Assessing students' clinical performance

In this article the authors review the history of clinical assessment and describe the development and implementation of an evidence-based assessment strategy for clinical practice prepared for the Diploma in Nursing curriculum at Keele University.     

The evaluation of clinical competence

This review examined new approaches to the definition and evaluation of clinical competence. Competence may be defined in terms of the components of the process of clinical performance or in terms of the outcomes of clinical performance. No single test method is capable of providing a valid and reliable evaluation of all defined aspects of clinical competence. Both in this country and overseas, new test methods and examinations are being developed and the implications which they will have for Australian medical schools are discussed.     

Assessment of clinical competence. The state of the art

Clinical competence (CC) can be defined as the professional skills required to act and represents the fundamental background required for the performance. From a taxonomic standpoint, CC regards the field of knowledges, gestures, behaviours and decision-making skills in patient management on the basis of a cost-benefit analysis. "Methods for the assessment of CC". Since the 50s, the National Board of Medical Examiners started to replace open-ended oral examinations with the "Multiple Choice Questions", which proved to be more objective, reliable and effective and were soon accepted worldwide. New educational tools were successively suggested as computer-aided simulation ("Computer Aided Instruction") for both learning and assessment phases. All the above mentioned methods are limited by the fact that they are unable to evaluate the field of gestures and behaviours of the future physician. In consideration of this limitation, new assessment tools as the "Standardized Patient" utilized in the context of "Objective Structured Clinical Examination" or "Simulated Clinical Encounter", were recently developed. There are still some problems regarding the elaboration of assessment standards able to provide uniformity in scoring. In addition the assessment tools utilized so far for the individual student do not provide predictivity on his/her outcome in the future medical practice. Nevertheless, there are still some perplexities on the use of a chart audit for the purpose of assessing individual competence and predicting future performance skill.     

Doctoral training in clinical psychology: A students' perspective.

Clinical graduate students (N?=?448), representing 75 of the American Psychological Association-accredited doctoral programs in clinical psychology, rated their satisfaction/competence on a variety of training areas, indicated whether their training programs offered specific curriculum, and rated their personal and program's emphasis on the research-application dimensions. Results indicated that the majority of respondents rated their training as favorable, that the curriculum areas of therapy, research, and assessment are frequently offered, and that over half of the respondents and programs have common research and application emphases. Comparisons of these results with those of a similar study conducted by Walfish, Kaufman, and Kinder resulted in significant differences. Significant differences also were noted in comparisons between training and degree programs. The results are discussed in light of previous studies and in terms of the implications for training programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Measuring students' perceptions of faculty competence in professional psychology: Development of the Perceived Faculty Competence Inventory.

[Correction Notice: An erratum for this article was reported in Vol 5(2) of Training and Education in Professional Psychology (see record 2011-09655-004). There were errors in Table 1 and Table 4. In Table 1, the factor loading of “-22.00” in Column 4 should have read “-22” In Table 4, under “Variance” in the “Program level PFCI” row, “.00” is not a significant value and therefore should not have asterisks after it.] This paper documents the development of a measure designed to assess doctoral students' perceptions of the professional competence of faculty in clinical, counseling, and school psychology. Study 1 yielded 33 items via principal components analysis that accounted for over 72% of the variance in the data across 5 domains: (a) Professionalism/Ethics; (b) Clinical Supervision; (c) Research; (d) Multicultural Competence; and (e) Advising/Mentoring. A confirmatory factor analysis in Study 2 provided support for the construct validity of the 5-factor model. Multilevel modeling was also used in Study 2 to demonstrate concurrent validity as aggregated group-level scores on the Perceived Faculty Competence Inventory were shown to explain significant variation in individual-level counselor and research self-efficacy. Implications for training and research in professional psychology are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Defining the boundaries of professional competence: Managing subtle cases of clinical incompetence.

