Clinical Evaluation: Concepts and Processes Copyright 2008 by The Health Alliance of MidAmerica LLC

5-2 Objectives  Review concepts applied in the evaluation of clinical performance.  Discuss factors related to the acquisition of clinical knowledge.  Determine the relationship of standards to evaluating clinical competence.  Examine the roles of the clinical teacher.  Describe a process for clinical evaluation.  Examine strategies to develop skill in clinical evaluation of students.

5-3 Assumptions  “Evaluation is a process by which judgments are made about performance.”  “Clinical evaluation is NOT objective.”  “The teacher’s values influence evaluation.” - Oermann and Gaberson, 1998, p. 167

5-4 Evaluation Concepts  Norm or Criterion Referenced Evaluation  Formative and Summative Evaluation  Subjectivity and Fairness - Oermann & Gaberson, 1998, pp

5-5 Norm or Criterion Referenced  Norm referenced Comparing student's performance to others in clinical group  Criterion referenced Compare student to criteria which constitute satisfactory performance

5-6 Norm or Criterion Referenced  Combination approach above average / average / below average outstanding / satisfactory / unsatisfactory

5-7 Formative and Summative Evaluation  Formative Diagnostic Frequent feedback Permits improvement

5-8  Summative Summarizes achievement Determination competency Occurs at the end Formative and Summative Evaluation

5-9 Formative and Summative  Both should be Documented and shared Based on multiple sources of data  Frequent formative  Periodic summative

5-10 Subjectivity and Fairness Devise a fair system by  Recognizing teacher values  Use pre-determined objectives or competencies  Provide supportive learning environment - Oermann & Gaberson, 1998, p

5-11 Clinical Knowledge  Acquired over time  Ability to recognize qualitative distinctions, common meanings, early warnings of distress  Understand situations in a global way, taking in multiple cues and processing them at once - Benner, 1984, p. 4

5-12 Novice Learners  Preparation involves learning facts and rules

5-13 Novice Learners  Have little to no experience in situations in which they are performing

5-14 Novice Learners  Require time, repetition and guidance to “put things together” (i.e. think critically)

5-15 Stress in Clinical  Learning “in public”  Being “evaluated” all the time  Fear of “harming a patient”

5-16 Determining Competency  Derive standards for performance or clinical objectives from Program objectives or outcomes Course objectives

5-17 Determining Competency: Standards Must  Be clear and understandable  Identify the expected level of performance  Be applied consistently - O’Connor, 2006, p. 219

5-18 Levels of Safety  Independent Performs safely and accurately each time, without supportive cues  Supervised and Assisted Performs safely and accurately each time observed  Provisional Performs safely under supervision, not always safe  Dependent Performs in unsafe manner - Krichbaum, K., et al as cited in O’Connor, 2006, p

5-19 Roles of the Clinical Teacher  Coach  Role Model  Observer  Evaluator

5-20 Roles  Coach Plans experiences Monitors and makes adjustments Provides collaboration Guides actions Supports and encourages

5-21 Roles  Role Model Demonstrates professional practice Complements care that student cannot incorporate Maintains collegial relationships

5-22 Roles  Observer of Student Performance Maintain safety of patient and student  Students ARE accountable for their own actions Insure appropriate and correct behaviors Accurate communication with staff

5-23 Roles  Observer “Written work”  Clinical Documentation  Written Assignments Use of Anecdotal Notes

5-24 Roles  Evaluator Compare to standards and expectations Provide Feedback  Verbal  Written

5-25 Clinical Evaluation: Process  Preparation  Clinical Activity  Documentation  Interpretation - Adapted from: Bonnel, W., Gomez, D.A., Lobodzinski, S., Hartwell West, C.D. (2005), p. 534

5-26 Confidentiality  FERPA  Private conference  Maintain security of records

5-27 Due Process Students must  Understand expectations  Receive timely feedback  Comprehend consequences  Have opportunity to improve  Be informed of rights - Johnson, E.G. & Halstead, J.A. 2005, p. 44

5-28 Performance Deficits  Compare performance to standards  Reflect patterns of performance  Communicate privately  Document thoroughly  Follow college/school procedures  Determine a plan to improve  Follow-up at predetermined intervals - O’Connor, 2006, pp ; Bonnel, 2005,

5-29 Summary: Strategies for Evaluation  Make course and personal expectations clear  Allow adequate observations  Provide feedback  Document and look for patterns  Compare performance to standards  Seek guidance