title: Validation of the simulated ward environment for assessment of ward-based surgical care.
abstract: OBJECTIVE
  To assess the feasibility of developing a simulated ward environment in which to assess the ward-based care of surgical patients by clinicians of varying levels of experience (construct validation).
  
  
  BACKGROUND
  Increasing evidence points to the importance of the postoperative or ward-based phase of surgical care in determining patient outcomes. Ward-based care is determined by the clinician ward round, with the simulated ward environment potentially providing a safe environment for training and assessment.
  
  
  METHODS
  A high-fidelity surgical ward environment was developed. Junior and senior trainees conducted ward rounds of 3 standardized surgical patients and were assessed using a checklist of assessment and management care processes, modified NOTECHS score, and fidelity questionnaire.
  
  
  RESULTS
  Nine senior and 9 junior trainees were observed. There was no significant difference in time taken to conduct the round (37.6 ± 2.7 vs 32.6 ± 1.9 minutes, P = 0.16). Senior trainees performed significantly more assessment processes (73% ± 2.8% vs 63% ± 2.5%, P = 0.016) and completed more management tasks (73% ± 4.5% vs 59.4% ± 5%, P = 0.058). Fifteen adverse events were committed by junior trainees versus 8 by seniors (P < 0.001). Seniors scored higher on nontechnical ability (NOTECHS score 21.8 ± 0.61 vs 18.1 ± 1.12, P = 0.017). All of subjects felt the ward, patients, and scenarios were realistic.
  
  
  CONCLUSIONS
  A high-fidelity, immersive, construct-valid ward simulator has been developed in which to observe and assess ward-based processes of surgical care.
authors.affiliation: *Division of Surgery, Department of Surgery and Cancer; and †Faculty of Medicine, Imperial College London, London, United Kingdom.
authors.forename: Philip H
authors.initials: PH
authors.lastname: Pucher
authors.forename: Rajesh
authors.initials: R
authors.lastname: Aggarwal
authors.forename: Tharanny
authors.initials: T
authors.lastname: Srisatkunam
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D057189:Checklist; D002983:Clinical Competence; D005240:Feasibility Studies; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D008131:London; D008297:Male; D008505:Medical Staff, Hospital / Q000193:education* / Q000592:standards; D008875:Middle Aged; D016544:Patient Simulation; D010362:Patients' Rooms; D011182:Postoperative Care / Q000193:education* / Q000379:methods / Q000592:standards; D011795:Surveys and Questionnaires