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Examining the Validity of the Implementation Quality Rubric for Simulation (IQR-SIM) for Assessing Implementation

Leizl Joy Nayahangan1, Adam Dubrowski, Krystina Clarke

  • 1Copenhagen Academy for Medical Education and Simulation (CAMES), The Capital Region of Denmark (L.J.N., L.K., A. G.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark (L.J.N., L.K., A.G.); maxSIMhealth Laboratory, Faculty of Health Sciences, Ontario Tech University, Oshawa (A.D., K.C.); Simulation Program, Unity Health Toronto (L.B.); Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (L.B.); NORDSIM, Aalborg University Hospital, Aalborg, Denmark (M.L.F.); Department of Medical Education, University of Illinois College of Medicine, IL (R.Y.).

Simulation in Healthcare : Journal of the Society for Simulation in Healthcare
|April 28, 2026
PubMed
Summary

The Implementation Quality Rubric for Simulation (IQR-SIM) tool shows validity for assessing simulation program implementation. This rubric can be used across various simulation centers and programs for reliable evaluation.

Keywords:
implementationimplementation sciencequality assurancesimulationsimulation trainingsimulationbased courses

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Area of Science:

  • Healthcare Simulation
  • Implementation Science
  • Program Evaluation

Background:

  • Reliable tools are needed to measure implementation processes and outcomes in healthcare simulation.
  • Existing tools often lack validity, weakening confidence in study findings and strategy effectiveness.
  • The Implementation Quality Rubric for Simulation (IQR-SIM) was developed to address this gap.

Purpose of the Study:

  • To gather validity evidence for the Implementation Quality Rubric for Simulation (IQR-SIM).
  • To assess the response process and internal structure of the IQR-SIM.
  • To support the use of IQR-SIM in evaluating simulation-based programs.

Main Methods:

  • The IQR-SIM, with a 3-point rating scale, was used to evaluate implementation data from semistructured interviews.
  • Data were collected from 20 simulation-based programs across 7 international simulation centers.
  • Inter-rater reliability (ICC=0.57) and internal consistency (Cronbach alpha=0.85) were assessed.

Main Results:

  • The IQR-SIM demonstrated good internal consistency reliability (Cronbach alpha=0.85).
  • Moderate inter-rater reliability (ICC=0.57) was observed, with values ranging from 0.39 to 0.52.
  • Phase 1 of implementation (stakeholder engagement) showed the highest proportion of fully accomplished items.

Conclusions:

  • Validity evidence for the IQR-SIM's response process and internal structure was established.
  • The IQR-SIM is suitable for evaluating the implementation quality of simulation-based programs.
  • The tool's applicability across diverse simulation centers supports its broad use in implementation evaluation.