Assessing the practical/clinical skills of students: Presented at the RITAL Conference 2010 By:...
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Transcript of Assessing the practical/clinical skills of students: Presented at the RITAL Conference 2010 By:...
Assessing the Assessing the practical/clinical skills of practical/clinical skills of
students:students:
Presented at the RITAL Conference 2010Presented at the RITAL Conference 2010By: Florence Davidson, Radiography By: Florence Davidson, Radiography
Lecturer, CPUT, GSH campus & Lecturer, CPUT, GSH campus & Curriculum Officer for RadiographyCurriculum Officer for Radiography
77thth December 2010 December 2010
Type of assessmentType of assessment
SimulationSimulation OSCEOSCE Clinical (practical, in the workplace)Clinical (practical, in the workplace)
Contents:Contents:
Presentation: (15 minutes)Presentation: (15 minutes) Defining “clinical competence”Defining “clinical competence” Types of instruments used for Types of instruments used for
assessing competenceassessing competence Drafting criteria for rating a clinical skillDrafting criteria for rating a clinical skill Aspects of defining “performance”Aspects of defining “performance” Additional considerationsAdditional considerations Round table discussion: (30 Round table discussion: (30
minutes)minutes)
A model of competenceA model of competence
Fitness for purpose: focuses on the immediate requirements of the workplace
Fitness for award: focuses on the educational preparation of the graduate
Fitness for practice: focuses on the legal aspects of the individual practitioner’s capabilities
A model of competence (Williams and Berry, 1999)
CPUTGRADUATE
Defining clinical Defining clinical competencecompetence
1. Novice
2. Advanced beginner
3. Competent
4. Proficient
5. Expert
The Dreyfus and Dreyfus model of skill acquisition (adapted from described Benner (2001.)
KEY:•Novice: 1st time in clinical,
no experience.
• Advanced beginner: some clinical exposure, but unable
to adapt to differentsituations.
• Competent performer:typically at the end of training/mentoring, able to cope, ready
registration.
• Proficient performer: has experience to modify their
response.
• Expert: has an intuitive grasp,can “hone in” on the problem.
Observable Practice
Potential practice
Professional field
•OP: what the HCP is observed doing in practice
* PP: what the HCP does not ordinarilydo (?specialties,? extended scope), but there may be reasonable expectation
• PF: holistic practiceencompassing all the above as well as key competencies
KEY:
Adapted from Melnick et al (2002)
Practice domains and assessment
““Technical ability”Technical ability”
What are we
assessing?
Motor skillsPrevious
experiencesCognitive elements
Adaptability to
new and changing
situations
Ability to work withpeers and
other Health Care Professionals
Procedural
checklistsGlobal
Rating scales
Instruments for assessing “technical” Instruments for assessing “technical” skills:skills:
1. Structured Technical Skills Assessment Form 1. Structured Technical Skills Assessment Form (STSAF)(STSAF)
Instruments for assessing “technical” Instruments for assessing “technical” skills:skills:
2. Global Rating Scales (GRS):2. Global Rating Scales (GRS):
Respect for tissueOften used unnecessary force on tissue or caused damage by inappropriate use of instruments
Careful handling of tissue but occasionally caused inadvertent damage
Consistently handled tissues appropriately, with minimal damage
Time and motion Many unnecessary moves Efficient time and motion, but some unnecessary moves
Economy of movement and maximum efficiency
Instrument handling
Repeatedly makes tentative or awkward moves with instruments
Competent use of instruments, although occasionally appeared stiff and awkward
Fluid moves with instruments and no awkwardness
Knowledge of instruments
Frequently asked for the wrong instrument or used an inappropriate instrument
Knew the names of most instruments and used appropriate instrument for the task
Obviously familiar with the instruments required and their names
Use of assistants
Flow of operation and forward planning
Knowledge of specific procedure
(Krishna Moorthy, Yaron Munz, Sudip K Sarker, Ara Darz:2003)i
Variable 1 2 3 4 5
Drafting criteria for rating a Drafting criteria for rating a clinical skill (STSAF)clinical skill (STSAF)
1.Decide on the type
of student to be assessed
4. Write down the performancecriteria you want to see a student
do to demonstrateacceptable skill
5. Discuss, revise and
select a master list ofcriteria
2. Decide on the setting forthe assessment
3. Select theclinical skill you
want to evaluate
(Adapted from Watts, N: 1990)
Essential elements in the Essential elements in the construction of the instrumentconstruction of the instrument
Inter-rater Inter-rater reliabilityreliability
Construct validityConstruct validity
10/1010/10
10/1010/10
10/1010/10
1st year: 42%
2nd year:
63%
3rd year:
88%
Essential elements in the Essential elements in the construction of the instrument construction of the instrument
Aspects of “performance”Aspects of “performance” ObservableObservable -(things you can see, hear or -(things you can see, hear or
feel someone do);feel someone do); EssentialEssential – not simply desirable, or – not simply desirable, or
characteristics of an excellent characteristics of an excellent performance, but performance, but necessary necessary in order to be in order to be acceptably safe, effective acceptably safe, effective and/or and/or efficient;
Directly related to this skill;Directly related to this skill; Likely to be called for under most (routine)
circumstances when this skill is employed(Watts, N: 1990)
Other considerations:Other considerations:
How often we need to see a student How often we need to see a student attempt the task before we are prepared attempt the task before we are prepared to judge their level of mastery;to judge their level of mastery;
What types or degrees of error would say What types or degrees of error would say mastery is not yet acceptable;mastery is not yet acceptable;
The importance of procedural steps v The importance of procedural steps v speed and smoothness;speed and smoothness;
Routine v unfamiliar situations; andRoutine v unfamiliar situations; and How many times until we are convinced of How many times until we are convinced of
mastery?mastery?
Discussion pointsDiscussion points
What What type of instrumentstype of instruments are you are you using to assess the practical using to assess the practical competence of your students?competence of your students?
What What aspectsaspects (technical/procedural/ (technical/procedural/ professional) are you assessing?professional) are you assessing?