# FonoTCS: validation of a tool for assessing clinical reasoning in Speech-Language pathology

## TL;DR

This study validates a new tool called FonoTCS to assess clinical reasoning in speech-language pathology students and professionals who speak Brazilian Portuguese.

## Contribution

The paper introduces and validates FonoTCS, a virtual, open-access clinical reasoning assessment tool tailored for Brazilian Portuguese speakers in speech-language pathology.

## Key findings

- FonoTCS achieved high internal consistency with a Cronbach's Alpha of 0.903.
- The final version of FonoTCS includes 88 items across 28 clinical cases.
- The tool is valid and reliable for assessing clinical reasoning in generalist speech-language pathology students and professionals.

## Abstract

To validate the internal structure of the Speech-Language Pathology Script Concordance Test (FonoTCS), which will be developed in a virtual, open-access format, to be used in the assessment of clinical reasoning among young professionals and students of speech-language pathology with a generalist background, speakers of Brazilian Portuguese.

This is a study to validate the internal structure of the instrument. Twenty-five specialist speech-language pathologists, with more than 10 years of generalist clinical experience, and 35 students summoned for Enade participated. Both groups evaluated the 30 clinical cases with 120 items from FonoTCS. For the final selection of specialists who made up the sample, judges whose evaluations showed Z2 results >2 and Z<-2 distant from the modal response were removed. For the selection of items present in the final format of the test, those that remained had a Pearson correlation between the transformed scores of students for a given item and the sum of the transformed scores for all items, with a value greater than 0.05. The Cronbach's Alpha test was applied to measure the internal consistency of FonoTCS, and the score of each item was defined based on the aggregated score method.

The responses of 13 specialists were considered for the definition of the final test score. The final instrument had 88 items distributed across 28 clinical cases. The internal consistency was 0.903 with a 95% confidence interval expressed by 0.86|---|0.95. These values indicate a high internal consistency among the items of FonoTCS.

FonoTCS is valid and reliable for use in evaluating the clinical reasoning of young professionals and speech-language pathology students with generalist training, who are Brazilian Portuguese speakers.

Validar a estrutura interna do Teste de Concordância de Scripts em Fonoaudiologia (FonoTCS) que será desenvolvido em formato virtual com acesso livre, para ser utilizado na avaliação do raciocínio clínico de jovens profissionais e estudantes de fonoaudiologia com formação generalista, falantes do português brasileiro.

Trata-se de estudo de validação de estrutura interna de instrumento. Participaram 25 fonoaudiólogos especialistas, com mais de 10 anos de experiência clínica generalista e 35 estudantes convocados para o Enade. Ambos os grupos avaliaram os 30 casos clínicos com 120 itens do FonoTCS. Para a seleção final dos especialistas que compuseram a amostra, foram retirados os juízes cujas avaliações apresentavam resultados de Z2 >2 e Z<-2 distantes da resposta modal. Para a seleção dos itens presentes no formato final do teste, permaneceram aqueles que, na correlação de Pearson entre as notas transformadas dos estudantes para um determinado Item, com a soma das notas transformadas para todos os Itens, obtiveram valor superior a 0,05. O teste Alfa de Cronbach foi aplicado para medir a consistência interna do FonoTCS e a pontuação de cada item foi definida a partir do método de escore agregado.

As respostas de 13 fonoaudiólogos foram consideradas para definição da pontuação final do teste. O instrumento final apresentou 88 itens distribuídos em 28 casos clínicos. A consistência interna foi igual a 0,903 com intervalo de confiança de 95% expresso por 0,86|---|0,95. Estes valores indicam uma alta consistência interna entre os itens do FonoTCS.

O FonoTCS é válido e confiável para ser utilizado na avaliação do raciocínio clínico de jovens profissionais e estudantes de fonoaudiologia com formação generalista, falantes do português brasileiro.