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Validity of the Medi-StuNTS behavioural marker system: assessing the non-technical skills of medical students during immersive simulation
  1. Emma Claire Phillips1,2,3,
  2. Samantha Eve Smith3,
  3. Benjamin Clarke2,
  4. Ailsa Lauren Hamilton2,
  5. Joanne Kerins2,
  6. Johanna Hofer2,
  7. Victoria Ruth Tallentire1,2,3
  1. 1Scottish Centre for Simulation and Clinical Human Factors, Larbert, UK
  2. 2NHS Lothian, Edinburgh, UK
  3. 3The University of Edinburgh College of Medicine and Veterinary Medicine, Edinburgh, UK
  1. Correspondence to Dr Emma Claire Phillips, Scottish Centre for Simulation and Clinical Human Factors, Larbert FK5 4WR, UK; e.c.phillips{at}


Background The Medical Students’ Non-Technical Skills (Medi-StuNTS) behavioural marker system (BMS) is the first BMS to be developed specifically for medical students to facilitate training in non-technical skills (NTS) within immersive simulated acute care scenarios. In order to begin implementing the tool in practice, validity evidence must be sought. We aimed to assess the validity of the Medi-StuNTS system with reference to Messick’s contemporary validity framework.

Methods Two raters marked video-recorded performances of acute care simulation scenarios using the Medi-StuNTS system. Three groups were marked: third-year and fourth-year medical students (novices), final-year medical students (intermediates) and core medical trainees (experts). The scores were used to make assessments of relationships to the variable of clinical experience through expert–novice comparisons, inter-rater reliability, observability, exploratory factor analysis, inter-rater disagreements and differential item functioning.

Results A significant difference was found between the three groups (p<0.005), with experts scoring significantly better than intermediates (p<0.005) and intermediates scoring significantly better than novices (p=0.001). There was a strong positive correlation between the two raters’ scores (r=0.79), and an inter-rater disagreement of more than one point in less than one-fifth of cases. Across all scenarios, 99.7% of skill categories and 84% of skill elements were observable. Factor analysis demonstrated appropriate grouping of skill elements. Inconsistencies in test performance across learner groups were shown specifically in the skill categories of situation awareness and decision making and prioritisation.

Conclusion We have demonstrated evidence for several aspects of validity of the Medi-StuNTS system when assessing medical students’ NTS during immersive simulation. We can now begin to introduce this system into simulation-based education to maximise NTS training in this group.

  • simulation
  • medical students
  • non-technical skills
  • behavioural marker systems
  • validation
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  • Contributors ECP, SES and VRT: conception and design of the work; data collection, analysis and interpretation; drafting of the paper; revisions to the paper; and approval of the final version of the manuscript for submission. BC, ALH and JK: conception and design of the work, data collection, drafting of the paper and approval of the final version of the manuscript for submission. JH: data collection, drafting of the paper and approval of the final version of the manuscript for submission. All authors agrede to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval This study obtained ethical approval from the University of Edinburgh College of Medicine and Veterinary Medicine Student Ethics Committee (approval number 2017/11), with NHS Research Ethics Committee review waived by NHS Forth Valley Research and Development department.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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