Professionals are people who problem solve for service in their particular discipline, through the use of technical or specialised knowledge and skills. If graduates from higher education are adequately prepared to perform their role as professionals, then the concept of competency comes to the forefront of the education charter. The literature reveals a variety of meanings concerning the concept of competency resulting in some academics adopting a narrow definition which focuses on psychomotor skills and vocational training. Competence, however, is a complex concept that encompasses such attributes as knowledge, skills and attitudes. It enables an individual/group, to perform a role or set of tasks, to an appropriate level, grade, quality or achievement, thus making the individual/group competent in that role. As competency is a complex concept, it follows that there should be multiple assessment strategies, to evaluate the effectiveness of student learning. Some of these include critical incidence, case studies, journal keeping, and self-evaluation.
A second and more generic interpretation of competency, can be found in the management literature (Boyatzis, 1982). This interpretation concentrates on the crucial general attributes of effective role performance that a practitioner demonstrates and which may be transferable to other roles (Gonczi, 1993). This model not only ignores the context in which the competency takes place, but also the literature on novice to expert, which suggests that expertise is domain specific (Benner, 1984; Mc Gaw, 1993).
A holistic perspective of competency marries both the above interpretations and considers the context in which the professional works. It allows for the incorporation of values, ethics and the need for reflective practice. This holistic interpretation of competency has been adopted by 19 professions, all of whom require specific standards of competency to be learnt at a university level of education.
A competency can be measured by using performance criteria that describe the processes, tasks and expectations of performance a competent professional will perform. That is the behaviour, the observable results and type of performance which would provide the evidence of competence. The nature of performance criteria for the professions can be complex and broad. They are not a check list of functions, but represent the complex attributes required to fulfil a professional role.
Thus the nature of nursing is dynamic. It changes in response to a variety of social/political, economic, cultural, religious and health factors. Professional nurses address these complex influences and the uniqueness of caring for the individual, by using knowledge, intuitiveness and logical thought. Mindful of this constantly changing nature of nursing, nurses have developed competency-based standards which make explicit the complex attributes of a novice practitioner. Nurse educators have sought and implemented a variety of strategies to assess a student's clinical competence based on these competency standards. These strategies of assessment are integrated, combining knowledge, comprehension, problem solving, technical skills, attitudes and ethics. By using multiple assessment techniques, the amount of evidence increases providing a more solid foundation on which to make a judgement about a students competence. Some strategies for assessing clinical competencies include: observation, written communication and self-evaluation.
One method of recording student performance in the clinical environment is the critical incident. This method not only records a learner's performance but can also be used to assess a student's problem solving and analytical abilities. In this strategy the clinical teacher records some aspect of the student's behaviour, to be evaluated according to specific performance criteria. Critical implies that the behaviour has a significant impact, either positive or negative, on the outcome of the activity. Before this technique for competency assessment is implemented, there must be agreement between clinical teachers as to the specific competencies to be assessed. The record of critical incidents can also provide a basis for student teacher discussion helping the student to visualise their own behaviours identifying both strengths and weaknesses. In nursing, questions posed concerning the critical incident usually relate to nursing judgements and/or actions such as those involved in the nursing process (Schweer and Gebbie 1976).
As with other forms of evaluation strategies, evaluation criteria should be set before the case study is written. These should be based on the students educational level, practice experience and competencies to be achieved. Students should be informed of these details so that they clearly understand what is expected. For example, at the comprehension level the student should include interpretive and extrapolative behaviours is whilst at the analytical and synthesis level the student would be expected to draw upon relevant theories (Reilly, 1980).
A further method of evaluating clinical practice by written work, is journal writing. 'Journals are written dialogues between the self and the chosen audience' (Strackbein and Tillman, 1987). The value of journals lies in the ability to actively engage the student in transferring classroom discussions to clinical experience and allowing the evaluator to participate in the learner's experience from the learner's perspective. Using a triangular approach, whereby the student links personal and professional experiences with theory from the classroom and the literature, prevents students from writing what they think the teachers want to read. Teachers must, however, clarify from the outset the guidelines for journal entries. These include the purpose and criteria for evaluation, which should be based on the clinical competency being assessed. It is important to inform the students if journals are to be used for peer evaluation since students need to know how much they can self-disclose.
Criteria for marking, using the triangulation approach, is based on determining the level of analysis and synthesis in the entries which reflect the students reading, classroom and life experiences. Using this method of journal keeping will foster the development of skills in introspection, reflection, and dialogue and provides an avenue for students to make sense of and to learn from their mistakes. For this to occur, however, teachers need to build a trusting relationship with the student. This can be achieved by responding in a sensitive manner to personal disclosures and providing constructive written feedback on specific aspects of content rather, than global references to 'good work' (Heinrich, 1992).
A further method of assessing clinical competencies is by self-evaluation. Self-evaluation is useful in formative evaluation of clinical practice as students can identify their progress towards meeting specific goals. Techniques include journaling, videotape and self-rating scales. Self-evaluation requires skill and practice and for this reason the process needs to be taught in systematic manner at the beginning of the instructional period and implemented on a continuous basis. The literature describes the process of self-evaluation as the learner taking the responsibility to set goals and to determine achievement of those goals (Schweer, 1976; Best, Carswell and Abbott, 1990; Reilly and Oermann, 1992). In nursing, however, where there is an expectation of adherence to standards for safe practice, the process of self-evaluation can be learnt by working collaboratively with an experienced nurse educator, in setting appropriate learning goals based on the specific clinical competencies and performance criteria (Best, Carswell and Abbott, 1990). This collaborative approach allows the student to gain the confidence to self-evaluate and allows time for the student be socialised into the profession. It will only be successful, however, if the teacher is willing to act as a mentor and facilitator. Feelings of anxiety and negativity can be reduced by building a trusting relationship and creating a climate where the student feels free to take risks. The locus of control will eventually shift from teacher to learner as the learner gains more confidence in self-evaluation.
The focus of self-evaluation is to assist the student to confidently make independent judgements about her/his own practice in accordance with the values of the profession and it offers students the opportunity to express opinions about their performances. Thus, the goal of self-evaluation is to have students work towards an independent state where they will eventually be able to judge and act upon their own behaviours. This is based on studies which suggest that a person who participates in self-evaluation and creates their own learning objectives and solves their own problems, ultimately controls their own life (Best, Carswell and Abbott, 1990).
There are a variety of competency-based assessment strategies which can be used to assess competency in clinical practice, these include observations such as critical incidents, written communication such as case studies and journaling and, finally, self evaluation. The degree of success, however, with these strategies depends on the teacher developing a trusting relationship with the learner and treating the learner as an adult, letting them take responsibility for their own learning. Vested interests and hidden agendas have to be dealt with if competency-based assessment is to function effectively. The change in assessment techniques means renouncing old habits, which is possible if university teachers are committed to preparing the graduate to the best of their ability. In the words of John Dewey 'We are free, not because of what we statically are, but as far as we are committed to becoming different from what we are' (Dewey, 1963 p291).
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|Please cite as: Piercey, C. (1995). Assessing clinical competencies. In Summers, L. (Ed), A Focus on Learning, p206-211. Proceedings of the 4th Annual Teaching Learning Forum, Edith Cowan University, February 1995. Perth: Edith Cowan University. http://lsn.curtin.edu.au/tlf/tlf1995/piercey.html|