Simulation for Milestone Assessment: Use of a Longitudinal Curriculum for Pediatric Residents.
BACKGROUND
Determining clinical competency on the milestones requires direct observation of residents, which is difficult for faculty members who are also providing patient care. Simulation can potentially represent an effective standardized tool for high-stakes assessment. Using a longitudinal simulation curriculum with formative and summative components, we conducted a pilot investigation to examine whether (1) performance on the formative cases predicted performance on the summative cases and (2) performance on the summative cases correlated with the clinical competency committee's (CCC) milestone placement.


METHODS
We developed 6 formative and 6 matched summative cases for pediatric interns that covered core pediatric topics. The interns progressed through the formative cases in pairs during the course of the academic year and then through the summative cases back to back individually at the end of the year. The interns were evaluated using a competency-based simulation evaluation. We determined the relationship between the formative and summative scores and between the summative scores and those from the CCC.


RESULTS
The relationship between formative and summative scores was not statistically significant. There was a statistically significant relationship between summative and CCC scores.


CONCLUSIONS
Significant methodological limitations preclude definite conclusions about the predictive power of simulation cases for Pediatric Milestones-based assessment. However, our work is an example of how simulation is a potentially useful tool for assessing residents' skill development on the Pediatric Milestones. More rigorous research is needed to determine the extent to which simulation can be used for high-stakes, milestones-based assessment.
From the Carl J. Shapiro Institute for Education and Research, Beth Israel Deaconess Medical Center (G.C.H.), and MassGeneral Hospital for Children (A.F.V., S.S.V., L.P.C.), Harvard Medical School, Boston, MA.
Ariel S
AS
Frey-Vogel
Shannon E
SE
Scott-Vernaglia
Lindsay P
LP
Carter
Grace C
GC
Huang
D003479:Curriculum; D007396:Internship and Residency; D008137:Longitudinal Studies; D010372:Pediatrics / Q000193:education*; D018794:Problem-Based Learning; D000066908:Simulation Training