Simulation-based summative assessment in healthcare: an overview of key principles for practice

Abstract

Background Healthcare curricula need summative assessments relevant to and representative of clinical situations to best select and train learners. Simulation provides multiple benefits with a growing literature base proving its utility for training in a formative context. Advancing to the next step, “the use of simulation for summative assessment” requires rigorous and evidence-based development because any summative assessment is high stakes for participants, trainers, and programs. The first step of this process is to identify the baseline from which we can start. Methods First, using a modified nominal group technique, a task force of 34 panelists defined topics to clarify the why, how, what, when, and who for using simulation-based summative assessment (SBSA). Second, each topic was explored by a group of panelists based on state-of-the-art literature reviews technique with a snowball method to identify further references. Our goal was to identify current knowledge and potential recommendations for future directions. Results were cross-checked among groups and reviewed by an independent expert committee. Results Seven topics were selected by the task force: “What can be assessed in simulation?”, “Assessment tools for SBSA”, “Consequences of undergoing the SBSA process”, “Scenarios for SBSA”, “Debriefing, video, and research for SBSA”, “Trainers for SBSA”, and “Implementation of SBSA in healthcare”. Together, these seven explorations provide an overview of what is known and can be done with relative certainty, and what is unknown and probably needs further investigation. Based on this work, we highlighted the trustworthiness of different summative assessment-related conclusions, the remaining important problems and questions, and their consequences for participants and institutions of how SBSA is conducted. Conclusion Our results identified among the seven topics one area with robust evidence in the literature (“What can be assessed in simulation?”), three areas with evidence that require guidance by expert opinion (“Assessment tools for SBSA”, “Scenarios for SBSA”, “Implementation of SBSA in healthcare”), and three areas with weak or emerging evidence (“Consequences of undergoing the SBSA process”, “Debriefing for SBSA”, “Trainers for SBSA”). Using SBSA holds much promise, with increasing demand for this application. Due to the important stakes involved, it must be rigorously conducted and supervised. Guidelines for good practice should be formalized to help with conduct and implementation. We believe this baseline can direct future investigation and the development of guidelines.

Simulation in contemporary medical education: Current practices and the way forward

“…Furthermore, Buléon et al . [ 40 ] highlighted that simulation-based summative assessment holds great potential as we advance if conducted meticulously and well-supervised. Hwang et al .…”

Contribution of Simulation in Paediatric Laparoscopic Surgery: Improving Suturing Skills Before Performing a Laparoscopic Procedure in Children

“…Mastering paediatric laparoscopic surgery competency (PLSC) is a long process, because of the small number of patients for each of the eligible procedures, and the technical challenges of limited workspace in children 1 . Over the last decades, training of laparoscopy for residents in paediatric surgery and urology has shifted from standard companionship in the operating room to a multimodal training including hands-on training on simulators, in line with the goal of "never the rst time on the patient" [2][3][4] . PLSC simulation programs have been developed worldwide, mainly consisting of repeated low-or highdelity procedural simulation in dry labs, [4][5][6] which vary in terms of timing and duration 7 .…”

“…Over the last decades, training of laparoscopy for residents in paediatric surgery and urology has shifted from standard companionship in the operating room to a multimodal training including hands-on training on simulators, in line with the goal of "never the rst time on the patient" [2][3][4] . PLSC simulation programs have been developed worldwide, mainly consisting of repeated low-or highdelity procedural simulation in dry labs, [4][5][6] which vary in terms of timing and duration 7 . The evaluation of these programs mostly consists of the comparison of residents' technical skills before and after training, sometimes with an interval for post-event retention, 8,9 but do not explore separately phases of learning and improvement of technical skills.…”

Design elements of simulation-based assessment for clinical reasoning in nursing students: A scoping review protocol

“…In determining the extent to which students have acquired this skill, assessments play a critical role. Simulation, in addition, can serve as a valuable performance-based assessment for clinical reasoning at both lower-and higher-stakes levels [8][9][10]. Lowerstakes simulation assessments allow students to practice and learn from their mistakes, while higher-stakes assessments determine their level of competency.…”