Assessing Students’ Performance

Competence in clinical practice is today, more than ever before, an essential outcome of undergraduate education in nursing and other health disciplines. As such, accurate and reliable evaluation of clinical performance, and the provision of formative and summative feedback on performance, are essential aspects of quality clinical education.

Principles for assessing competence
There are a number of relevant competency standards or frameworks. These standards or frameworks are designed to provide a resource for people assessing the competence of health professionals for professionals whose performance is undergoing assessment. Issues of particular note include the comprehensive nature of competence, use of multiple assessment methods and the need for an evidence-based approach to the assessment of competence.

Assessment External link
This resource written by Lake (2005) as part of the Teaching on the Run Tips Series, highlights some particular aspects of assessment in the workplace, the measurement of performance, challenges for assessors in assessing individual students and general strategies for ongoing improvement.

Giving feedback External link
This article by Vickery and Lake (2005) is also part of the Teaching on the Run Tips Series. It builds on the comprehensive notion of competence (see the ANMC resource above) and briefly highlights best practice characteristics of good feedback. It is also worth noting the connections with other LaCE modules, particularly Envisioning (Setting clear directions) and Enhancing (Interacting in a range of contexts and Empowering others to achieve).

7 tips for giving positive feedback External link
Writing from a management perspective, Lyndsay Swinton (2005) outlines 7 tips for giving (positive) feedback. Her slightly different ‘take’ on this issue adds to the information provided in the resources identified above.

Exercise

This short video clip has been designed to assist your thinking about giving feedback on students’ performance in the clinical setting:

After watching the video, we suggest you reflect on the following questions:

  • To what extent do you think feedback was provided effectively in this interaction, and why?
  • What were the strengths in the way feedback was provided? What are your reasons here?
  • What were the gaps, if any, in the way feedback was provided? What are your reasons here?
  • What, if anything, would you have done differently in this situation, and why?

Thinking Points

  • What does ‘assessment’ within the context of clinical education mean to you? What is the basis of your view?
  • What is your definition of ‘competence’ and how does it apply to your approach to the assessment of students' performance in the workplace?
  • In your view, what are the similarities and differences between formative and summative assessment? How do you action these concepts in practice?
  • To what extent do you agree with Vickery and Lane's best practice indicators of quality feedback (see the Giving Feedback resource above)? What are the reasons for your views? Based on your experience, what additional/alternative suggestions do you have?

 

Transcript

Student: That’s great Mr Billington, it’s looking much better today. If you have any pain or irritation or anything just give us a buzz and we’ll come back in to you. But we’ll be in to check on you soon anyway.

Supervisor: So how do you feel you went out there?

Student: I thought I was quite good today, actually.

Supervisor: You seemed to be a little bit nervous, lacking a bit of confidence there.

Student: Well maybe that’s because I haven’t practiced this skill in probably about six months, since last prac. And also because you were in the room I was a little bit uncomfortable with you watching me.

Supervisor: They’re fairly general lack of confidence things. Have you got something more specific, things that you were actually really worried about the procedure itself?

Student: Well just not, with the sterile field, I guess, I’m just not familiar, like really comfortable with it. So knowing where I can put things and which is okay to use and all that sort of thing.

Supervisor: Alright, so can you identify for me the main principles of asepsis?

Student: Well it’s keeping a sterile field and making sure that you don’t introduce anything like infection into the person’s wound.

Supervisor: Okay, alright. Can you identify any ways in which you might have compromised that during which you did that procedure on that patient?

Student: Well I can’t think of anything. Did you notice anything?

Supervisor: Well what about when you put the gauze on the field and it was right on the edge? It was touching the...

Student: Oh, and I brought it back in.

Supervisor: Yep, what could that do?

Student: Well I guess if there’s micro-organisms around the sides and then I brought the gauze back into the sterile field and if I put it on the patient, they’re more open to infection.

Supervisor: Yep definitely, yeah. So that’s quite a big problem. The other thing I was a bit worried about was just that you seemed really, really nervous when you were dealing with the patient.

Student: Probably just because I was uncomfortably like with the knowing what to do and haven’t had practice, so I was more intent on just practising.

Supervisor: So just a bit of a lack of exposure problem.

Student: Yeah, it would be.

Supervisor: Okay, so can you identify any ways that we can improve this for you?

Student: Well I think I just need more practice. Maybe if I ask my RN, my buddy RN if I can watch next time. And then the time after that, maybe I can do it and she can observe me. That would be good.

Supervisor: So I guess what you’re saying there is you would like some better examples. So watching somebody do it just so you can be reminded how to do it properly.

Student: That would be great, yeah.

Supervisor: So we can build upon what you suggest. I think this is a really good ward to see lots of dressings. So other nurses have dressings to do as well. So you could actually ask them to let you know when they’ve got dressings to do. So maybe you can do lots of dressings over a few days. Because that lack of exposure, the more you do something the more confident you’re going to become. So next time you’ve got a dressing to do maybe give me a page and I can come down and go through what I expect and demonstrate how to do it properly.

Student: I can also go home tonight and have a look in my text. Have another look over it would be a good idea.

Supervisor: Yep, or if you’re in at the university you can watch the video on asepsis or something like that. I think you’re going to do fine. You’ve got a good understanding of the principles that apply, you just need practice. So I’ll come back and assess you in a couple of days. You know, just we’ll go through it again together and see how you’re going. And if you’re still struggling we might actually formalise that and identify some of the strategies and ways we can help you to improve. We’ll put them in a little learning contract.

Student: Oh, okay.

Supervisor: Okay, alright? Thank you.

Student: Thanks.