Document Type : Original Article


Department of Emergency Medicine, Faculty of Medicine, King Abulaziz University, Jeddah, Saudi Arabia, Clinical Skills and Simulation Center, King Abulaziz University, Jeddah, Saudi Arabia


Using simulation in high‑stakes assessments has been evolving as a method to improve the
assessment process. There is a concurrent need to address challenges and establish best practices
to ensure the best quality when implementing high‑stakes evaluations. The aim of this study is to
provide an insight for stakeholders about using multiple modalities of simulation in high‑stakes
evaluations by presenting challenges, best practices, and future directions described in the relevant
literature.A scoping review of original studies (from the year 1994–2021) including the use of common
modalities (standardized patients, high‑fidelity mannequins, part‑task trainers, virtual simulation, and
hybrid simulation) was conducted. The search covered the common databases: PubMed, Education
Resource Information Center, Cumulative Index to Nursing and Allied Health Literature, and the
Cochrane library.Initial screening in the databases resulted in 111,253 articles. After the application
of a refining search strategy, 47 articles were included for comprehensive evaluation. Most articles
were about credentialing/licensure purposes of assessment. Many articles were specialty‑specific,
especially focusing on anesthesia. Most challenges described were related to the validity of the
assessment that should be considered in the planning phase. Best practices were mostly related
to planning for measures to assure the validity of the assessment tools and process.The use of
multimodality simulation for high‑stakes assessment is growing despite challenges; this growth is
associated with the accumulation of experience shared in literature. This growth will help to improve
planning, practices, and goals achievement from such an application.


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