AbstractSchemes that aim to provide some form of academic accreditation in recognition of work-basedlearning are not a new concept. Work-based learning is seen as one of many ways to help tobuild a modern workforce that is fit for practice (DoH 2000a). Northumbria University hasdeveloped a BSc (Hons) and a higher education diploma in critical care practice pathway that isopen to all practitioners in critical care. One of the core modules of this is ‘Foundations inCritical Care’. However, it was recognized that not all practitioners would need to complete afoundation-level module to access the pathway and an Accreditation of Experiential Learning(APEL) scheme was developed in order to accredit experienced practitioners with academicpoints for learning gained from practice. What is new about the Northumbria University APELprocess is the abandonment of the usual portfolio approach and the adoption of an annotatedCV that outlines students’ experience and a viva voce assessment. At their vivas students areasked a number of questions pertaining to the learning outcomes of the module. The assessmentpanel members comprises one academic and one expert practitioner, who then make ajudgement on whether or not the knowledge gained through students’ experience equates withthe learning outcomes of the module. This has been an interesting and enlightening experience:most students who have been through the process have been successful. However, the processhas made a number of students think very carefully about whether or not they need to undertakea foundation module and a number have opted to do just that. The advantages over portfoliosubmission are numerous, the most obvious being that during the viva the only knowledge thatstudents can demonstrate is their own.

Key words: academic accreditation, core modules, foundation model, learning outcome

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Does experienceequate with learningin critical care nurses?

Innovation in practice

Margaret Douglas—Senior Lecturer–Practitioner, School of Health, Communityand Education Studies, Northumbria University and the Newcastle upon TyneHospitals NHS Trust, UK

Vanessa Gibson—Senior Lecturer, School of Health, Community and EducationStudies, Northumbria University, UK

Alan Gregg—Principal Lecturer, School of Health, Community and EducationStudies, Northumbria University, UK

Practice Development in Health Care, 2(2) 139–147, 2003 © Whurr Publishers Ltd

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IntroductionSchemes that aim to provide some form of academic accreditation in recognition ofwork-based learning are not a new concept. They do, however, appear to be growing inpopularity (Manley 2000). Work-based learning is seen as one of many ways to help tobuild a modern workforce that is fit for practice (DoH 2000a). Not only can thislearning be used to directly develop practice and create a better service but also it is ourexperience that nurses want to use this learning to gain formal academic credits, whichthey can use towards a recognized qualification. One way of achieving this is toexamine the links between practice and academic outcomes.

The planning team for the new critical care pathway described in the previousarticle was also keen to recognize the value of experience without compromising thequality of the course.

As part of the new critical care pathway an opportunity for accreditation ofprior experiential learning (APEL) was developed. The APEL scheme would allowstudents to gain 20 academic points while offering flexibility and valuing learningthrough experience. What is different about the Northumbria University APELscheme is its use of an annotated curriculum vitae (CV) and viva voce assessmentrather than written submission, for instance, a portfolio of evidence. Here, we set outour experience of developing this different approach to APEL, and recount the way ithas been received by critical care nurses.

What is APEL?At its simplest, experiential learning is learning that results from experience (Quinn2000). APEL is a means whereby academic credit is awarded for non-certificatedlearning that has been acquired through work experience, and which has not beendirectly and formally assessed through academic or professional certification (Myles1995). However, simply undergoing an experience is not synonymous with experientiallearning, as practitioners may have learned little or nothing as a result (Quinn 2000).Therefore, although the planning team wished to acknowledge and accredit learningfrom experience it was also recognized that quality and equity needed to be ensured.Credit would be awarded for learning that could be articulated, not for the experienceitself. This credit is considered to be of equal standing to that awarded to other studentswho have followed the ‘Foundations in Critical Care’ module. In order to ensure this,students who wished to apply for APEL would be required to undertake a formalassessment of their experiential learning.

Rationale for the inclusion of APEL in a criticalcare pathway

The ‘Foundations in Critical Care’ module recently developed by the University ofNorthumbria started life as an accredited, bespoke course for a particular acute,healthcare trust. However, other trusts soon became interested in this development

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and the module has been run successfully by the university in conjunction with localtrusts as a formal, structured introduction for staff new to critical care.

The new critical care pathway uses ‘Foundations in Critical Care’ as a coremodule, which then enables staff who have undertaken this as an inductionprogramme to gain access to the rest of the pathway without having to repeat any studyunnecessarily. However, the critical care pathway is not only open to new staff but alsoto existing staff, many of whom had been on the waiting list for the old ENB awards inhigh dependency or intensive care. The planning team recognized that these practi-tioners may have gained a considerable knowledge base and clinical expertise fromtheir practice and may not wish, or need, to undertake a foundation module. This ledto the development of an APEL exercise—enabling applicants who wish to beaccredited for their experience to articulate their practice knowledge and be awardedacademic credits for this. (See Figure 1 in the previous article for the structure of thepathway.)

