The use of simulation for emergency medicine resident assessment.

Simulations are exercises designed to mimic real-life situations in which learners are given the opportunity to reason through a clinical problem and make critical decisions without the potential of harming actual patients. Simulation, using a variety of formats, is useful for assessing the core competencies-particularly patient care (decision making, prioritizing, procedural skills), interpersonal skills (team leadership, communication), and systems-based practice (team structure and utilization, resource use). High-fidelity computerized human simulators are a relatively new tool for use in medical simulation. These realistic mannequins mimic physical findings including respiratory rate, breath sounds, central and peripheral pulses, murmurs, and pupil reactivity. They generate an electrocardiographic (ECG) waveform, cardiac indices, and oxygen saturation that can be viewed on standard cardiac monitoring equipment and can be programmed to respond physiologically to medications and invasive procedures. The use of human simulators to reproduce life-threatening situations will be especially useful in assessing the clinical competence of emergency medicine physicians. Operational definitions of competence and tools with which to evaluate performance must first be developed. Standardization of scenarios and evaluation tools will permit assessment of the reproducibility of scenarios and the reliability and validity of the tools used to measure competence.