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Digital twins hold substantial promise in many applications, but rigorous procedures for assessing their accuracy are essential for their widespread deployment in safety-critical settings. By formulating this task within the framework of causal inference, we show it is not possible to certify that a twin is "correct" using real-world observational data unless potentially tenuous assumptions are made about the data-generating process. To avoid these assumptions, we propose an assessment strategy that instead aims to find cases where the twin is not correct, and present a general-purpose statistical procedure for doing so that may be used across a wide variety of applications and twin models. Our approach yields reliable and actionable information about the twin under only the assumption of an i.i.d. dataset of real-world observations, and in particular remains sound even in the presence of arbitrary unmeasured confounding. We demonstrate the effectiveness of our methodology via a large-scale case study involving sepsis modelling within the Pulse Physiology Engine, which we assess using the MIMIC-III dataset of ICU patients.

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