A CanMEDS Competency-Based Assessment Tool for High-Fidelity Simulation in Internal Medicine: The Montreal Internal Medicine Evaluation Scale (MIMES)

Main Article Content

Patrice Chrétien Raymer http://orcid.org/0000-0002-5501-5299
Jean-Paul Makhzoum
Robert Gagnon
Arielle Levy
Jean-Pascal Costa


High-Fidelity simulation, Evaluation Scale, Medical Evaluation, Acute Care, CanMEDS


Introduction: High-fidelity simulation is an efficient and holistic teaching method. However, assessing simulation performances remains a challenge. We aimed to develop a CanMEDS competency-based global rating scale for internal medicine trainees during simulated acute care scenarios.

 Methods: Our scale was developed using a formal Delphi process. Validity was tested using six videotaped scenarios of two residents managing unstable atrial fibrillation, rated by 6 experts. Psychometric properties were determined using a G-study and a satisfaction questionnaire.

Results: Most evaluators favorably rated the usability of our scale, and attested that the tool fully covered CanMEDS competencies. The scale showed low to intermediate generalization validity.

Conclusions: This study demonstrated some validity arguments for our scale. The best assessed aspect of performance was communication; further studies are planned to gather further validity arguments for our scale and to compare assessment of teamwork and communication during scenarios with multiple versus single residents.

Abstract 900 | pdf Downloads 754 HTML Downloads 196


1. Boulet JR. Summative assessment in medicine: the promise of simulation for high-stakes evaluation. Acad Emerg Med 2008; 15(11): 1017-24.

2. Regehr G, et al. Comparing the psychometric properties of checklists and global rating scales for assessing performance on an OSCE-format examination. Acad Med 1998; 73(9): 993-7.

3. Doyle JD, Webber EM, Sidhu RS. A universal global rating scale for the evaluation of technical skills in the operating room. Am J Surg 2007; 193(5): 551-5.

4. Kneebone R, et al. An innovative model for teaching and learning clinical procedures. Med Educ 2002; 36(7): 628-34.

5. Bruppacher HR, et al. Simulation-based training improves physicians' performance in patient care in high-stakes clinical setting of cardiac surgery. Anesthesiology 2010; 112(4): 985-92.

6. Yee B, et al. Nontechnical skills in anesthesia crisis management with repeated exposure to simulation-based education. Anesthesiology 2005; 103(2): 241-8.

7. McGaghie WC, et al. Does Simulation-based Medical Education with Deliberate Practice Yield Better Results than Traditional Clinical Education? A Meta-Analytic Comparative Review of the Evidence. Acad Med 2011; 86(6): 706-11.

8. Ker JS, et al. Can a ward simulation exercise achieve the realism that reflects the complexity of everyday practice junior doctors encounter? Med Teach 2006; 28(4): 330-4.

9. Khan K, Pattison T, Sherwood M. Simulation in medical education. Med Teach 2011; 33(1): 1-3.

10. Weller JM, et al. Evaluation of high fidelity patient simulator in assessment of performance of anaesthetists. Br J Anaesth 2003; 90(1): 43-7.

11. Klampfer B, et al. Enhancing Performance in High Risk Environments: Recommendations for the use of Behavioural Markers. In: Gottlieb Deimler and Kerl Benz foundation Kolleg group interaction in High Risk environnement (GIHRE). Behavioural Markers Workshop. Zurich: Swissair Training Center; 2001.

12. Patey R, et al. Developing a Taxonomy of Anesthetists' Nontechnical Skills (ANTS). In: Henriksen K, et al, eds. Advances in Patient Safety: From Research to Implementation, Volume 4: Programs, Tools, and Products. Rockville: Agency for Healthcare Research and Quality; 2005.

13. Flin R, et al. Anaesthetists' non-technical skills. Br J Anaesth 2010; 105(1): 38-44.

14. Yule S, et al. Development of a rating system for surgeons' non-technical skills. Med Educ 2006; 40(11): 1098-104.

15. Fletcher G, et al. Anaesthetists' Non-Technical Skills (ANTS): evaluation of a behavioural marker system. Br J Anaesth 2003; 90(5): 580-8.

16. Frank JR, Snell L, Sherbino J, editors. Can Meds 2015 Physician Competency Framework. Ottawa: Royal College of Physicians and Surgeons of Canada; 2015.

17. Neira VM, et al. "GIOSAT": a tool to assess CanMEDS competencies during simulated crises. Can J Anaesth 2013; 60(3): 280-9.

18. Hatala R, et al. Constructing a validity argument for the Objective Structured Assessment of Technical Skills (OSATS): a systematic review of validity evidence. Adv Health Sci Educ Theory Pract 2015; 20(5): 1149-75.

19. Cook DA, et al. A contemporary approach to validity arguments: a practical guide to Kane's framework. Med Educ 2015; 49(6): 560-75.

20. Tavares W, et al. Applying Kane's validity framework to a simulation based assessment of clinical competence. Adv Health Sci Educ Theory Pract 2017; [Epub ahead of print]

21. Hall AK, et al. Queen's simulation assessment tool: development and validation of an assessment tool for resuscitation objective structured clinical examination stations in emergency medicine. Simul Healthc 2015; 10(2): 98-105.

22. Hodges B, McIlroy JH. Analytic global OSCE ratings are sensitive to level of training. Med Educ 2003; 37(11): 1012-6.

23. Morgan PJ, et al. Nontechnical skills assessment after simulation-based continuing medical education. Simul Healthc 2011; 6(5): 255-9.

24. Preusche I, Schmidts M, Wagner-Menghin M. Twelve tips for designing and implementing a structured rater training in OSCEs. Med Teach 2012; 34(5): 368-72.

25. Cardinet J, Johnson S, and Pini G. Applying generalizability theory using EduG. New York:Taylor & Francis; 2010.

26. Welke TM, et al. Personalized oral debriefing versus standardized multimedia instruction after patient crisis simulation. Anesth Analg 2009; 109(1): 183-9.

27. Savoldelli GL, et al. Value of debriefing during simulated crisis management: oral versus video-assisted oral feedback. Anesthesiology 2006; 105(2): 279-85.

28. Feldman M, et al. Rater training to support high-stakes simulation-based assessments. J Contin Educ Health Prof 2012; 32(4): 279-86.

29. Boulet JR, Murray DJ. Simulation-based assessment in anesthesiology: requirements for practical implementation. Anesthesiology 2010; 112(4): 1041-52.

30. Kim J, et al. A pilot study using high-fidelity simulation to formally evaluate performance in the resuscitation of critically ill patients: The University of Ottawa Critical Care Medicine, High-Fidelity Simulation, and Crisis Resource Management I Study. Crit Care Med 2006; 34(8): 2167-74.

31. Setyonugroho W, Kennedy KM, Kropmans TJ. Reliability and validity of OSCE checklists used to assess the communication skills of undergraduate medical students: A systematic review. Patient Educ Couns 2015; 98(12): 1482-91.

32. Hamstra SJ. Keynote address: the focus on competencies and individual learner assessment as emerging themes in medical education research. Acad Emerg Med 2012; 19(12): 1336-43.

33. Harris K, Frank J, eds. Competence by design: Reshaping Canadian medical education. Ottawa:Royal College of Physicians and Surgeons of Canada; 2014.