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Simulation and assessment

Simulation has been used in the assessment of health professionals for many years, particularly in the formative (developmental, assessment for learning) assessment of clinical and communication skills.  It is less well-used in high stakes, summative (assessment of learning) assessment, primarily because of doubts about the fidelity of simulation and relevance to real-life practice. However, more recently, simulation is being used in high stakes assessments due to the development of simulation assessments that include high validity and reliability, utilising effective metrics, checklists and global rating scales.  Good assessment and learning practice would include a combination of appropriate methods, with simulation activities and assessments being embedded in the overall assessment strategy of a curriculum or programme (Gale and Roberts, 2013). The fidelity is important and will vary according to the assessment required and the assessors and equipment available.

The use of simulation in assessments includes many of the simulation techniques, equipment and modalities already described, for example:

  • Part task trainers may be used to assess practical skills such as catheterisation, cannulation, basic life support or placing of ECG leads.
  • Simulated or standardised patients, actors or healthy volunteers may be used to assess communication skills such as taking a history; working with different cultures/languages/sensory impairments; giving drug or other information or breaking bad news or clinical skills such as assessing for treatment, manipulation or making a diagnosis (see Involving Patients in Clinical Teaching module for more information).
  • Virtual patients which are computer-based can be used to assess knowledge of or adherence to clinical protocols, making a diagnosis, ethical issues, planning or evaluating treatment or referral/discharge processes.
  • Manikins can be used to assess more complex situations or techniques, non-technical skills such as leadership or teamworking and specific procedural techniques. Some involve haptic feedback or internal metrics which helps learners self-assess as well as gives more objective feedback about motor skills to assessors (examples include Basic and Advanced life support manikins; anaesthetics simulators and a range of simulators for specific skills, e.g. ophthalmic surgery, endoscopy, naso-gastric tube insertion or ultrasound examination).


In addition to these assessments being used for assessment for learning, most health programmes include summative assessments of clinical and communication skills.  Examinations such as the OSCE (Objective Structured Clinical Examination) are now widely used in health professions education with stations using many of the simulations described above with an agreed checklist that assessors use to mark off the achievement or performance of specific elements as well as making a global rating of overall performance against the expected standard for the stage of learning.

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