This document discusses assessment of students in clinical practice. It addresses who can supervise and assess students, methods of assessment, ensuring reliability and validity, and giving feedback. It emphasizes the importance of assessing practical skills to evaluate competence. The document also discusses challenges like inconsistent assessors and outlines standards and frameworks to support learning and assessment in practice according to the NMC. It provides guidance on assessment processes, preparing students, and managing difficult situations like failing a student.

1. Assessing Students
in Clinical Practice

2. Assessment
Who can supervise and assess?
Continuous assessment
Assessment validity
Reliability
Methods and strategies of assessment
Giving effective feedback
Failing a student

3. Assessment – what is it for?
To motivate students to learn
To punish those who do not!
To provide feedback – „it‟s about getting to know
students and the quality of their learning‟
(Rowntree 1987)
To improve the quality of the learning
As a „quality control‟ check for our teaching
With vocational courses, to ensure graduates are „fit
for purpose‟ as well as „fit for award‟

4. Assessment – our task for today is to
consider how we address the following:
Applying the principles and stages of the
assessment process to the effective assessment of
learners in practice.
Providing constructive feedback to facilitate the
enhancement of learner performance.
Managing the assessment process in challenging
situations.
Critically examining mentor accountability in relation
to assessing learners.

5. Assessment of practical skills – why?
Practical skills are central to professional practice
It defines what students take to be important
(Rowntree 1987)
If delegated to staff in placements:
Lack of consistency between assessors
Seen as less important than other subjects
To assess competence

6. Competence
The acquisition of knowledge, skills and abilities at a
level of expertise sufficient to be able to perform in
an appropriate work setting (Harvey 2004)
Competence - what the person is capable of doing
Performance - what the person does in his or her
day-to-day practice
One needs to be competent in order to assess
competence; professionals need to be assessed by
professionals.

7. Conscious competence model
Unconscious competence
Conscious competence
Conscious incompetence
Unconscious incompetence

8. Benner (1984)
Expert
Proficient
Competent
Advanced beginner
Novice

9. Standard to Support Learning and
Assessment in Practice
Agreed Mandatory Requirements
First published August 2006.
2nd edition published July 2008
Developmental framework
Specific outcomes for:
Mentors
Practice teachers
Teachers

10. Remaining the same
All Registered Nurses are required to supervise &
facilitate the needs of learners
(NMC Code of Conduct, 2008)

11. NMC Code
“This Code of Conduct should be considered with
the Nursing and Midwifery Council‟s rules,
standards, guidance and advice.”
“You must facilitate students and others to develop
their competence.‟‟
“Failure to comply with this Code of Conduct may
bring your fitness to practise into question and
endanger your registration.”
(NMC 2008b)

12. 8 Standard domains
1) Establishing effective working relationships
2) Facilitation of Learning
3) Assessment & Accountability
4) Evaluation of Learning
5) Creating an environment for learning
6) Context of Practice
7) Evidence Based Practice
8) Leadership

13. The Developmental Framework
The NMC standards to support learning and
assessment in practice
1
5
2
6
3
7
Stage 1 Registrant
Stage 2 Mentor
Stage 3 Practice Teacher
Stage 4 Teacher
4
8

14. Mentor Standard
2.1 “An NMC mentor is a registrant who, following
successful completion of an NMC approved
mentor preparation programme-or comparable
preparation that has been accredited by an AEI as
meeting the NMC mentor requirements-has
achieved the knowledge, skills and competence
required to meet the defined outcomes” (P.17).

15. Scenario
You are working with Amanda, a second year student nurse
who commenced in your area five days ago. Amanda’s
mentor has been off sick since her commencement on
placement. A cardiac arrest occurs in the area and you
instruct Amanda to call the cardiac arrest team and to
collect the emergency equipment to commence
resuscitation. She becomes very flustered and says “I don’t
know what to do!”

16. Scenario
Focus Group Activities:
1) After the incident – describe how you would
manage Amanda‟s distress.
2) Consider and identify why this situation may have
occurred.
3) How will you address the lack of mentor support for
this student?
4) Develop a plan of action which would minimise the
risk of this incident recurring.

