Competency-based assessment is an important component of neonatal simulation-based training programs, as it provides a systematic approach to evaluating learners' cognitive, technical, and behavioral skills.1,2 Competency-based assessment involves using performance indicators, which describe observable and measurable behaviors or actions that reflect a learner's level of competence in a particular area. Assessment can be formative, summative, or high-stakes.3 Formative assessment refers to ongoing assessments that occur during the learning process. Summative assessment is typically conducted at the end of a learning period. High-stakes assessment refers to assessments that have significant consequences or implications. Competency-based assessment is critical for evaluating learners' performance and can enable feedback and identify areas for improvement.

In neonatal simulation-based training, cognitive competency is typically assessed by evaluating learners' performance in managing critical care scenarios. Learners' technical competency may be assessed on their ability to perform procedures such as intubation, chest compressions, and medication administration. Behavioral skills competency can also be assessed by observing team interactions or difficult conversations.

Competency-based assessment requires observation and evaluation using an assessment tool. Assessment tools used in neonatal simulation-based training may include checklists, behaviorally anchored rating scales (BARS), and global rating scales (GRS).4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20 Recently, the use of cumulative sum analysis (CUSUM) has been explored as a way to examine the development of competency during training.21

In this report, we examine the topic of competency-based assessment in neonatal simulation-based training. We begin with a brief review of the history of neonatal simulation-based training. Next, we review the concept of 'competency' and strategies to evaluate it. Then we explore validity and reliability and the evidence needed to make a validity argument. Finally, we present an evidence-based approach to neonatal simulation-based training and competency-based assessment.