There is evidence that simulation-based learning and assessment are effective in increasing medical expert knowledge, procedural skills, learner confidence for real-life practice, discriminating the novice from expert learner, and improving patient outcomes. The body of validity evidence supporting simulation as a performance-based environment for assessment is constantly growing. From the perspective of those training and certifying physicians, simulation is becoming an attractive option for assessing physician competence in certain domains, but it is still unclear if competence demonstrated in the simulation setting can be used as a valid indicator of competence in the clinical setting. Assessment of competence in this complex clinical environment is fraught with bias, poor reliability, and practical difficulty. It is imperative to consider narrative comments in supporting the rationale for numerical entrustment scores in both settings and to include both simulation and workplace-based assessment in high-stakes decisions of progression.ДЄcute care physicians are often faced with critical time-sensitive decisions in the resuscitation setting. However, multiple factors contribute to this complicated and imperfect relationship. This study suggests that resuscitation performance in simulation settings may be an indicator of competence in the clinical setting. In this single-center study with a limited sample size, assessment of residents using entrustment scoring in simulation settings was demonstrated to have a moderate positive correlation with assessment of resuscitation competence in the workplace. Both workplace-based and simulation-based narratives frequently commented on communication skills. Further, qualitative analysis demonstrated overall management and leadership themes were more common narratives in the workplace, while more specific task-based feedback predominated in the simulation-based assessment. There was a moderate, positive correlation found between mean entrustment scores in the simulated and workplace-based settings, which was statistically significant ( rвЂ‰=вЂ‰0.630, nвЂ‰=вЂ‰17, pвЂ‰<вЂ‰0.01). Inductive thematic analysis of written commentary was conducted to compare workplace-based with simulation-based feedback. Resident mean entrustment scores were compared using PearsonвЂ™s correlation coefficient to determine the relationship between entrustment in simulation cases and in the ED. Emergency medicine (EM) residents were assessed using the RAT on cases in simulation-based examinations and in the ED during resuscitation cases from July 2016 to June 2017. The RAT uses an anchored global assessment scale to generate an entrustment score and narrative comments. The resuscitation assessment tool (RAT) was derived from the previously implemented and studied QueenвЂ™s simulation assessment tool (QSAT) via a modified expert review process. We sought to directly compare entrustment scoring of resident performance in the simulation environment to clinical performance in the ED. However, there is limited direct evidence that supports performance in the simulation lab as a surrogate of workplace-based clinical performance for non-procedural tasks such as resuscitation in the emergency department (ED). Simulation is increasingly being used in postgraduate medical education as an opportunity for competency assessment.

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