an appropriate clinical reasoning approach for large groups teaching.
Our results found significance differences between the scores of the lower achievers and the teams scores. This indicates that the SCT/TBL helped the lower achievers to get more involved in the learning process and improve their clinical reasoning skills.
All the interactions that results from the TBL approach , provide the SCT with the interactive and the dynamic context that is needed to teach clinical reasoning [19]. The SCT/TBL approach builds up a clinical reasoning that respect the environment and interactions with peers and instructor. As suggested by Torre et al., [20] any clinical reasoning teaching and assessment approach advocate for the raise awareness among educators, enhance their understanding and promote the implementation of a more social cognitive aspects. The TBL/SCT exposed the student capacity to evaluate hypotheses and judge the situation according to the new information [21].
According to the students’ opinions in our study, the approach helped them to solve patients’ clinical problems, thinking critically and develop clinical judgment skills. These skills may explain a relatively good relation between SCT and TBL. It may be because these students doubly benefitted from the merge between the advantages of both the SCT and TBL. The SCT can assess the knowledge organization and focus on the process rather than outcome [7] and the TBL enhances effective active learning approaches especially among low academic performers [14].
Additionally, combining SCT and TBL can prepare the students for future life and improve the future practice. It was found that physician’s tolerance of uncertainty influences her or his clinical practice and those are more likely to order excessive diagnostic testing and additional empiric treatment [22].
Moreover, adopting the TBL approach may foster active learning and student engagement [23]. This was confirmed by the findings of our study in which students reported that they were attentive during the session. Also, students preferred to have the ISCT before starting the group discussion as it may connect them to the team assignment/application [24]. Moreover, the TBL/SCT approach energizes each student to examine his/her knowledge then explore the different opinions through the tSCT. Finally, the instructor provides the knowledge in an active student-centred approach away from didactic teaching.
The TBL/SCT approach can also foster teamwork and collaborative learning. As reported previously that TBL that can enhance problem-solving skills, ensure that students build collaborative, teamwork skills and achievement during the group sessions [12,15]. This point was approved by our students eho confirmed that TBL/SCT approach is an effective way to practice what they have learnt.
The currents study declared that students prefer SCT as a teaching method but not as a summative assessment tool and this is in congruence with the study assumption. This can be attributed to the nature of the test that may be challenging but at the same time confusing as it is a first-time experience for undergraduate students. The Likert scale may be sophisticated for their level and it may be better to use three-anchor scale for undergraduate student. Fournier [6] mentioned that if SCT is used as a learning stimulus, it appears that using three-anchor scale is more effective for induction of relevant discussion. Another possible explanation is the students training and familiarity with the test format. This point met agreement with Roberti et al. [25] who suggested that the SCT difficulties in construction of the test and scoring key might make its application unfeasible in units with limited resources [25,26]. Also, Lineberry et al. 2019 [26] reported that SCT can be used as a guide for assessment for learning.
Although the research design of our study does not lack rigor, the study has some limitations. One notable limitation is the study sample may affect the findings. Another limitation is the training of students and unfamiliarity of the students and panel with the SCT format that may affected their responses. However, the current study was a prospective study introducing a new approach for assessing clinical reasoning among undergraduate students.