A Taxonomy of Delivery and Documentation Deviations during Delivery of High-Fidelity Simulations

William R. McIvor, Arna Banerjee, John R. Boulet, Tanja Bekhuis, Eugene Tseytlin, Laurence Torsher, Samuel Demaria, John P. Rask, Matthew S. Shotwell, Amanda Burden, Jeffrey B. Cooper, David M. Gaba, Adam Levine, Christine Park, Elizabeth Sinz, Randolph H. Steadman, Matthew B. Weinger

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Introduction We developed a taxonomy of simulation delivery and documentation deviations noted during a multicenter, high-fidelity simulation trial that was conducted to assess practicing physicians' performance. Eight simulation centers sought to implement standardized scenarios over 2 years. Rules, guidelines, and detailed scenario scripts were established to facilitate reproducible scenario delivery; however, pilot trials revealed deviations from those rubrics. A taxonomy with hierarchically arranged terms that define a lack of standardization of simulation scenario delivery was then created to aid educators and researchers in assessing and describing their ability to reproducibly conduct simulations. Methods Thirty-six types of delivery or documentation deviations were identified from the scenario scripts and study rules. Using a Delphi technique and open card sorting, simulation experts formulated a taxonomy of high-fidelity simulation execution and documentation deviations. The taxonomy was iteratively refined and then tested by 2 investigators not involved with its development. Results The taxonomy has 2 main classes, simulation center deviation and participant deviation, which are further subdivided into as many as 6 subclasses. Inter-rater classification agreement using the taxonomy was 74% or greater for each of the 7 levels of its hierarchy. Cohen kappa calculations confirmed substantial agreement beyond that expected by chance. All deviations were classified within the taxonomy. Conclusions This is a useful taxonomy that standardizes terms for simulation delivery and documentation deviations, facilitates quality assurance in scenario delivery, and enables quantification of the impact of deviations upon simulation-based performance assessment.

Original languageEnglish (US)
Pages (from-to)1-8
Number of pages8
JournalSimulation in Healthcare
Issue number1
StatePublished - Feb 1 2017

All Science Journal Classification (ASJC) codes

  • Epidemiology
  • Medicine (miscellaneous)
  • Education
  • Modeling and Simulation


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