Design of the mechanismOther APEL mechanisms often require students to submit a portfolio of evidence. Thestructure of the Northumbria University APEL mechanism created much debatewithin the planning team. There is little consensus about the use of portfolios, eitherby students or teachers and this lack of agreement has led to students experiencingdifficulties and expressing anxieties concerning the use of a portfolio (Mitchell 1994).

It has been suggested that portfolios are an effective mechanism to facilitatereflection on practice (Rickert 1990) and that this process can develop criticalawareness. Within education, therefore, portfolios are often used as part of anassessment strategy. A major problem identified by Jasper (1995a) in assessing work ofthis kind is its individual nature, in that it is not amenable to standardization in termsof normative content. It is not enough simply to ask students to complete ‘a portfolio’.There are many definitions of a portfolio. Knapp (1975), cited in Oechsle et al. (1990),defined the portfolio as:

a collection of information and evidence used to summarise what has been

learned from prior experiences and opportunities. This learning can then be made

explicit by translating it into recognisable educational currency of learning

outcomes. (Oeschle et al. 1990; 54)

Early literature about the development of portfolios focused on their use as part of anassessment strategy employed to help students to develop their ability to become self-directed learners (Oechsle et al. 1990; Glen and Hight 1992; Mitchell 1994; Cayne1995; Jasper 1995b).

Glen and Hight (1992) advise that student preparation is vital. They advocatethe use of preparatory workshops, clearly stating that lack of student and tutor prepa-ration in the use of portfolios is likely to result in a scheme that does not achieve itsgoals. These authors also emphasize the importance of the development and

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assessment of portfolios being based on clear criteria. This is a particularly importantpoint given their individuality.

There are issues of privacy and confidentiality. If portfolios are to be used as anassessment vehicle, students should understand that their portfolio will be open toscrutiny, a situation that may result in students being very selective about what theyreveal within their portfolio, and which may affect the use of the portfolio as a vehiclefor critical reflection. This could present a dilemma for students: it is important toreflect on critical incidents in terms of experiential learning, but many nurses will bereluctant to admit to errors in practice if these may be used in disciplinary proceedings,either at work or with the UKCC (Jasper 1995a).

A disadvantage to both assessors and students (Oechsle et al 1990; Mitchell1994) is the time taken, both to compile the portfolio and to assess its content. Takingthese factors into consideration the planning team at Northumbria University decidedagainst the use of portfolios and instead developed the notion of using an annotatedCV and viva voce assessment.

The planning team itself consisted of academic and clinical staff from nursing andallied health professionals. It was therefore important that any APEL mechanism metboth the rigorous standards of the university’s quality assurance processes and the flexi-bility required by practitioners and employers. It was finally agreed that students whowished to apply for APEL must have two or more years’ experience of working with criti-cally ill, Level 3 patients (Table 1). Our experience of teaching both the old intensivecare and high dependency courses had led us to believe that staff who had only experiencein caring for levels 0–2 patients would benefit from undertaking the ‘Foundations inCritical Care’ module and this was reiterated by clinical experts in the field.

The APEL mechanismAs APEL is considered to be of equal standing to the award given to other studentswho have followed the ‘Foundations in Critical Care’ module, students must demon-

Douglas et al.

Table 1. Classification of critically ill patients recommended by the DoH (2000)

Level 0 Patients whose needs can be met through normal ward care in an acute hospital

Level 1 Patients at risk of their condition deteriorating, or those recently relocated from

higher levels of care, whose needs can be met on an acute ward with additional

advice and support from the critical care team

Level 2 Patients requiring more detailed observation or intervention, including support for a

single failing organ system or post-operative care and those ‘stepping down’ from

higher levels of care

Level 3 Patients requiring advanced respiratory support alone or basic respiratory support,

with at least two organ systems; this level includes all complex patients requiring

support for multi-organ failure

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strate the achievement of the learning outcomes of this module (Table 2). Because wewere awarding 20 academic credit points based on experience we wanted this to be arigorous process. These points are awarded at diploma or degree level, depending onthe students’ previous academic achievements and on the level at which they wishedto follow the pathway.

