Objective Measurement of Student Clinical Performance

1
Objective Measurement of Student Clinical
Performance

• Kassie McKenny, RN, MSN
• Bobbie Weber, RN, MSN
• Clarkson College

2
Rationale for Project Development

• Faculty needed an evaluation method that
  distinguished clinical performance beyond that of
  simple pass or fail.
• Students needed a motivational tool to achieve
  academic excellence within the clinical setting.

3
Subjective Evaluation

• Does not adequately reflect clinical performance
  and distinctly does not reward high achievers
  (Wiles Bishop, 2001, p. 37)
• Clinical performance is assumed to be
  satisfactory but carries no weight in the
  students average for the total program (Reilly
  Oermann, 1992, p. 436)

4
Subjective Evaluation

• Formatively evaluation scale
• SP Satisfactory Progress
• UP Unsatisfactory progress
• IP In progress
• Summative evaluation
• No required number of SP or limited number of UP
• Students could pass a course based solely on the
  their last week of clinical performance. In that,
  if a student received a satisfactory rating
  during the last week of clinical this
  demonstrated understanding and application of
  clinical competencies. Therefore, students could
  pass the course based on one final week of
  satisfactory performance.

5
Objective Evaluation

• Often perceived to be more discriminating
  (Reilly Oermann, 1992, p. 436)
• Applies consistent standards to student
  performance (OConnor, 2001, p )
• Generates a valid and reliable evaluation tool
  (OConnor, 2001)

6
Development of a Dimensional Grading Scale

• Five-level dimensional rating scales reviewed
• Three domains of learning addressed
• Psychomotor
• Cognitive
• Affective
• Student level within the program considered

7
Pilot Project Scale

• 1-5 rating
• 1 Dependent
• 2 Marginal
• 3 Assisted
• 4 Supervised
• 5 Minimally Supervised
• Needed a final average of 3 or above in each
  course competency to pass

• Effective change from subjective scale
• Faculty and students found it was difficult to
  determine the difference between a 4 versus a 5
• Unsuccessful attempt at student self evaluation
• Final Outcome
• Condensed scale into 3 levels of achievement

8
Current Evaluation Scale

• 1 Below Average
• Unsafe, unskilled, inefficient, continuous verbal
  and physical cues needed
• Lacks confidence, unable to demonstrate behavior
• Paperwork inconsistently completed after CI
  counseling, unable to incorporate CI comments or
  no changes made based on CI comments/counseling
  regarding repetitive error

9
Current Evaluation Scale

• 2 Average
• Safe, accurate, able to complete tasks on time,
  supportive cues, frequent verbal cues
• Affect appropriate most of the time, desired
  outcome most of the time
• Paperwork received and completed. Comments
  offered, student receptive to CI suggestions.
  Corrections made based on CI comments, has shown
  improvements

10
Current Evaluation Scale

• 3 Above Average
• Safe, accurate, proficient, coordinated,
  confident
• Appropriate affect each time, desired outcome
  each time
• Paperwork received, completed with minimal
  corrections

11
Summative Evaluation Using the Current Scale

• In order to pass a clinical course, students must
  now received an average of 2 in all clinical
  competencies by the end of the semester.
• A passing grade now demonstrates continual
  progression toward understanding of clinical
  competencies.

12
Effectiveness

• Faculty have accepted the evaluation scale
• It allows for clear delineation of clinical
  performance
• Helps me be more consistent when evaluating
  students
• It gives students something to strive for, they
  always want to get that 3
• I can finally fail a student based on
  unprofessional behaviors

13
Limitations

• Bias is still present
• Evaluation is always subjective for it involves
  human beings with their own set of values that
  influence the process (Reilly Oermann, 1992,
  p. 383).
• Increase time commitment to complete evaluation
  tool

14
Future Recommendations

• Schools of Nursing review current student
  clinical evaluation process to determine
  objectivity and effectiveness
• Consideration of a number rating scale for
  evaluation if current process is found to be more
  subjective than objective
• Further research to determine reliability and
  validity of a number rating scale

15
References

• OConnor, A. (2001). Evaluation strategies for
  the laboratory and clinical practice settings. In
  Clinical Instruction and Evaluation A Teaching
  Resource. (pp. 177-200). New York National
  League of Nursing.
• Reilly, D. E., Oermann, M. H. (1992). Clinical
  evaluation. In Clinical Teaching in Nursing
  Education (2nd Ed., pp. 379-420). New York
  National League of Nursing.
• Reilly, D. E., Oermann, M. H. (1992). Grading
  of clinical experience. In Clinical Teaching in
  Nursing Education (2nd Ed., pp. 421-449). New
  York National League of Nursing.
• Wiles, L. L., Bishop, J. F. (2001). Clinical
  performance appraisal Renewing graded clinical
  experiences. Journal of Nursing Education, 40,
  37-39.