International Journal of Healthcare Simulation

Background:

Clinical reasoning is interconnected with decision-making which is a critical element to ensure patient safety ^[1]. To avoid practice mistakes, healthcare professionals should be competent with effective clinical reasoning skills. To develop effective clinical reasoning skills, healthcare professionals should get the chance to practise and be exposed to various experiences and levels of patient complexities. Simulation can immerse learners in scenarios that mimic clinical situations, simultaneously mitigating safety risks and increasing standardization in healthcare education ^[2]. Through simulation, learners can get the chance to practise clinical reasoning with focussed learning opportunities ^[3]. Several assessment tools have been used to measure clinical reasoning while attending simulation-based activities. However, we would like to explore the most valid and reliable tools to assess clinical reasoning while attending simulation, in addition to finding out whether these tools have considered the seniority and competency levels of their users.

Method:

A scoping review was undertaken to answer the questions: What are the best available valid and reliable tools to evaluate clinical reasoning while attending simulation-based activities? Do we have valid and reliable clinical reasoning assessment tools for simulation that measure clinical reasoning considering different seniority and competency levels? We searched Medline, Scopus, Education Research Complete, and Google Scholar to identify relevant recent primary research conducted on this topic from 2000 onwards. The search included MeSH topics of: ‘Clinical reasoning’, ‘Simulation-based courses’ and ‘Clinical Reasoning tools’. The inclusion criteria were primary studies that described the use of tools measuring clinical reasoning while attending simulation-based courses. Two independent researchers agreed on the inclusion of the identified papers for full-text review. This review followed the review guidelines of Joanne Briggs institute.

Findings:

There are valid and reliable tools to evaluate clinical reasoning while attending simulation which is Clinical Reasoning Evaluation Simulation Tool CREST ^[1]; 
Lasater Clinical Judgment Rubric LCJR ^[4]; Creighton Competency Evaluation Instrument Creighton C-SEI- Tool ^[5]. 
However, the validity and reliability of these tools were tested on undergraduate student nurses, and there was no consideration for different seniority and competence levels, and applicability to other healthcare professions.

Implications for practice:

There is an adequate number of tools to measure clinical reasoning while attending simulation. However, there is a significant basis to test the reliability and validity of these tools against different competence and seniority levels, and applicability to other healthcare professions.