"I Look into the Mouth, What Do I See?" A Study on the Co-Constructed Assessment Environment within Emergency Care Simulation-Based Education.

Simulation-based assessment is an effective method for evaluating the competence of individuals in emergency situations. Certain skills are challenging to assess since they cannot be simulated. Consequently, participants need to engage in discursive work to facilitate practice and assessment of unsimulable medical information. This study employs an interactional approach to examine how residents and assessors shape the simulated assessments discursively and what effect this has on the assessment. Simulation-based assessments performed by general practitioners were videotaped. The iterative inductive process of conversation analysis was used to analyze and categorize each verbal initiative to discursively introduce unsimulable medical information. The participants used a range of practices to discursively introduce unsimulable medical information in the scenario. In most cases, residents introduced the medical information with a request for information, thus displaying comprehension of the situation. Residents also asked for confirmation of a specific assessment, thus displaying comprehension of the situation and the expectations. Conversely, assessors can introduce the medical information on behalf of the resident, which restricted residents to display their comprehension. The process of bringing unsimulable medical information discursively into play can be seen as a joint construction. This has implications for understanding assessment and learning in simulation contexts. While assessors gain maximum insight in the residents' competence when residents themselves introduce medical information, assessors only gain partial insight into the resident's competence when assessors volunteer information. Different practices influence the assessment environment and validity. Raising awareness about such discursive effects helps optimize simulation-based learning and assessment.