Flagrant cases of professional incompetence are often identified and corrected through formal remediation procedures. However, many subtle cases exist that can go undetected and uncorrected. This article describes a 5-component schema for categorizing the elements of competence necessary to provide quality psychological services: factual knowledge, generic clinical skills, orientation-specific technical skills, clinical judgment, and interpersonal attributes. Case examples are used to illustrate the types of problems that are likely to occur in these different areas. Peer education and supportive confrontation are suggested as appropriate means of addressing subtle cases of incompetence. Also, suggestions are made for system changes (graduate training, licensure requirements, and continuing education) designed to promote competence among clinicians. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist competence ratings in relation to clinical outcome in cognitive therapy of depression.

This study reports on the relationship of therapist competence to the outcome of cognitive-behavioral treatment in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Outpatients suffering from major depressive disorder were treated by cognitive-behavioral therapists at each of 3 U.S. sites using a format of 20 sessions in 16 weeks. Findings provide some support for the relationship of therapist competence (as measured by the Cognitive Therapy Scale) to reduction of depressive symptomatology when controlling for therapist adherence and facilitative conditions. The results are, however, not as strong or consistent as expected. The component of competence that was most highly related to outcome is a factor that reflects the therapist's ability to structure the treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nursing students' stress during the initial clinical experience

The purpose of this exploratory longitudinal study was to identify nursing students' perceptions of stress in their initial clinical experiences in a hospital setting. Guided by the relational view of stress, a Nursing Student's Stress Scale (NSSS) was developed to include six subscales: adequate knowledge, close supervision, averse sights, causing pain, insufficient resources, and reality conflict. The NSSS was administered three times during the clinical experience to 46 nursing students. Results showed significant differences between the students' preclinical expected stress levels and the actual levels of stress in the clinical setting. Theoretical, methodological, and practical implications of the findings are discussed. Nurse educators are encouraged to acknowledge students' perceptions of stressful situations as a basis for stress reduction intervention. Students must first cope with their own stress in the clinical reality before being expected to deal with patients' stress.     

Undergraduate nursing students' perceptions of their clinical learning environment

The clinical learning environment (CLE) is an interactive network of forces influencing student learning outcomes in the clinical setting. This study used mixed methods to identify factors characterizing students' perceptions of the CLE. The sample consisted of 229 undergraduate students in the second or third year of their biophysical nursing strand. The five subscales of the Clinical Learning Environment Scale, 'staff-student relationships', 'nurse manager commitment', 'patient relationships', 'student satisfaction' and 'hierarchy and ritual', were supported by qualitative data obtained from student interviews. Interpersonal relationships between the participants in the CLE were crucial to the development of a positive learning environment. Student satisfaction with the CLE was both a result of, and influential in creating, a positive learning environment. Nurse educators, clinical venues, and all others participating in the undergraduate nursing students' clinical education, must collaborate in order to create a CLE which promotes the development of well-educated registered nurses capable of providing safe, cost-effective patient care.     

Assessing the clinical ethical competence of undergraduate medical students

At the University of Newcastle, health law and ethics is taught and assessed in each year of the five-year curriculum. However, the critical question for assessment remains: 'Does teaching ethics have a measurable effect on the clinical activity of medical students who have had such courses?' Those responsible for teaching confront this question each year they sit down to construct their assessment tools. Should they assess what the student knows? Should they assess the student's moral reasoning, that is, what decisions the student makes, and, how these decisions are justified, or should they assess what the student actually does when dealing with patients in the clinical setting, and how he or she does it? From 1982 to 1991, assessment at Newcastle was primarily aimed at determining the quality of the students' ethics knowledge base. This paper describes the strengths and limitations of a purely knowledge-based method of evaluation and why in 1992, we are now attempting to redefine and assess, what we call 'clinical ethical competence' in terms of how students actually apply this knowledge base in a controlled clinical context.     

Relation between teachers' early expectations and students' later perceived competence in physical education classes: Autonomy-supportive climate as a moderator.

