title: Assessing procedural skills in context: Exploring the feasibility of an Integrated Procedural Performance Instrument (IPPI).
abstract: BACKGROUND
  The assessment of clinical procedural skills has traditionally focused on technical elements alone. However, in real practice, clinicians are expected to be able to integrate technical with communication and other professional skills. We describe an integrated procedural performance instrument (IPPI), where clinicians are assessed on 12 clinical procedures in a simulated clinical setting which combines simulated patients (SPs) with inanimate models or items of medical equipment. Candidates are observed remotely by assessors whose data are fed back to the clinician within 24 hours of the assessment. This paper describes the feasibility of IPPI.
  
  
  RESULTS
  A full-scale IPPI and 2 pilot studies with trainee and qualified health care professionals has yielded an extensive data set including 585 scenario evaluations from candidates, 60 from clinical assessors and 31 from simulated patients (SPs). Interview and questionnaire data showed that for the majority of candidates IPPI provided a powerful and valuable learning experience. Realism was rated highly. Remote and real-time assessment worked effectively, although for some procedures limited camera resolution affected observation of fine details.
  
  
  CONCLUSIONS
  IPPI offers an innovative approach to assessing clinical procedural skills. Although resource-intensive, it has the potential to provide insight into individual's performance over a spectrum of clinical scenarios and at no risk to the safety of patients. Additional benefits of IPPI include assessment in real time from experts (allowing remote rating by external examiners) as well as provision of feedback from simulated patients.
authors.affiliation: Division of Surgery, Oncology, Reproduction and Anesthetics, Department of Biosurgery and Technology, Faculty of Medicine, Imperial College London, UK. r.kneebone@imperial.ac.uk
authors.forename: R
authors.initials: R
authors.lastname: Kneebone
authors.forename: D
authors.initials: D
authors.lastname: Nestel
authors.forename: F
authors.initials: F
authors.lastname: Yadollahi
authors.forename: R
authors.initials: R
authors.lastname: Brown
authors.forename: C
authors.initials: C
authors.lastname: Nolan
authors.forename: J
authors.initials: J
authors.lastname: Durack
authors.forename: H
authors.initials: H
authors.lastname: Brenton
authors.forename: C
authors.initials: C
authors.lastname: Moulton
authors.forename: J
authors.initials: J
authors.lastname: Archer
authors.forename: A
authors.initials: A
authors.lastname: Darzi
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D003142:Communication; D004504:Education, Medical, Undergraduate; D005240:Feasibility Studies; D007400:Interprofessional Relations; D008131:London; D016544:Patient Simulation; D010817:Physician-Patient Relations; D013647:Task Performance and Analysis; D013663:Teaching / Q000379:methods*; D013664:Teaching Materials; D014741:Video Recording