ASSESSMENT OF CLINICAL COMPETENCE: WRITTEN AND COMPUTER‐BASED SIMULATIONS

Abstract

Written and computer‐based clinical simulations have been used in the health professions to assess aspects of clinical competence for many years. However, this review of the dozens of studies of their psychometric characteristics fmds little evidence to justify their continued use. While studies of the fidelity of simulations have demonstrated that examinees feel they are realistic and have good face validity, reliability studies have repeatedly shown that scores are too imprecise for meaningful interpretation, unless unpractically large numbers of simulations are included in a test. Validity studies have demonstrated that simulations have the expected relationships with a host of criterion measures, but it appears that similar assessment information can be obtained using clinically‐oriented multiple choice questions in much less testing time. Some common methodological weaknesses in study design and analysis are identified, and some research directions are suggested to improve the psychometric characteristics of simulation‐based tests.