Understanding Context-Dependent Assessment
This format presents the SAME 8 treatment options across 3 different patient scenarios.
However, the correct answers change dramatically based on patient context (age, health status,
preferences, prognosis). This assesses nuanced, context-aware clinical reasoning rather than
simple memorization. Students who select the same options for all scenarios demonstrate
context-blindness and receive a penalty.
1
Scenario 1: Young, Healthy, Aggressive Cancer
Age: 45 years old
Cancer Type: Early-stage localized aggressive lymphoma
Overall Health: Excellent (no comorbidities)
Performance Status: ECOG 0 (fully active)
Family Support: Strong (married, two children)
Patient Preference: "I want to beat this. Do whatever it takes."
Prognosis: 70-80% cure rate with aggressive treatment
Which treatment approaches are APPROPRIATE to discuss with this patient? (Select ALL that apply)
2
Scenario 2: Elderly, Multiple Comorbidities
Age: 82 years old
Cancer Type: Same type as Scenario 1 (aggressive lymphoma)
Overall Health: Poor (severe heart failure, dementia, diabetes)
Performance Status: ECOG 3 (capable of limited self-care only)
Life Expectancy: 6-12 months even without cancer
Advance Directive: Clearly states "No aggressive treatment, comfort care only"
Family Agreement: Supportive of comfort-focused care
Which treatment approaches are APPROPRIATE to discuss with this patient? (Select ALL that apply)
3
Scenario 3: Moderate Case, Uncertain Prognosis
Age: 60 years old
Cancer Type: Intermediate-stage, moderate aggressiveness
Overall Health: Fair (controlled hypertension, mild kidney disease)
Performance Status: ECOG 1 (some limitations but mostly active)
Prognosis: Uncertain - 40-60% cure rate with treatment
Patient Question: "What would you do if this was your family member, doctor?"
Context: Patient wants full information about all reasonable options
Which treatment approaches are APPROPRIATE to discuss with this patient? (Select ALL that apply)
Scoring: Context-Awareness is Key
Component 1: Per-Scenario Accuracy (75%)
Scenario 1: (Correct selections / 3) × 25%
Scenario 2: (Correct selections / 3) × 25%
Scenario 3: (Correct selections / 6) × 25%
Example: If you get all 3 scenarios 100% correct = 75%
Scenario 2: (Correct selections / 3) × 25%
Scenario 3: (Correct selections / 6) × 25%
Example: If you get all 3 scenarios 100% correct = 75%
Component 2: Cross-Scenario Awareness Bonus (25%)
+10% if you select DIFFERENT options for Scenarios 1 vs 2 (shows context awareness)
+10% if you select MORE options for Scenario 3 than 1 or 2 (uncertainty management)
+5% if you avoid selecting palliative/hospice for Scenario 1 (appropriate exclusion)
Maximum Bonus: 25%
+10% if you select MORE options for Scenario 3 than 1 or 2 (uncertainty management)
+5% if you avoid selecting palliative/hospice for Scenario 1 (appropriate exclusion)
Maximum Bonus: 25%
Penalty: Context-Blindness (-15%)
-15% if you select the SAME options for all 3 scenarios
This indicates failure to adapt reasoning to different contexts - a critical clinical reasoning flaw
This indicates failure to adapt reasoning to different contexts - a critical clinical reasoning flaw
SAMPLE STUDENT SCORES
Student A (Context-Aware): S1=3/3, S2=3/3, S3=6/6 + All bonuses = 100%
Student B (Partial Context): S1=2/3, S2=3/3, S3=4/6 + Some bonuses = 78%
Student C (Context-Blind): Selected B,D,G for all scenarios - Penalty = 35%
Why Context-Dependent SATA Works
- Nuanced Reasoning: Assesses ability to adapt knowledge to different contexts
- Prevents Memorization: Same options, different answers - can't just memorize
- Clinical Realism: Mirrors real medical decision-making (context determines appropriateness)
- Ethical Assessment: Tests patient-centered care and autonomy respect
- Diagnostic Value: Reveals if student has rigid vs. flexible thinking
- Efficiency: Assesses 3 scenarios with 1 option pool (reusable infrastructure)
- Professional Judgment: Reflects real-world complexity (no one-size-fits-all solutions)
Answer Key Summary
Scenario 1: B, D, G (curative focus)
Scenario 2: C, F, H (comfort focus)
Scenario 3: A, B, D, E, F, G (wide range)
Key Insight: Notice how options B and D appear in Scenarios 1 and 3 but NOT Scenario 2,
while options C and H appear ONLY in Scenario 2. This demonstrates true context-dependency.