Patient-Management Problems: Simulations in Clinical Evaluation

Abstract

Simulation as an assessment technique can be used in a variety of clinical performance areas. All such simulations represent some aspects of reality in the clinical setting and provide methods for understanding, assessing, manipulating, and predicting behavior in complex clinical situations. Depending on the purpose of the simulation, it may be in the written, oral, audiovisual, computer-assisted, or laboratory interactive model form. Simulations, also called "patient management problems," are most useful in assessing the application of knowledge in clinical situations and in evaluating the complex processes of problem solving and judgment. The degree to which this evaluation is effective depends in part on the freedom given to the clinician being evaluated in choosing options to the solution of the clinical task. The design mechanism that provides complete freedom of choice is called free-branching, while modified free-branching, forced-choice, and linear designs provide progressively less choice in options. The information that simulations provide about a person's clinical performance may be either qualitative (when the intent is to improve skills and to facilitate learning) or quantitative (when the intent is to evaluate competence). Simulations are generally regarded as valid assessment tools in terms of content, ie, when they represent an accurate delineation of clinical practitioner roles. Achievement of concurrent and predictive validity awaits further development and research, however.