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Development and evaluation of a simulation-based resuscitation scenario assessment tool for emergency medicine residents.

OBJECTIVE
We sought to develop and validate a three-station simulation-based Objective Structured Clinical Examination (OSCE) tool to assess emergency medicine resident competency in resuscitation scenarios.


METHODS
An expert panel of emergency physicians developed three scenarios for use with high-fidelity mannequins. For each scenario, a corresponding assessment tool was developed with an essential actions (EA) checklist and a global assessment score (GAS). The scenarios were (1) unstable ventricular tachycardia, (2) respiratory failure, and (3) ST elevation myocardial infarction. Emergency medicine residents were videotaped completing the OSCE, and three clinician experts independently evaluated the videotapes using the assessment tool.


RESULTS
Twenty-one residents completed the OSCE (nine residents in the College of Family Physicians of Canada-Emergency Medicine [CCFP-EM] program, six junior residents in the Fellow of the Royal College of Physicians of Canada-Emergency Medicine [FRCP-EM] program, six senior residents in the FRCP-EM). Interrater reliability for the EA scores was good but varied between scenarios (Spearman rho = [1] 0.68, [2] 0.81, [3] 0.41). Interrater reliability for the GAS was also good, with less variability (rho = [1] 0.64, [2] 0.56, [3] 0.62). When comparing GAS scores, senior FRCP residents outperformed CCFP-EM residents in all scenarios and junior residents in two of three scenarios (p < 0.001 to 0.01). Based on EA scores, senior FRCP residents outperformed CCFP-EM residents, but junior residents outperformed senior FRCP residents in scenario 1 and CCFP-EM residents in all scenarios (p = 0.006 to 0.04).


CONCLUSION
This study outlines the creation of a high-fidelity simulation assessment tool for trainees in emergency medicine. A single-point GAS demonstrated stronger relational validity and more consistent reliability in comparison with an EA checklist. This preliminary work will provide a foundation for ongoing future development of simulation-based assessment tools.