Screen-Based Simulation as a Novel Recertification Tool for Certified Registered Nurse Anesthetists

Published:December 25, 2022DOI:


      • Screen-based simulation (SBS) activities incorporated into the Continued Professional Certification (CPC) Program could target and improve the management of high-acuity, low-frequency events like intraoperative emergencies.
      • Simulation modalities like SBS offer greater distribution, accessibility, and scalability than in-person simulation and should be explored for potential inclusion in the CPC Program.
      • Quality improvement projects and research on SBS are needed to guide future use of SBS for recertifying CRNAs and the CPC Program.



      Certified registered nurse anesthetists (CRNAs) recertify through the Continued Professional Certification (CPC) Program. Screen-based simulation (SBS) is broadly accessible and should be considered as a recertification option.


      Using the modified Delphi method, eight CRNAs with simulation expertise evaluated the usability and utility of a SBS.


      Eighty percent of modified System Usability Scale items reached consensus and established content validity (ICC=0.674) while 87.5% of utility survey items reached consensus with ICC=0.805, indicating good reliability.


      Technological aptitude may impact usability yet SBS may be a viable adjunct to the CPC Program. Future SBS exploration for recertification is warranted.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinical Simulation In Nursing
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Aebersold M.
        The history of simulation and its impact on the future.
        AACN Advanced Critical Care. 2016; 27: 56-61
      1. American Association of Nurse Anesthetists. (2021). Certified registered nurse anesthetists fact sheet. Retrieved from

      2. American Society of Anesthesiologists. (2021). Navigate anesthesia emergencies through realistic simulations. Retrieved from

        • Arno A.
        • Fry C
        • Patel D.
        • Rogge C.
        • Titch, J.F.
        • Vacchiano C.A.
        • Muckler V.C.
        Recertification and reentry to practice for nurse anesthetists using high-fidelity simulation: Phase III.
        Journal of Nursing Regulation. 2020; 11: 22-32
        • Benner P.
        Finding teaching-learning opportunities in the current crisis of COVID-19 and the demand for online nursing education.
        Educating Nurses. 2020; (Retrieved from)
        • Brooke J.
        SUS: A retrospective.
        Journal of Usability Studies. 2013; 8 (Retrieved from): 29-40
        • Collins R.M.
        • Svoboda C.J.
        • Vacchiano C.A.
        • Titch J.F.
        • Muckler V.C.
        Recertification and reentry to practice for nurse anesthetists, phase II: Evaluating reentry to anesthesia practice using high-fidelity simulation technology.
        Journal of Nursing Regulation. 2019; 10: 21-30
        • Cook D.A.
        • Hatala R.
        Validation of educational assessments: A primer for simulation and beyond.
        Advances in Simulation. 2016; 1: 31
        • Erlinger L.R.
        • Bartlett A.
        • Perez A.
        High-fidelity mannequin simulation versus virtual simulation for recognition of critical events by student registered nurse anesthetists.
        American Association of Nurse Anesthetists Journal. 2019; 87 (Retrieved from): 105-109
        • Gerard J.M.
        • Scalzo A.J.
        • Borgman M.A.
        • Watson C.M.
        • Byrnes C.E.
        • Chang T.P.
        • Lopreiato J.O.
        Validity evidence for a serious game to assess performance on critical pediatric emergency medicine scenarios.
        Simulation in Healthcare: Journal of the Society for Simulation in Healthcare. 2018; 13: 168-180
        • Haerling K.A.
        Cost-utility analysis of virtual and mannequin-based simulation.
        Simulation in Healthcare. 2018; 13: 33-40
        • Heyes M.E.
        • Schnitzen L.
        • Starr D.G.
        • Vacchiano C.
        • Muckler V.C.
        • Thiemann L.
        • Frank Titch J.
        Recertification and reentry to practice for nurse anesthetists: Determining core competencies and evaluating performance via high-fidelity simulation technology.
        Journal of Nursing Regulation. 2018; 8: 43-55
        • Jaunay L.-B.
        • Zerr P.
        • Peguin L.
        • Renouard L.
        • Ivanoff A.-S.
        • Picard H.
        • Duracinsky M.
        Development and evaluation of a new serious game for continuing medical education of general practitioners (Hygie): Double-blinded randomized controlled trial.
        Journal of Medical Internet Research. 2019; 21: e12669
        • Katz D.
        • Zerillo J.
        • Kim S.
        • Hill B.
        • Wang R.
        • Goldberg A.
        • DeMaria S.
        Serious gaming for orthotopic liver transplant anesthesiology: A randomized control trial.
        Liver Transplantation. 2017; 23: 430-439
        • Koo T.K.
        • Li M.Y.
        A guideline of selecting and reporting intraclass correlation coefficients for reliability research.
        Journal of Chiropractic Medicine. 2016; 15: 155-163
        • Liang C.-J.
        • Start C.
        • Boley H.
        • Kamat V.R.
        • Menassa C.C.
        • Aebersold M.
        Enhancing stroke assessment simulation experience in clinical training using augmented reality.
        Virtual Reality. 2020;
        • Lioce L.
        • Lopreiato J.
        • Downing D.
        • Chang T.P.
        • Robertson J.M.
        • Anderson M.
        • the Terminology and Concepts Working Group
        Healthcare Simulation Dictionary – Edition.
        Agency for Healthcare Research and Quality, Rockville, MD2020
        • Lynn M.R.
        Determination and quantification of content validity.
        Nursing Research. 1986; 35 (Retrieved from): 382-386
        • McDermott D.S.
        • Ludlow J.
        • Horsley E.
        • Meakim C.
        Healthcare Simulation Standards of best practice prebriefing: Preparation and briefing.
        Clinical Simulation In Nursing. 2021; 58: 9-13
        • McGrath J.L.
        • Taekman J.M.
        • Dev P.
        • Danforth D.R.
        • Mohan D.
        • Kman N.
        • Bond W.F.
        Using virtual reality simulation environments to assess competence for emergency medicine learners.
        Academic Emergency Medicine. 2018; 25: 186-195
        • Miller G.E.
        The assessment of clinical skills/competence/performance.
        Academic Medicine: Journal of the Association of American Medical Colleges. 1990; 65: S63-S67
      3. National Board of Certification and Recertification for Nurse Anesthetists. (2017). NBCRNA reviewing future alternatives to CPC program exam. Retrieved from

