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“I believe in evidence. I believe in observation, measurement, and reasoning, confirmed by independent observers. I'll believe anything, no matter how wild and ridiculous, if there is evidence for it. The wilder and more ridiculous something is, however, the firmer and more solid the evidence will have to be.”

-Isaac Asimov


  • Describe the rationale for evaluating simulations.

  • Describe the four levels of evaluation, including characteristics and guidelines for completing evaluations at each level.

  • Explore the International Nursing Association for Clinical Simulation and Learning (INACSL) Standards of Best Practice: Simulation Participant Evaluation.

  • Identify resources for finding evaluation instruments to suit various evaluation objectives.

Educators in the health professions have long used various forms of simulation for teaching and learning. However, until recently, they have given little attention to evaluating the effectiveness of simulation endeavors. This chapter focuses on assessment and evaluation—two essential activities for planning, implementing, and continually improving a successful simulation program.

For many charged with the responsibility of managing or running a simulation program—even those who have established competence and confidence in teaching with simulation—evaluating the effectiveness of simulation endeavors may seem like a daunting task. This chapter seeks to make it less intimidating by:

  • Answering the essential question of why we assess and evaluate

  • Describing a framework for categorizing simulation evaluation strategies

  • Suggesting guidelines and instruments from practice and the literature that may be used for evaluation

  • Providing exemplars of simulation evaluation

Why Evaluate?

At first glance, assessment and evaluation seem like interchangeable terms. However, it is important to differentiate between the two:

  • Assessment refers to the process of gathering information about a simulation participant, activity, or program (INACSL Standards Committee, 2016b).

  • Evaluation refers to the application of the data collected during the assessment process.

We collect data about simulation participants, activities, and programs (assess) and then apply those data (evaluate) for several purposes. These purposes include (Bourke & Ihrke, 2016; Halstead, 2020):

  • Helping participants learn and identify what they have learned (or not learned)

  • Identifying actual or potential problems, including shortfalls in participant learning or gaps in a specific simulation activity or program

  • Assigning participant scores

  • Improving current practices

  • Identifying how well or efficiently intended outcomes were achieved

Through this reflective practice of generating knowledge (assessment) and applying that knowledge to make decisions (evaluation), we can keep track of how well we are meeting individual, team, and organizational objectives. This is how we communicate to stakeholders (administrators, funders, etc.) about how simulation endeavors contribute to student learning, the bottom line, and the mission of the organization (W. K. Kellogg Foundation, 2017).

In healthcare education, simulation is used to address several challenges including:

  • Expanding enrollments

  • Faculty shortages

  • Graduates who are underprepared for the workforce


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