Date Approved


Degree Type

Open Access Dissertation

Degree Name

Doctor of Philosophy (PhD)


College of Technology

Committee Member

Ali Eydgahi

Committee Member

John Dugger

Committee Member

Konnie Kustron

Committee Member

Toni Stokes Jones

Committee Member

Jonathon Rohrer


Historically, the assessment of medical resident knowledge and skill has occurred through standardized written examinations and faculty observation during real patient encounters. The written examinations, including three levels of board qualifying examinations (USMLE and COMLEX-USA) and specialty specific annual in-training examinations, are used to identify each resident’s knowledge deficiencies. Research shows that faculty evaluations are unable to predict how residents will perform on emergency medicine in-training examinations, and that practicing skills on real patients puts patients’ lives at risk. To improve patient care and enhance the learning environment, medical educators have created simulation tools for medical residents to practice procedures without using real patients. However, simulation curricula and assessment techniques have not been standardized although they have been used for many years in different residency programs. In this study, a longitudinal record review, USMLE, COMLEX-USA, and American Board of Emergency Medicine in-training scores were compared to annualized simulation scores to determine whether there is any relationship between the assessment types in one emergency medicine residency program in Michigan. The canonical correlation and variance analysis were utilized to determine if a relationship exists between the written and simulation assessment methods as well as between different demographic groups. Seven research questions were designed and analyzed to identify if there is a relationship between the assessment methods, medical school type, and the resident sex. The research questions indicated no relationship existed within this single residency program. In conclusion, the study has determined that the performance scores for written and simulation types of assessment should both be reviewed and considered to appropriately measure the resident’s performance. Also, it has been shown that the significance of the fourth year of training for osteopathic residents requires further study.