The FY16 JPC-1/MSIS RealMETRX is seeking research to determine, define, and validate the best indicators (metrics/evaluation criteria) of training proficiency that are amenable to appraisal using medical simulation systems and are empirically linked to optimal provision of patient care. What are some of the best metrics and evaluation criteria to measure effective decision making of novice or even not-so novice healthcare personnel to better measure the multitude of variables and patient outcome contributors that could occur from the first healthcare encounter, to the time of discharge and even near-term follow-up (such as within the first 6 months)? What are the best metrics/evaluation criteria that could be used to (1) accelerate acquisition of maturity and experience level for novice and not-so novice healthcare personnel and (2) compare them to similar high-performing colleagues considered to be experienced within their discipline? It is expected that award recipients will use statistical approaches to determine the best metrics and evaluation criteria that will objectively assess and measure the transition from training using medical simulation systems to that of actual medical practice. It is expected that award recipients will concentrate their research within acute trauma care, critical care, and prolonged care. It is expected that the award recipients will consider healthcare scenarios and medical conditions in order to uncover common patient outcomes or training-sensitive outcome indicators versus those that are currently used to evaluate tasks, skills, and procedures. Metrics produced should include as many aspects of the continuum of care as possible and should focus on acute trauma care, critical care, and prolonged care. Military-relevant injuries and conditions should be considered, but should not constitute the entirety of the variables, metrics, and evaluation criteria. It is anticipated that many of these variables, metrics, and evaluation criteria will transcend across the military, Veterans Health Administration, academic, inpatient, outpatient clinics, rural healthcare settings, private and public hospitals, and international healthcare situations.