Background: Simulation in healthcare lacks a dedicated framework and supporting taxonomy for instructional design (ID) to assist educators in creating appropriate simulation learning experiences. Aims: This article aims to fill the identified gap. It provides a conceptual framework for ID of healthcare simulation. Methods: The work is based on published literature and authors' experience with simulation-based education. Results: The framework for ID itself presents four progressive levels describing the educational intervention. Medium is the mode of delivery of instruction. Simulation modality is the broad description of the simulation experience and includes four modalities (computer-based simulation, simulated patient (SP), simulated clinical immersion, and procedural simulation) in addition to mixed, hybrid simulations. Instructional method describes the techniques used for learning. Presentation describes the detailed characteristics of the intervention. The choice of simulation as a learning medium is based on a matrix of simulation relating acuity (severity) to opportunity (frequency) of events, with a corresponding zone of simulation. An accompanying chart assists in the selection of appropriate media and simulation modalities based on learning outcomes. Conclusion: This framework should help educators incorporate simulation in their ID efforts. It also provides a taxonomy to streamline future research and ID efforts in simulation.
This study demonstrates that Canadian postgraduate training programmes use a variety of assessment tools to evaluate the CanMEDS competencies. Programme directors are neutral or concerned about how the CanMEDS roles other than that of Medical Expert are evaluated in their programmes. Further efforts are required to establish best practice in CanMEDS evaluation.
CONTEXT Progress tests, in which learners are repeatedly assessed on equivalent content at different times in their training and provided with feedback, would seem to lend themselves well to a competency-based framework, which requires more frequent formative assessments. The objective structured clinical examination (OSCE) progress test is a relatively new form of assessment that is used to assess the progression of clinical skills. The purpose of this study was to establish further evidence for the use of an OSCE progress test by demonstrating an association between scores from this assessment method and those from a national high-stakes examination. CONCLUSIONS This study provides further evidence for the use of OSCE progress testing by demonstrating a correlation between scores from an OSCE progress test and a national high-stakes examination. Furthermore, there is evidence that OSCE progress test scores are predictive of future performance on a national high-stakes examination.
High-stakes assessment of clinical performance through the use of standardized patients (SPs) is limited by the SP's lack of real physical abnormalities. The authors report on the development and implementation of physical examination stations that combine simulation technology in the form of digitized cardiac auscultation videos with an SP assessment for the 2003 Royal College of Physicians and Surgeons of Canada's Comprehensive Objective Examination in Internal Medicine. The authors assessed candidates on both the traditional stations and the stations that combined the traditional SP examination with the digitized cardiac auscultation video. For the combined stations, candidates first completed a physical examination of the SP, watched and listened to a computer simulation, and then described their auscultatory findings. The candidates' mean scores for both types of stations were similar, as were the mean discrimination indices for both types of stations, suggesting that the combined stations were of a testing standard similar to the traditional stations. Combining an SP with simulation technology may be one approach to the assessment of clinical competence in high-stakes testing situations.
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