Simulation-based assessments in health professional education: a systematic review

Abstract

Introduction

The use of simulation in health professional education has increased rapidly over the past 2 decades. While simulation has predominantly been used to train health professionals and students for a variety of clinically related situations, there is an increasing trend to use simulation as an assessment tool, especially for the development of technical-based skills required during clinical practice. However, there is a lack of evidence about the effectiveness of using simulation for the assessment of competency. Therefore, the aim of this systematic review was to examine simulation as an assessment tool of technical skills across health professional education.

Methods

A systematic review of Cumulative Index to Nursing and Allied Health Literature (CINAHL), Education Resources Information Center (ERIC), Medical Literature Analysis and Retrieval System Online (Medline), and Web of Science databases was used to identify research studies published in English between 2000 and 2015 reporting on measures of validity, reliability, or feasibility of simulation as an assessment tool. The McMasters Critical Review for quantitative studies was used to determine methodological value on all full-text reviewed articles. Simulation techniques using human patient simulators, standardized patients, task trainers, and virtual reality were included.

Results

A total of 1,064 articles were identified using search criteria, and 67 full-text articles were screened for eligibility. Twenty-one articles were included in the final review. The findings indicated that simulation was more robust when used as an assessment in combination with other assessment tools and when more than one simulation scenario was used. Limitations of the research papers included small participant numbers, poor methodological quality, and predominance of studies from medicine, which preclude any definite conclusions.

Conclusion

Simulation has now been embedded across a range of health professional education and it appears that simulation-based assessments can be used effectively. However, the effectiveness as a stand-alone assessment tool requires further research.

Keywords:

• health care
• technical skills
• competency
• students

Supplementary materials

Definitions

High-fidelity patient simulators

These are designed to allow a large range of noninvasive and invasive procedures to be performed and offer realistic sensory and physiological responses, with outputs such as heart rate and oxygen saturation usually displayed on a monitor. They can be run by a computer technician or preprogrammed to react to the participant’s actions.

Objective structure clinical examinations

These involve participants progressing through multiple stations at predetermined time intervals. They may have active or simulation-based stations that assess practical skills or passive stations such as written or video analysis, commonly used to assess theoretical knowledge.

Standardized patients

These are people trained to portray a patient in a consistent manner and present the case history of a real patient using predetermined subjective and objective responses.

Task trainers

These are models that are designed to look like a part of the human anatomy and allow individuals to perform discrete invasive procedures, for example a pelvis for internal pelvic examinations, or an arm to practice cannulation.

Disclosure

The authors report no conflicts of interest in this work.