General practice trainees' learning experiences of formative think-aloud script concordance testing

General practitioners (GPs) make timely and accurate clinical decisions, often in the contexts of complexity and uncertainty. However, structured approaches to facilitate development of these complex decision-making skills remain largely unexplored. Here, the educational use of formative script concordance testing (SCT), a written assessment format originally designed to test clinical reasoning, is evaluated in this context through an in-depth qualitative exploration of the learning experiences of participating GP trainees. A 'think-aloud' approach to SCT is used, which requires question responses to be justified with a short clinical rationale. Eleven 1st-year GP trainees in Oxford (United Kingdom) completed the formative SCT activity, before taking part in individual semi-structured interviews. Data exploring their learning experiences was transcribed and analysed using reflexive thematic analysis. Thirty-seven codes were generated, and schematically organised into six sub-themes, that provide a descriptive summary of the data and insights into the practical educational utility of the SCT format. Three overarching themes were subsequently produced that relate specifically to aim of exploring in-depth the learning experiences of GP trainees to formative think-aloud SCT: 1) developing complex decision-making skills; 2) opportunity for self-evaluation and awareness; and 3) promoting community and professional identity. The development of complex clinical decision-making and reasoning skills is proposed to occur through guided reflection on performance, facilitated by the think-aloud approach to questioning. Together, this suggests a potential role for think-aloud SCT as a distinctive, structured learning activity to complement trainees' professional development.