Application of the ACTS Tool in Learning Activities with Simulation: Spanish Version
DOI:
https://doi.org/10.22201/fm.30617243e.2025.5.121Keywords:
Clinical simulation, Medical education, Standardized patient, Validation study, Educational measurementAbstract
Introduction:
In health professional education, clinical simulation has become an essential tool to develop competencies in a safe and controlled environment. The standardized patient (SP) plays a key role in this process, making it necessary to have valid instruments that objectively assess their performance.
Objective:
To document the evidence of validity and reliability of the Spanish translation and adaptation of the Actions, Communication, and Teaching in Simulation (ACTS) instrument for the evaluation of standardized patients in clinical simulations.
Material and Methods:
A prospective validation study was conducted with authorization from the original author. The translation process followed the RAND Corporation guidelines. Ten experts with over 200 hours of experience as SPs assessed each item for sufficiency, clarity, coherence, and relevance using Fleiss’ kappa coefficient. Internal consistency (Cronbach’s alpha) and exploratory factor analysis were performed.
Results:
Fleiss’ kappa indicated almost perfect agreement for sufficiency (0.855), clarity (0.934), coherence (0.922), and relevance (0.920). Internal consistency reached a Cronbach’s alpha of 0.968 and the average inter-item correlation was 0.861. Exploratory factor analysis yielded values between 0.916 and 0.941.
Conclusions:
The Spanish version of the ACTS instrument provides strong evidence of validity and reliability for evaluating standardized patient performance within medical education based on simulation.
Keywords: clinical simulation; medical education; standardized patient; validation study; educational measurement.
References
Bandura, A. (1978). Self-efficacy: Toward a unifying theory of behavioral change. Advances in Behaviour Research and Therapy, 1(4), 139–161. https://doi.org/10.1016/0146-6402(78)90002-4
Corvetto, M., Bravo, M. P., Montaña, R., Utili, F., Escudero, E., Boza, C., Varas, J., & Dagnino, J. (2013). Simulación en educación médica: Una sinopsis. Revista Médica de Chile, 141(1), 70–79. https://doi.org/10.4067/S0034-98872013000100010
Escobar-Pérez, J., & Cuervo-Martínez, Á. (2008). Validez de contenido y juicio de expertos: Una aproximación a su utilización. Avances en Medición, 6, 27–36.
Gaba, D. M. (2004). The future vision of simulation in health care. Quality and Safety in Health Care, 13(Suppl 1), i2–i10. https://doi.org/10.1136/qshc.2004.009878
Galicia Alarcón, L. A., Balderrama Trápaga, J. A., & Edel Navarro, R. (2017). Content validity by experts judgment: Proposal for a virtual tool. Apertura, 9(2), 42–53. https://doi.org/10.32870/Ap.v9n2.993
Gliva-McConvey, G., Nicholas, C. F., & Clark, L. (Eds.). (2020). Comprehensive healthcare simulation: Implementing best practices in standardized patient methodology. Springer International Publishing. https://doi.org/10.1007/978-3-030-43826-5
Leighton, K., Mudra, V., & Gilbert, G. E. (2018). Development and psychometric evaluation of the facilitator competency rubric. Nursing Education Perspectives, 39(6), E3–E9. https://doi.org/10.1097/01.NEP.0000000000000409
Lioce, L. (Ed.). (2020). Healthcare simulation dictionary (2nd ed.). Agency for Healthcare Research and Quality. https://doi.org/10.23970/simulationv2
Moore, P., Leighton, M. I., Alvarado, C., & Bralic, C. (2016). Pacientes simulados en la formación de los profesionales de salud: El lado humano de la simulación. Revista Médica de Chile, 144(5), 617–625. https://doi.org/10.4067/S0034-98872016000500010
RAND Corporation. (2022). Basic guidelines for translating surveys. RAND Health Care. https://www.rand.org/health-care/surveys_tools/about_translations.html
Ruiz-Moral, R., & Caballero-Martínez, F. (2014). Programa para seleccionar y entrenar pacientes estandarizados en el contexto de un currículo universitario de simulación clínica. Educación Médica, 15(2), 103–109. https://doi.org/10.4321/S2014-98322014000400005
Sanko, J. S., Shekhter, I., Gattamorta, K. A., & Birnbach, D. J. (2016). Development and psychometric analysis of a tool to evaluate confederates. Clinical Simulation in Nursing, 12(11), 475–481. https://doi.org/10.1016/j.ecns.2016.07.006
Weller, J. M., Nestel, D., Marshall, S. D., Brooks, P. M., & Conn, J. J. (2012). Simulation in clinical teaching and learning. Medical Journal of Australia, 196(9), 594–594. https://doi.org/10.5694/mja10.11474
Wilbur, K., Elmubark, A., & Shabana, S. (2018). Systematic review of standardized patient use in continuing medical education. Journal of Continuing Education in the Health Professions, 38(1), 3–10. https://doi.org/10.1097/CEH.0000000000000190
