Tuesday, 19 June 2018

The A word

In a recent blogpost Paul Phrampus argued that we should not shy away from the word “assessment” in simulation. He states: “...every simulation is an assessment!”

Words shape our world. We communicate through the words we use, to relay information and influence people. The words we use also tell listeners about us, think of “economic migrants”, “illegal aliens” and “hostile environment”. Lastly, our vocabulary has a direct effect on our thinking; if we don’t know the words and their definitions it is difficult to think rationally about a subject.


The word evokes feelings of stress. It is synonymous with judgment, passing and failing, a dispassionate observer providing an objective grade based on performance.
Some try to soften the word (formative assessment) or its synonyms (good judgment). Yet the people being assessed are unlikely to be reassured.

I would like to offer an alternative: “Analysis” Why not stop assessing people’s performance and start analysing it? The word evokes less stress and does not suggest judgment, but rather a review of what happened. For those who like modifiers perhaps “gap analysis” would work. The observer’s role is to look for the gaps in performance.

If we are analysing we are not assessing. We can be open and clear about what the goals of the scenario and debrief are. And we can remind ourselves that, in the end, it does not matter what we think the performance gaps were. What matters is that we have, through analysis and conversation, facilitated the realisation of these gaps in our learners. Moving from assessment to analysis may also help with another common problem that Paul has identified:


  1. I recall being a bit reluctant to take part in scenarios as a trainee, but always taking a lot from them. I was worried about underperformance, and messing up so went into them feeling quite nervous. For me, i think what set me off was attending a simulation faculty course for the first time as an ST3 and one of the faculty teaching the course started off by saying it was all non-judgemental but then followed that up by saying if someone did something really appalling they might need to feed back to supervisors, and in the case of middle grade doctors take them off solo nights. So that undermined my faith in a process for quite some time, I really pulled back from simulation unless i really had no choice. Instructing on ALS however, I have grown to enjoy the simulated casteach scenarios (I accept that these are low fidelity- but I dont necessarily think that fidelity is everything) and these have become my favourite part of the course. I fully accept that its not all the bells and whistles, but you really have an opportunity to observe the candidates in action and to facilitate some learning in the debrief. Mentoring new instructors has also been an eye opener for me, as debrief is often the most challenging part. I am now involved in simulation as a senior clinician, but I am starting out again in a new environment. I hope that I can help to embed simulation both in the department I work in and the hospital as a whole.

  2. I also feel like taking part in simulation is potentially more stressful as a consultant, as I worry more about 'messing up' or looking foolish. This perhaps just needs to be reframed, but I do wonder how much of that comes from our mentality as medics. m