APPLYING THE EVIDENCE: PORTFOLIO ASSESSMENT IN MIDWIFERY Margaret Fisher Senior Lecturer in Midwifery/ Ceppl Activity Lead, University of Plymouth Alison Stone Midwife, Torbay Hospital/ Ceppl Team member th Annual Interdisciplinary Research Conference, Dublin, 7/11/08

Background: Triggers for change Ceppl research: “Assessment of Practice” Literature evidence Anecdotal feedback Professional body requirements Re-validation of Midwifery curriculum

Evidence from the literature Assessment of practice is crucial in determining whether or not a student meets the criteria required of their profession, thus ensuring safety of the public UKCC 1999, Watkins 2000, Cowburn et al 2000

Defining competence has long been a challenge Cowan et al 2005 Efforts to ‘measure’ competence and professional abilities have resulted in a wide variety of methods of assessment Baume and Yorke 2002, McMullan et al 2003 The student may also be required to fulfil set criteria or outcomes and practice may be graded Caraccio and Englander 2004, Slater and Boulet 2001

Unless outcomes are clear, the result may be that the student focuses too heavily on completing the portfolio [or other tool] rather than learning from the experience itself Scholes et al 2004 Reflections on practice may form part of portfolio assessments, and this process may also contribute to the student’s learning Mountford and Rogers 1996

Ceppl project: Assessment of Practice Longitudinal case studies Staff focus groups Literature search Trawl of websites Conference networking

Aim To establish an evidence-based set of key principles and resources to guide Assessment of Practice, relevant across professional boundaries.

Research Questions 1. What are perceptions of validity and reliability of the practice assessment methods used? 2. What are perceptions of the impact of the practice assessment process on the student learning experience?

Methodology 14 participants from Midwifery, Social Work and Emergency Care programmes (nurses and paramedics) Semi-structured interviews at the end of each year Longitudinal case study approach Single-case and cross-case analysis and synthesis of findings – “Framework technique” Ritchie and Spencer 1984

Methods used 1.Portfolios * 2.Reflections 3.Tripartites/ 3-way meetings * 4.Criterion referenced assessments * 5.Conversations 6.Observations 7.OSCEs

Portfolios Provide focus Evidence of capability/ achievement Encourage student as see their progress Self-directed Motivate learning × Prescriptive/ restrictive (“tick boxes”) × Weighting of marks unbalanced/ difficult to assess × Potential to “cheat the system” × Bulk (paper format) × Heavy workload

Tripartites/ 3-way meetings Useful checkpoint Opportunity to reflect on progress and learning Opportunity to get feedback from mentor and tutor Enable clarification of issues Student-centred Reliable if student and mentor have worked closely together × Difficult to arrange × May be challenging to express conflicting opinions × Likened to a “parent’s evening” × Some students though mentor and tutor should also have private discussion

Criterion referenced assessment Focused learning Best if continuous assessment Mostly valid, reliable and achievable × Criteria not always relevant to placement × Some criteria ambiguous/ overly complex/ unclear × Dependent on professional judgement and experience of mentor

Key themes

Application to Midwifery: A new curriculum Incorporating new NMC requirements: All graduate Grading of practice Sign-off mentor throughout programme Ongoing Achievement Record Case-loading and focus on normality Essential Skills Clusters (ESC’s) for Midwifery – theory and practice

And a new Portfolio  Portfolio work-party  Decision to develop part-paper (summative) and part-electronic (formative/ evidence learning) portfolio

Key changes to the portfolio Ongoing Achievement Record (OAR) – paper component Electronic portfolio Assessment tool: MAP (Mentor Assessment of Proficiencies) based on Essential Skills Clusters and Midwifery Proficiencies and graded annually during tripartite meeting Entire portfolio summative at end of programme – pass/ fail

Ongoing Achievement Record (paper component) Comprises all documents needing signature by sign-off mentor or others: 1.Signature record 2.Mandatory sessions 3.EU Midwifery record 4.Placement record 5.Learning contract 6.MAP

MAP CRITERIA Communication and Confidentiality * Evidence Based Practice and Health Education/Promotion Personal and Professional Growth Risk Assessment and Management Skills Initial Consultation between the Woman and the Midwife * Ongoing Antenatal Care Normal Labour and Birth * Postnatal and Neonatal Care Initiation and Continuation of Breastfeeding * High Risk Care across the Childbirth Continuum Emergency Procedures Medicines Management *

Electronic Portfolio Evidence of student’s practice learning:  Learning through SWOT analysis and reflection  How Midwifery Proficiencies, Essential Skills Clusters and learning outcomes achieved  Evidence of case-loading and other core clinical experiences (eg: non-maternity placements, skills packs) Demonstration

Pilot of Portfolio: Methodology 12 students and mentors (students with a range of IT abilities and learning styles) 7 lecturers 6-week trial including tripartite Questionnaire follow-up

Pilot of portfolio: Key findings  Guidelines: very positive  Hyperlinks : logical system tricky to begin with but became easier with use particularly useful when making external links (eg: to national guidelines)  Feedback facility : valuable  Varied IT skills/ learning styles: coped

Summary

Copyright statement: Copyright for this portfolio belongs to Margaret Fisher in collaboration with the University of Plymouth Midwifery, Ceppl and Emily teams