17. Ideas you might have considered in
relation to the student...
Commentary:
There may be a requirement to review existing or
develop new orientation and induction processes for
students coming to your area.
Guidelines may be a useful source of information in
determining what critical topics need to be addressed
and when in any induction/orientation.
Continued…

18. Ideas you might have considered in
relation to the student...
You may also need to consider the efficacy of the
initial assessment of a student‟s knowledge and skills,
particularly in relation to their previous experience in
this environment, including fears as well as their stage
of learning/development.
It may also be useful to consider mechanisms which
would ensure students continue to be appropriately
supported at all times during their placement.

19. Ideas you might have considered in
relation to yourself…
Plan your future learning needs based on this scenario.
Think about and share your reactions on this scenario
with your mentor other colleagues.
Reflect on and reinforce your learning from this
learning experience.
Reflect on other learning outcomes which could relate
to this experience.

20. Applying the standard in practice
Allocated learning time for mentor activity
“All students must be supervised at all times, either
directly or indirectly, by a mentor/practice teacher”
(3.2.3 p.29).
40% of a student‟s time, when providing direct care,
should be spent being supervised by a mentor or
practice teacher.
Mentors are accountable for decisions relating to
the delegation of activities to students.

21. Assessing learning in practice
“Mentors will have been prepared to assess
students in practice and will be accountable for their
decisions to pass refer or fail a student” (p.31).
Use evidence from various sources for making a
judgment on performance.
Seek advice and guidance from others when
making complex judgments.

22. 5 required attributes of an assessment
process (McKinley et al. 2001)
Reliability – consistency of assessors rating the
same performance
Validity – degree to which the assessment
assesses what should be assessed
Face validity often high but are we assessing
what we should or what we can assess?
Acceptability – to all stakeholders (assessors,
student and the public)
Continued…

23. 5 required attributes of an assessment
process (McKinley et al. 2001)
Feasibility – can it be delivered to all who need to
be assessed within the cost constraints (time &
staff)
Educational impact – the degree to which the
assessment will help the student to improve his or
her performance. This requires:
Feedback on strengths & weaknesses
Strategies for improvement

24. Reliability
Simulation
Agreed checklists mean less subjectivity
Criteria for assessment clearly defined
Moderator to ensure fairness and consistency
Can be video recorded
The student feels watched
Usually one-off performance and may be a „bad day‟
Continued…

25. Reliability
Workplace
Wide variety of assessors involved
Student‟s previous performance may influence the
assessment
Have to „do it our way‟
Informal assessment usually occurs on several
occasions before it is formalised
The student may not realise he or she is being
assessed
Practitioners sometimes „fail to fail‟

26. Validity – Simulation
Simulated setting which may not feel real, despite
good simulation.
Advantages those who can act.
Students do not know their patient; may know
assessor.
Able to assess skills that are not available „to order‟
in the workplace e.g. emergency resuscitation.
Continued…

27. Validity – Simulation
Environment can be controlled to the level of the
student
Assessors trained for and observed during
assessment
Fair – all students do the same assessment

28. Validity – workplace
Real workplace - authentic assessment.
Students know their patients/clients & the assessor.
Safety takes precedence – cannot allow student to
make mistakes.
Reliant on the experience/patients available at the time.
Assessment may vary considerably between students
The competence of the assessors is assumed
Experts in practice does not necessarily make an
expert assessor

29. Acceptability - workplace
Often viewed as easier than assessment using
simulation
Not a „one-off‟ performance
Includes an element of self assessment – can
usually choose when to be assessed
Receive immediate feedback on their performance

30. Types of assessment
Formative assessment vs Summative assessment
Continuous assessment
Formal and Informal assessment
Portfolio – not truly an assessment, merely a
collection of evidence, reflections etc. Why should
students keep a portfolio?
Self and Peer assessment
Testimony or Witness statements

31. Norm referencing vs criterion referencing
"Best practice in grading in higher education involves striking a
balance between criterion-referencing and norm-referencing “
James et al (2002)
Norm referencing - The main purpose behind the
use of norm-referenced assessment is to rank the
performance of students in a particular group in
order to generate a final grade.
Criterion referencing method involves "determining
a student's grade by comparing his or her
achievements with clearly stated criteria for learning
outcomes and clearly stated standards for particular
levels of performance" (James et al, 2002).

