CONTEXT AND OBJECTIVE: Routine use of the script concordance test (SCT) is not common in Brazilian universities. This study aimed to analyze application of the SCT in the medical school of a Brazilian university. DESIGN AND SETTING: Quantitative, analytical and descriptive study in the medical school of a Brazilian university. METHODS: A total of 159/550 students participated. The test comprised ten clinical cases within internal medicine, with five items per case, rated on a five-point Likert scale. The test was scored in accordance with a marking key that had been validated by a reference panel. RESULTS:In the pre-clinical and clinical phases, the mean scores were 51.6% and 63.4% of the maximum possible scores, respectively. Comparison of the means of the responses among all the years showed that there were significant differences in 40% of the items. The panel marked all the possible answers in five items, while in one item, all the panelists marked a single answer. Cronbach's alpha was 0.64. The results indicated that the more senior students performed better. Construction of an SCT with discriminative questions was not easy. The low reliability index may have occurred due to: a) problems with the construction of the questions; b) limitations of the reference panel; and/or c) the scoring key. CONCLUSION:This instrument is very difficult to construct, apply and correct. These difficulties may make application of an SCT as an assessment method unfeasible in units with limited resources. RESUMO

CONTEXT AND OBJECTIVE: The cognitive processes relating to the development of clinical reasoning are only partially understood, which explains the difficulties in teaching this skill in medical courses. This study aimed to understand how clinical reasoning develops among undergraduate medical students. DESIGN AND SETTING: Quantitative and qualitative exploratory descriptive study conducted at the medical school of Universidade Federal de Goiás. METHODS:The focus group technique was used among 40 students who participated in five focus groups, with eight students from each year, from the first to fifth year of the medical school program. The material was subjected to content analysis in categories, and was subsequently quantified and subjected to descriptive statistical analysis and chi-square test for inferential statistics. RESULTS:The content of the students' statements was divided into two categories: clinical reasoningin the preclinical phase, clinical reasoning was based on knowledge of basic medical science and in the clinical phase, there was a change to pattern recognition; knowledge of basic medical science -80.6% of the students recognized its use, but they stated that they only used it in difficult cases. CONCLUSION: In the preclinical phase, in a medical school with a traditional curriculum, clinical reasoning depends on the knowledge acquired from basic medical science, while in the clinical phase, it becomes based on pattern recognition. RESUMO CONTEXTO E OBJETIVO:Tem-se compreensão parcial dos processos cognitivos relacionados ao desenvolvimento do raciocínio clínico, o que justifica as dificuldades no ensino dessa competência nos cursos de medicina. Este estudo tem como objetivo compreender como se desenvolve o raciocínio clínico em acadêmicos de medicina. TIPO DE ESTUDO E LOCAL: Pesquisa descritiva exploratória quantitativa e qualitativa, realizada na Faculdade de Medicina da Universidade Federal de Goiás. MÉTODOS: A técnica de grupos focais foi utilizada entre 40 acadêmicos, que participaram de cinco grupos focais, com oito acadêmicos de cada ano, do primeiro ao quinto ano do curso médico. O material foi submetido a análise de conteúdo por categorias, posteriormente quantificado e submetido a análise estatística descritiva e teste de qui-quadrado para estatística inferencial. RESULTADOS: O conteúdo das falas dos participantes foi dividido em duas categorias: raciocínio clínico -na fase pré-clínica, o raciocínio clínico é baseado no conhecimento das disciplinas básicas e, na fase clínica, há uma mudança para o reconhecimento de padrões; conhecimento das disciplinas básicas -80,6% percebem sua utilização, porém assinalam que o usam apenas em casos difíceis. CONCLUSÃO: Na fase pré-clínica, em uma escola médica com currículo tradicional, o raciocínio clínico é dependente dos conhecimentos adquiridos nas disciplinas básicas e, na fase clínica, passa para o reconhecimento de padrões.