High stakes assessment using simulation -- an Australian experience.

The use of simulation for high stakes assessment has been embedded in the New South Wales Medical Practice Act and has been used for high stakes assessment on a number of occasions. Simulation has rarely been used in this manner elsewhere in the world. We outline the use of simulation in particular focussing on its relationship to a performance assessment programme featuring performance focus, peer assessment of standards, an educative, remedial and protective framework, strong legislative support and system awareness.