Development and Psychometric Analysis of a Tool to Evaluate Confederates

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4 Scopus citations


Background Confederates defined as an individual other than the (standardized/simulated) patient who is scripted in a simulation to provide realism, additional challenges, or additional information for the participant are considered important for the success of simulation encounters; however, these support people are only as good as the quality of their contribution to the overall educational experience. Assessment of confederates is important in the establishment of consistent and high-quality educational experiences. The Actions, Communication, and Teaching in Simulation tool is a single-factor, five-item measure, utilizing a seven-point behaviorally anchored scale rating structure developed to tap into important attributes of confederates’ role portrayal in simulation encounters. The assessed items include acting, verbal, and nonverbal characterization; flexibility and adaptability; use of props and attire; and interactions with participants and other confederates. Methods Eight experts compiled an inventory of attributes and skills thought important for confederates to possess and, or acquire. Content and face validity established using an iterative process were utilized to review and modify each version of the measure until it was felt that the included items correctly measured the construct. Following this, psychometric evaluation of the tool was undertaken. Results Nine experts reviewed and scored seven confederate performances, 58 cases were included in the final analysis. Initial reliability of the tool was established with findings of 0.91 Cronbach's alpha. Internal consistency was good with all total item correlations above 0.50. Conclusion The results of this study provide initial evidence to support the validity and reliability of a tool to measure confederate's contribution to simulation-based learning. It is the first of its kind to be published and establishes a convention for assessing and ultimately improving confederate performances.

Original languageEnglish (US)
Pages (from-to)475-481
Number of pages7
JournalClinical Simulation in Nursing
Issue number11
StatePublished - Nov 1 2016


  • ACTs tool
  • confederates’ assessment
  • confederates’ evaluation
  • embedded actor
  • portrayal accuracy

ASJC Scopus subject areas

  • Nursing (miscellaneous)
  • Education
  • Modeling and Simulation


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