Students who wished to be considered for the APEL mechanism were invitedto attend a preparatory workshop where they could meet the course team and discussconcerns about APEL. At this point students need to decide if APEL is the correctoption for them. For some, the formal taught module will better meet their needs. Thiswas indeed our experience of running the workshops. Students who felt that APEL wasnot for them were at liberty to apply for the taught module. It was emphasized duringthe workshop that experience does not always equate with knowledge, expertise andapplication, and that students may gain more from undertaking the module than theythink! (Scholes and Endacott 2002). In addition to both students and teachers beingsatisfied that APEL was the best option, students were asked to seek the agreement oftheir managers for this option. This agreement was necessary because the courses werefunded through a continuing education voucher scheme, the costs of which were metby the Northern England Workforce Development Confederation (NEWDC), so thecost of the APEL exercise would be met from deduction of continuing education

Experience equates with learning? 143

Diploma level

● Undertake an assessment of the patient’s

physiological needs and recognize the signifi-

cance of the assessment findings in relation to

levels 0–2 patients

● Demonstrate the ability to manage the patient’s

airway and develop an understanding of non-

invasive ventilation

● Assess and manage the patient with potential

haemodynamic instability

● Assess the extent and significance of renal

impairment

● Identify the physiological effects of malnu-

trition in critical care

● Identify and discuss the psychosocial stressors

of the critical care environment and their

effects on patients, family and staff

● Evaluates the care received by levels 0–2

patients using contemporary sources of

evidence

Degree level

● Undertake an assessment of the patient’s

physiological needs, recognize and analyse the

significance of the assessment findings in

relation to level 0–2 patients

● Demonstrate ability to manage the patient’s

airway and develop an understanding of non-

invasive ventilation

● Assess and manage the patient with potential

haemodynamic instability

● Assess the extent and significance of renal

impairment

● Identify and provide an appropriate rationale

regarding the physiological effects of malnu-

trition

● Identify and debate the psychosocial stressors

of the critical care environment and their

effects on patient’s, family and staff

● Rationalize and critically evaluate the care

received by levels 0–2 patients using contem-

porary sources of evidence

Table 2. Learning outcomes for the ‘Foundations in Critical care’ module

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vouchers allocated to students’ employing authorities. It was vital, therefore, to elicitmanagers’ opinions, as they are able to make judgements on students’ abilities and may(or may not) recommend the APEL mechanism.

After the workshop, students are asked to prepare and submit an annotatedCV. This should not only outline the length of their experience but should makeexplicit reference to its applicability to critical care. The CV should also outline whatstudents have learnt from practice and how they have applied this to developindividual practice. Students were encouraged to do this by providing very shortaccounts of cases, incidents or developments in which they had been involved, and byproviding contemporary evidence and use of published literature. They were thendirected to the learning outcomes of the modules and advised to make links betweenthe two. In addition to the learning outcomes for the module, students were given theoutline syllabus so they were aware of exactly what was covered in the module. Theywere offered further individual tutorial support in preparing their CV and given aformal submission date. The CVs were to be no longer than three sides of A4 paper.

After submission, the CVs were scrutinized by the assessment panel, whichused them to prepare further questions they wished to ask to ensure that students wereable to meet learning outcomes.

Students were then invited to a viva voce assessment, which would last for 30minutes. This assessment was conducted by a panel of two experts, one academic andone clinical, who used the basis of the CV to further probe experience, understandingand application of knowledge. The answers given were measured against the learningoutcomes of the module.

Undertaking the viva voceTen and six years’ experience, respectively, of running the intensive and high depen-dency courses had led us to believe that some critical care nurses were overconfidentabout their knowledge base, and this belief is supported by other authors (Day et al.2001; Day et al. 2002). The experience of introducing a CV and of viva voce assessmentgave a whole new dynamic to the process of APEL. Normally confident nurses did notlike the idea of having to articulate their knowledge explicitly, and the process led themto question the right option for them; some opted to complete the formal taught modulebecause of this. If the APEL mechanism had led to submission of a portfolio of evidenceit is more likely that more students would have chosen the APEL mechanism. However,we wanted to be satisfied that the knowledge that students were reproducing was theirown. In addition, we wanted them to articulate how they had applied their knowledgeinto practice. It begs the question: why were a lot of students unnerved by this?

The experience of introducing a CV and viva voce assessmentgave a whole new dynamic to the process of APEL.

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After the initial APEL workshop, six students opted to undergo the APEL exercise. Allhad attended a preparatory workshop and had submitted CVs that adhered to theguidelines. Some students were more specific than others in that they identified actualprojects they had been involved with, which would meet a key outcome. Others linkedoutcomes together more generally.