      4. National Board of Certification and Recertification for Nurse Anesthetists. (2018). CPC program: Continued professional certification. Retrieved from

      5. National Board of Certification and Recertification for Nurse Anesthetists. (2022a). About the NBCRNA. Retrieved from

      6. National Board of Certification and Recertification for Nurse Anesthetists. (2022b). Simulation centers. Retrieved from

        • Nayahangan L.J.
        • Stefanidis D.
        • Kern D.E.
        • Konge L.
        How to identify and prioritize procedures suitable for simulation-based training: Experiences from general needs assessments using a modified delphi method and a needs assessment formula.
        Medical Teacher. 2018; 40: 676-683
        • Pottle J.
        Virtual reality healthcare simulation: Economic evaluation and return on investment.
        Oxford Medical Simulation. 2019; (Retrieved from)
        • Shewaga R.
        • Uribe-Quevedo A.
        • Kapralos B.
        • Lee K.
        • Alam F.
        A serious game for anesthesia-based crisis resource management training.
        Computers in Entertainment. 2018; 16: 1-16
        • Spence D.
        • Wicks T.
        • Wojnakowski M.
        • Plaus K.
        Benchmarking study on continuing certification in healthcare and allied health fields: Program variables, commonalities, and trends.
        Journal of Nursing Regulation. 2021; 12: 34-40
      7. Stanford Anesthesia Cognitive Aid Program. (2021). Emergency manual: Cognitive aids for perioperative crises. Retrieved from

        • Swerdlow B.
        • Soelberg J.
        • Osborne-Smith L.
        Distance education in anesthesia using screen-based simulation – A brief integrative review.
        Advances in Medical Education and Practice. 2020; 11: 563-567
        • Taekman J.M.
        • Foureman M.F.
        • Bulamba F.
        • Steele M.
        • Comstock E.
        • Kintu A.
        • Olufolabi A.
        A novel multiplayer screen-based simulation experience for African learners improved confidence in management of postpartum hemorrhage.
        Frontiers in Public Health. 2017; 5: 1-7
        • Tavares W.
        • Brydges R.
        • Myre P.
        • Prpic J.
        • Turner L.
        • Yelle R.
        • Huiskamp M.
        Applying Kane's validity framework to a simulation based assessment of clinical competence.
        Advances in Health Sciences Education: Theory and Practice. 2018; 23: 323-338
        • United States General Services Administration
        System usability scale (SUS).
        Usability.Gov, 2021 (Retrieved from)
        • Waldner M.H.
        • Olson J.K.
        Taking the patient to the classroom: Applying theoretical frameworks to simulation in nursing education.
        International Journal of Nursing Education Scholarship. 2007; 4 (Article18)
        • Watts P.I.
        • McDermott D.S.
        • Alinier G.
        • Charnetski M.
        • Ludlow J.
        • Horsley E.
        • Nawathe P.A.
        Healthcare simulation standards of best practice simulation design.
        Clinical Simulation in Nursing. 2021; 58: 14-21
        • Weinger M.B.
        • Banerjee A.
        • Burden A.R.
        • McIvor W.R.
        • Boulet J.
        • Cooper J.B.
        • Gaba D.M.
        Simulation-based assessment of the management of critical events by board-certified anesthesiologists.
        Anesthesiology. 2017; 127: 475-489
        • Wilkes L.
        Using the Delphi technique in nursing research.
        Nursing Standard. 2015; 29: 43-49