Assessing healthcare simulation facilitation using a competency-based tool derived from practice in low-resource...

The worldwide expansion in healthcare simulation training includes accelerated uptake in low-resource settings. Until recently, no framework has specifically delineated the competencies underpinning effective facilitation practice in low-resource settings. We describe the development of the Facilitation Behavioural Assessment Tool for simulation facilitation training and report reliability in scoring facilitation performance. This tool was informed by healthcare simulation facilitation practice in low-resource settings.

The tool has 32 facilitation competencies, organised across three performance categories (techniques, artistry and values) and a three-point scale is used for scoring. Following a short, self-directed online training module, participants scored three videos that depicted facilitation performance at three levels. Videos were presented in a random order. Intraclass correlations and internal consistency with Cronbach's α were calculated. A random intercepts 3 × 3 linear mixed model assessed discrimination across the three levels of facilitation performance and the influence of previous facilitation on scoring.

In total, 104 participants from 29 countries completed rater training and scored at least one video. The inter-rater reliability was 0.73 (95%CI 0.66-0.79) and 0.89 (95%CI 0.85-0.92) for the intraclass correlation coefficient 2 and intraclass correlation coefficient 2k, respectively. Cronbach's α was 0.84 (95%CI 0.79-0.89) for the positive video; 0.84 (95%CI 0.78-0.88) for the mixed video; and 0.91(95%CI 0.87-0.93) for the negative video. Previous simulation facilitation experience did not affect the ability to distinguish between the videos meaningfully, but novice facilitators scored facilitation behaviours higher for mixed and negative videos compared with participants with intermediate and high levels of experience.

Our study shows that suitable reliability and internal consistency can be achieved when using the Facilitation Behavioural Assessment Tool. We recommend using the tool to support learning conversations for simulation faculty development in low-resource settings.