The interview panel consisted of two experts: a senior lecturer–practitionerand a practitioner–lecturer in critical care or a senior member of clinical staff. Whenplanning interviews, care was taken to ensure that the practitioner–lecturer did notwork in the same clinical area as the student to avoid possible interviewer bias. Theroles of the interviewers were clearly defined in that the senior lecturer would beencouraging critical thinking and primarily represent the university, whereas thepractitioner–lecturer would be the ‘clinical’ expert and ensure that the issues raisedwere an accurate reflection of clinical practice. All of the interviewers were familiarwith the content and learning outcomes for the ‘Foundations in Critical Care’ module.

Both interviewers met before the interviews and reviewed the CVs along withthe seven learning outcomes from the module. This enabled them to formulate thequestions that could be used to enable students to articulate their knowledge and appli-cation further from the information in their CVs. As expected, it was found thatalthough there was sometimes a different focus, all students had similar themes in theirCVs.

Initially, it was anticipated that the interviews would take 30 minutes;however, as the interviews progressed it became clear that for all seven outcomes to beexplored an hour was more realistic. All six students were able to meet the APELrequirements. This process has been repeated with 14 candidates, with most being ableto meet the APEL requirements. Those students who were not able to demonstrateachievement of the learning outcomes were not accredited and were given the optionto undertake the ‘Foundations in Critical Care’ module.

There were concerns, from the interviewers’ perspective, that students mayhave found the process an ‘easy’ option. However, anecdotally, students have statedthat they found the experience very challenging and felt that they definitely earnedthe 20 CAT points they were awarded. Throughout the APEL exercise, a variety ofassessors have been involved, all of whom now believe that this is a rigorous processthat should be continued. The learning points from the assessors were that:

● students require good support and preparation in the form of a workshop toenable them to prepare adequately before interview

● students need to make explicit the links between their experience and themodule outcomes within their CV

● at interview, the assessors are required to explore and give students opportu-nities to articulate their knowledge about the module outcomes

● sufficient time is needed to allow all seven outcomes to be explored● if students are unable to articulate their knowledge adequately they should be

advised to undertake the taught foundation module.

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Innovation in accreditationFollowing the use of the APEL mechanism described above, approval was sought byother courses to use the same route. The proposed process was therefore submitted tothe university’s quality assurance committee. Submission of the proposed structurecaused some stimulating debate, as it appeared to be the first time APEL had beenconceptualized in this way. The process was approved for use with the wholecontinuing professional development framework. Furthermore, the quality assurancecommittee praised the process as being an innovative solution to the problem of fairbut rigorous accreditation of previous experiential learning. Indeed, the issue wasviewed so favourably that the process was disseminated as an exemplar of good educa-tional practice. The dissemination of the new APEL structure has resulted in theprinciples of the process being adopted by diverse educational areas, such as playworkand multidisciplinary practice education.

The dissemination of the new APEL structure has resulted inthe principles of the process being adopted by diverse educa-tional areas, such as playwork and multidisciplinary practiceeducation.

ConclusionSchemes that aim to provide some form of academic accreditation in recognition ofwork-based learning are not new and recent changes to education have allowed scopefor them to be included in new critical care pathways. The team developing the newcritical care pathway at Northumbria University was keen to adopt an accreditationscheme for experienced practitioners in order to acknowledge and value the knowledgethey had gained from their practice. However, the team was also keen to avoid the useof lengthy and cumbersome portfolios of evidence.

Since its initial validation for the critical care pathway, the APEL mechanismhas proved a success and has been adopted by other courses in the university, includingthose from nursing, playwork and multidisciplinary practice education.

The innovative approach to APEL, through use of a CV and viva voceassessment, gives students an opportunity to articulate how their knowledge matchestheir current practice. This process is dynamic, enabling assessors to be confident thatthe knowledge articulated by students is their own, and providing opportunities forstudents to turn their practice experience into academic currency.

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AcknowledgementsThe authors would like to acknowledge the valuable contributions of all members ofthe planning team and staff who have acted as assessors: Lesley Bolding, Sarah Carr,Debbie Cheetham, Anne Gray, Elaine Henderson, Karen Imrie, Mike Kelleher, LizKlein, Leigh Mansfield, Alan Platt, Annette Richardson, Iain Rutherford, JohnStephens and Beverly Wilkinson.

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Address correspondence to: Vanessa Gibson, Senior Lecturer, Room H217,Northumbria University, Coach Lane Campus, Coach Lane, Benton, Newcastle uponTyne NE7 7XA, UK (E-mail: vanessa.gibson@unn.ac.uk).

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