Thirty years of illness scripts: Theoretical origins and practical applications

Abstract

Aim: This study describes the introduction and spread of the concept of ''illness script'' in the medical education literature. Method: First, I will concisely discuss the development of the ''script'' concept in the general psychological literature and the results of the studies performed to provide it with the necessary empirical basis. Next, I will sketch how ''scripts'' entered the medical domain via efforts to develop diagnostic systems in the field of artificial intelligence. Subsequently, I will describe how the illness script concept was elaborated and specified by medical educators and educational researchers. Results and discussion: The illness script concept has solid underpinnings and can be used to elucidate aspects of medical expertise development. It can also be used to formulate recommendations for clinical teaching and has yielded a specific test, the Script Concordance Test.

Addressing the development of both knowledge and clinical reasoning in nursing through the perspective of script concordance: An integrative literature review

“…[9][10][11] For its part, the concept of illness scripts first appeared in the medical literature during the 80's. This concept describes the structure of professional knowledge and its link to the wealth and quality of the professional knowledge that one develops and organizes over time.…”

“…These scripts are generated by an automatic, iterative, and relatively unconscious thought process [13] where experts systematically assess causal and event-related characteristics, as well as the future consequences of a health problem. [9,14] In other words, experts reason by having a hypothesis in mind, and all the subsequent data obtained is interpreted in order to nuance, reject or reinforce the formulated hypothesis. [15] What experts seek to uncover is whether the current situation bears the same characteristics than that of its usual representation, as mapped by their scripts.…”

“…[15] What experts seek to uncover is whether the current situation bears the same characteristics than that of its usual representation, as mapped by their scripts. [9,16] It is important to clarify that experts also develop back-up potential hypotheses and that the recursive exercise of clinical reasoning leads to the confrontation and hierarchizing of these hypotheses. [16,17] Their reasoning also relies on a situational awareness of the key elements of a health problem.…”

“…This validity corroborates the theoretical foundations of the measuring instrument and can be explained by the professional experience of experts, who are continuously refining their mental scripts over the years and through their practice. [9][10][11] However, choosing experts for the reference panel can sometimes raise problems and expose difficulties inherent to creating a standardised and certified assessment. [26,31,33] Moreover, studies where the psychometric properties were more or less significant contained some methodological limitations, including an insufficient number of clinical scenarios on the test, writing which needed to be fine-tuned, and an inadequate period of time allotted to complete the test.…”

Understanding Clinical Reasoning from Multiple Perspectives: A Conceptual and Theoretical Overview

“…Scripts are activated as integral wholes in appropriate contexts that should contain relevant variables, including clinical findings in the patient. "Slots" in the reasoning process can be filled with information present in the actual situation, retrieved from memory, or inferred from the context (Custers 2015). Illness scripts, first introduced by Barrows and Feltovich, are believed to be chunks in long-term memory that contain three components, enabling conditions (past history and causes), fault (pathophysiology), and consequences (signs and symptoms) (Feltovics and Barrows 1984), and are elaborated further by Schmidt and Boshuizen (1993).…”