Learning-by-Concordance Approach in Health Professions Education: A Scoping Review

Abstract

Introduction: Learning by concordance (LbC) is an educational approach designed to develop expertise, particularly in the field of clinical reasoning (CR) among healthcare professionals. It is based on the script concordance test (SCT) with the addition of feedback based on expert responses. The objective of this study was to map the scientific literature on this rapidly growing learning approach.

Methods: A scoping review was conducted following the Arksey and O'Malley framework and the PRISMA-ScR guidelines. A systematic search was conducted in MEDLINE, Embase, CINAHL, Web of Science and Google Scholar up to March 10, 2025. Eligible primary studies had to focus on the LbC approach targeting healthcare learners.

Results: Twenty-eight studies met the inclusion criteria: twenty focused on the implementation of the LbC approach and eight on its development. Most of the studies used mixed methods (quantitative and qualitative). The results mainly indicate that learners perceive the LbC approach as engaging and beneficial for decision-making. The articles mention five elements related to the development of LbC that would contribute to its success.

Discussion: The LbC approach could be applicable to a wide range of disciplines and learning levels. The variability in the procedures for developing the approach, as well as the variability of the objectives and methodologies of the studies, limit the comparability of the results.

Conclusion: LbC is a promising approach for promoting decision-making skills in a variety of uncertain clinical contexts. The concept of standardized development and evaluation frameworks for this approach could improve its applicability, effectiveness and reproducibility.