The validity of performance assessments using simulation.
BACKGROUND
The authors wished to determine whether a simulator-based evaluation technique assessing clinical performance could demonstrate construct validity and determine the subjects' perception of realism of the evaluation process.


METHODS
Research ethics board approval and informed consent were obtained. Subjects were 33 university-based anesthesiologists, 46 community-based anesthesiologists, 23 final-year anesthesiology residents, and 37 final-year medical students. The simulation involved patient evaluation, induction, and maintenance of anesthesia. Each problem was scored as follows: no response to the problem, score = 0; compensating intervention, score = 1; and corrective treatment, score = 2. Examples of problems included atelectasis, coronary ischemia, and hypothermia. After the simulation, participants rated the realism of their experience on a 10-point visual analog scale (VAS).


RESULTS
After testing for internal consistency, a seven-item scenario remained. The mean proportion scoring correct answers (out of 7) for each group was as follows: university-based anesthesiologists = 0.53, community-based anesthesiologists = 0.38, residents = 0.54, and medical students = 0.15. The overall group differences were significant (P < 0.0001). The overall realism VAS score was 7.8. There was no relation between the simulator score and the realism VAS (R = -0.07, P = 0.41).


CONCLUSIONS
The simulation-based evaluation method was able to discriminate between practice categories, demonstrating construct validity. Subjects rated the realism of the test scenario highly, suggesting that familiarity or comfort with the simulation environment had little or no effect on performance.
Devitt
J H
JH
Department of Anaesthesia, University of Toronto, Sunnybrook and Women's College Health Sciences Centre, Ontario, Canada. exhd@qe2-hsc.ns.ca
Kurrek
M M
MM
Cohen
M M
MM
Cleave-Hogg
D
D
D000368:Aged; D000758:Anesthesia; D002170:Canada; D002983:Clinical Competence / Q000592:standards*; D003198:Computer Simulation; D006801:Humans; D007431:Intraoperative Complications / Q000628:therapy; D008297:Male; D016544:Patient Simulation; D015203:Reproducibility of Results