Table 6.

Messick´s validity framework

Aspect of Messick´s Validity	Definition	Evidence from Study
Content validity	The degree to which the content reflects the construct being measured.	Simulation includes all relevant procedures (e.g., SI-screw placement, external fixation).
Substantive validity	The relationship between participants’ responses and the construct.	Increased confidence in performing critical procedures, consistent with the aim of the simulation.
Structural validity	How well the structure of the assessment reflects the construct.	Confidence ratings and procedural outcomes align with expected skill improvements.
Generalizability	The extent to which results apply to other populations and settings.	Participants included residents and consultants; limited by single institution and small sample size.
Consequential validity	The impact of using the assessment on behavior and outcomes.	Increased interest in future practice and improved confidence, but no long-term outcomes (e.g. skills) assessed.