Clinical reasoning is a core competency in the cultivation of competent medical professionals, requiring practitioners to integrate professional knowledge, clinical experience, and individual patient variability to make sound judgments and therapeutic decisions under conditions of incomplete information, uncertain evidence, and multiple treatment options. Traditional assessment modalities—including written examinations, case analyses, and the objective structured clinical examination (OSCE)—can effectively evaluate learners′ theoretical knowledge and fundamental clinical skills, yet they have limited capacity to capture the dynamic reasoning processes deployed in complex clinical scenarios. The script concordance test (SCT) offers a novel approach to address this gap. Grounded in script theory, the SCT presents typical clinical situations with inherent uncertainty, examining learners′ abilities to interpret new information and their adjustments in diagnostic hypotheses, test selection, and treatment decisions. Responses are scored by comparison with a reference panel of experts using a weighted scoring system, thereby assessing the degree of concordance between the learner′s clinical reasoning and expert patterns. The SCT authentically mirrors real-world clinical decision-making logic, is applicable across various specialties and training stages, and demonstrates particular strength in formative assessment by facilitating early identification of learners′ thinking patterns and potential deficiencies in information analysis, hypothesis revision, and risk-benefit balancing. At present, the application of SCT in Chinese clinical medical education remains in its preliminary stages. Future efforts should focus on developing standardized SCT item banks and feedback mechanisms tailored to the domestic educational context, and incorporating artificial intelligence-assisted technologies to enhance instructional feedback, thereby improving the effectiveness of clinical reasoning training and the overall quality of medical education.

Objective To investigate DNA methylation markers in the whole blood of patients with systemic lupus erythematosus(SLE),in hope to facilitate the evaluation of SLE severity.Methods Whole blood samples were obtained from 58 patients with SLE(including 14 cases of severe SLE,25 moderate SLE,19 inactive SLE)and 50 healthy controls.Bisulphite sequencing was performed to determine the methylation status of interleukin-2 common receptor gamma chain(IL-2RG)promoter region,and real-time reverse transcriptionPCR to quantify the expression level of IL-2RG mRNA,in these subjects.Results The methylation level of IL2RG promoter region was 0.217 ± 0.140,0.325 ± 0.230,0.342 ± 0.085 and 0.175 ± 0.036 in the patients withsevere,moderate and inactive SLE and healthy controls,respectively.A significant increase was observed in the methylation level of IL-2RG promoter region in the patients with inactive SLE compared with the patients with severe SLE and healthy controls(both P ＜ 0.01),and in the patients with SLE compared with the healthy controls(0.263 ± 0.047 vs.0.175 ± 0.036,P ＜ 0.05).The expression level of IL-2RG mRNA was significantly lower in the patients with SLE than in the healthy controls(2.550 ± 0.823 vs.4.293 ± 1.283,P ＜ 0.05).A negative correlation was observed between the expression level of IL-2RG mRNA and methylation level of IL2RG promoter region in 20 patients with SLE(r =-0.44,P ＜ 0.05).Conclusion The methylation status of IL2RG promoter region is statistically higher in patients with SLE than in healthy controls,and significantly different between patients with active SLE and those with stable SLE.