The purpose of this study was to explore whether, in naturalistic physical education classes, the relation between teachers' early expectations and students' later perceived competence was moderated by the extent to which the motivational climate created by the teachers was autonomy supportive. Using a 1-year longitudinal design, data were obtained from 421 students and 22 teachers from 10 French junior high schools. Multilevel analyses revealed that (a) teachers' early expectations were related to students' later perceived competence, particularly when these expectations were positive, and (b) this relation was stronger when the classroom motivational climate was low in autonomy support. Implications for future research and educational practices are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Human diversity and professional competence: Training in clinical and counseling psychology revisited.

Psychologists have increasingly recognized the need to appropriately train students to serve individuals from diverse groups. These groups have been characterized by racial-ethnic membership or defined by sexual orientation, SES, gender, and physical ability. Recent reports have documented that many applied graduate training programs still do not provide courses and experiences specific to working with diverse populations. This study presents results from a survey of 259 graduates of counseling and clinical psychology programs. Respondents were asked about training and professional work experiences with diverse groups. Results indicate restricted opportunities for training with diverse clients. Training experiences reported to be most effective are presented. Findings are discussed in light of continuing efforts to promote appropriate services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Children's emotional competence and attentional competence in early elementary school.

The current study examined the relations between two aspects of emotional competence--emotion knowledge and emotion expression, and children's attentional competence during one school year. Participants were 263 first- and second-grade students at two rural elementary schools. A multiple regression analysis showed that emotion knowledge predicted attentional competence while controlling for age, gender, verbal ability, and initial levels of attentional competence. Multiple regression analyses examining predictors of peer nominations of emotion expression showed that attentional competence predicted peer nominations of happiness, sadness, and anger expression, and emotion knowledge predicted peer nominations of anger expression. Potential improvements for prevention programs and the importance of the findings for school personnel are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

College students' help-seeking preferences.

136 undergraduates completed a questionnaire indicating the relative likelihood that they would turn to 7 potential helpgivers with 11 personal or 5 career problems. For personal problems, Ss indicated they would be more likely to turn to a close friend for help. For career problems, Ss stated that they would be more likely to seek help from an academic advisor, instructor, close friend, or close relative. A total of 36% and 26% of the Ss said they would seek help from a professional counselor for a personal or career problem, respectively. The extent to which these findings replicate previous research is discussed. (23 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Childhood competence and depression.

Examined whether children with both academic and social skill deficiencies have higher levels of peer-nominated and self-ratings of depression than their more competent peers and whether depression levels can distinguish academically skilled children from socially skilled ones. Objective measures of academic and social competence classified 169 3rd–6th grade children as competent (above the median on both measures), incompetent (below on both), academically skilled (above only on academic competence), or socially skilled (above only on social competence). Children completed the Perceived Competence Scale for Children, Children's Depression Inventory, and a peer nomination inventory of depression. Results demonstrate information about academic and social competence best predicted Ss' depression. Peer-nominated and self-rated depression were highest among incompetent Ss and lowest among competent Ss. Peer-nominated happiness was higher among the socially skilled than among the academically skilled. (46 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Extending Masterpasqua's competence paradigm.

Agrees with F. Masterpasqua's (see record 1990-05261-001) competence paradigm and attempts to broaden the conceptual base of the competence paradigm. A 3rd definition of competence originated by R. White (1959, 1963) is also described. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Minority students' self-control of procrastination.

Examined the effects of self-monitoring alone and self-monitoring plus self-reward on 3 academic and 3 related procrastinative behaviors of 6 academically disadvantaged minority undergraduates. It was hypothesized that self-monitoring plus self-reward would increase academic behaviors and decrease related procrastinating behaviors. It was also predicted that self-monitoring alone would not be as effective as with reward. A 3rd hypothesis was that Ss would be able to maintain multiple self-reward contracts simultaneously. Research assistants recorded academic, procrastinative, and percentage of initial contract maintenance behaviors. Results indicate that Ss self-monitored consistently and accurately and self-rewarded frequently the occurrences of their academic behaviors. Self-monitoring alone did not reduce academic or procrastinative behaviors. Self-monitoring plus self-reward was effective in producing substantial increases in academic behaviors and grades and in producing decreases in related procrastinative behaviors. Ss were able to initiate sequential multiple self-reward contracts and to continue these self-reward contracts simultaneously. (40 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)