CBX, a clinical simulation model developed by the National Board of Medical Examiners, was studied as an evaluation instrument. These studies show that CBX measures need not be influenced by prior experience with or anxiety about computers. However, a practice effect was observed that was independent of prior computer experience or anxiety. Complex sets of actions can be recorded and used in developing scores. Scores developed for CBX differentiate among physicians at different levels of training. They correlate modestly with multiple-choice question tests and written clinical simulations. Computer-based simulation systems like CBX could become valuable methods for the study and assessment of problem-solving and patient management skills of physicians.
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