Development and validation of the QASSH scale: a tool for assessing the quality of simulation scenarios in healthcare education.

Simulation-based education has become essential for pre- and post-graduate training of healthcare professionals. However, there is no tool to help simulation educators or program managers in assessing the educational quality of simulation scenario scripts for team-based immersive simulation (IS), simulated participants (SP) and procedural simulation (PS). To that end, we developed the Quality Assessment of Simulation Scenario in Healthcare (QASSH) tool. This study aims at providing validity evidence for QASSH. We set up a francophone group of experts within the French-speaking Society for Simulation in Healthcare (SoFraSimS) network and designed this scale based on recently published best practices and our long experience in conceiving simulation scenarios. We tested it by submitting three scenarios of high, borderline and low quality for assessment to a group of experts, a third of which were involved in its development. Analysis of reliability and validity of the QASSH was done using the Standards for educational and psychological testing. Generalizability theory (GT) was used to assess the internal structure and reliability of the tool. The absolute reliability coefficients (G coefficients) calculated through GT were: 0.97 (IS), 0.96 (SP), and 0.98 (PS). G-facet analyses showed that no removal of a single item of QASSH significantly increased the G coefficient above 0.01 for any of the three variants. Cronbach's alpha coefficients were 0.94 (IS), 0.94 (SP) and 0.97 (PS). Estimating the impact of the number of raters on reliability (i.e. D-studies) showed that two raters were enough to achieve a G coefficient above 0.85. The G study shows a high generalizability coefficient (≥0.90), which demonstrates high reliability. The response process evidence for validity provides evidence that no error was associated with using the instrument and its reliability was high with two raters. The QASSH is a tool to assess the quality of healthcare simulation scenarios and will be helpful to instructors wishing to build effective IS, PS and SPs scenarios.