32. Determining Learning Needs
How can you prepare for a student about to start a
placement?
What are the main issues you should cover at the
initial interview?
How do you prepare for the Intermediate interview
How can you prepare for the final interview?
Suggest ways by which you and your colleagues
may attempt to reduce inconsistencies amongst
assessors, thereby increase the validity and
reliability of your assessment?

33. Common problems experienced by students
Difficulty learning during clinical practice.
Managing the situation when a student has to be
failed.

34. References
Allin L and Turnock C (2007a) Assessing Student
Performance in Work-Based Learning. Making
Practice-Based Learning Work. Available: :
www.practicebasedlearning.org
Allin L and Turnock C (2007b) Reflection On and In
the Workplace. Making Practice-Based Learning
Work. Available: : www.practicebasedlearning.org
Allin L and Turnock C (2007c) Working with others
in the workplace. Making Practice Based Learning
Work. Available
www.practicebasedlearning.org/resources/materials/
intro.htm

35. References
Bray L and Nettleton (2007) Assessor or mentor?
Role confusion in professional education. Nurse
Education Today Nov, 27(8): 848- 855.
Calman L, Watson R, Norman I, Redfern S and
Murrells T (2002) Assessing practice of student
nurses: methods, preparation of assessors and
student views. Journal of Advanced Nursing
38(5), pp 516-523.

36. References
Cassidy S (2009) Subjectivity and the valid
assessment of pre-registration student nurse clinical
learning outcomes: Implications for mentors. Nurse
Education Today 29(1), pp 33 – 39
Clarke A, Gibb A, Ramprogus A(2003) Clinical
learning environments: an evaluation of an
innovative role to support pre-registration nursing
placements. Learning in Health and Social Care
2(2), pp 105 – 115

37. References
Cowan D, Norman I, Coopamah V (2005)
Competence in nursing practice: a controversial
concept: a focused review of literature. Nurse
Education Today 25(5), pp 355 – 362
Daly W and Carnwell R. (2001) The case for a multimethod approach. Nurse Researcher 8 (3), 30–44
Duffy K (2003) Failing students: a qualitative study
of factors that influence the decisions regarding
assessment of students‟ competence in practice.
London: NMC

38. References
Gopee N (2008) Assessing student nurses‟ clinical
skills: the ethical competence of mentors.
International Journal of Therapy and Rehabilitation
15(9), pp 401 – 407
Hutchings A, Williamson GR, Humphries A (2005).
Supporting learners in practice: capacity issues.
Journal of Clinical Nursing 14, pp 945 – 955
James, R., McInnes, C. & Devlin, M. (2002).
Assessing learning in Australian universities.
Canberra: Centre for the Study of Higher Education,
Melbourne University and the Australian Universities
Teaching Committee.

39. References
March S, Cooper K, Jordan G, Merrett S, Scammell
J, Clark V (no date) Assessment of Students in
Health and Social Care: Managing Failing Students
in Practice. Making Practice-Based Learning Work.
Available: www.practicebasedlearning.org
McKinley R, Fraser R and Baker R (2001) Model for
directly assessing and improving clinical
competence and performance in revalidation of
clinicians British Medical Journal 322:712-715

40. References
Neary M. (2001) Responsive assessment:
assessing student nurses' clinical competence.
Nurse Education Today 21, 3–17
NMC (2008a) Standards to support learning and
assessment in practice. 2nd Edn. London: NMC
NMC (2008b) The Code: Standards of
conduct, performance and ethics for nurses and
midwives. London: NMC

41. References
Phillips T., Schostak J., Tyler J. and Allen L. (2000)
Practice and Assessment in Nursing and Midwifery:
Doing it for Real. English National Board for
Nursing, Midwifery & Health Visiting, London
Stuart C C (2007) Assessment, supervision and
support in clinical practice 2nd ed London, Churchill
Livingstone
Turnock C and Mulholland J (2007) Learning in the
Workplace: A toolkit for placement
tutors, supervisors, mentors and facilitators.
Chichester: Kingsham Press.

42. References
Watson R, Stimpson A, Topping A and Porock D
(2002) Clinical competence assessment in nursing:
a systematic review of the literature. Journal of
Advanced Nursing 39(5): 421-431.
Additional resource:
www.practicebasedlearning.org/home.htm