Clinical Evaluation: Concepts and Processes

Copyright 2008 by The Health Alliance of MidAmerica LLC

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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.

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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

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Evaluation Concepts Norm or Criterion Referenced Evaluation Formative and Summative Evaluation Subjectivity and Fairness

- Oermann & Gaberson, 1998, pp. 168-169

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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

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Norm or Criterion Referenced Combination approach

• above average / average / below average • outstanding / satisfactory / unsatisfactory

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Formative and Summative Evaluation

Formative • Diagnostic• Frequent feedback • Permits improvement

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Summative• Summarizes achievement• Determination competency• Occurs at the end

Formative and Summative Evaluation

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Formative and Summative Both should be

• Documented and shared • Based on multiple sources of data

Frequent formative Periodic summative

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Subjectivity and FairnessDevise a fair system by Recognizing teacher values Use pre-determined objectives or

competencies Provide supportive learning environment

- Oermann & Gaberson, 1998, p.169-170

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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

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Novice Learners Preparation involves learning facts and rules

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Novice Learners Have little to no experience in situations in

which they are performing

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Novice Learners Require time, repetition and guidance to “put

things together” (i.e. think critically)

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

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Determining Competency Derive standards for performance or

clinical objectives from• Program objectives or outcomes • Course objectives

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Determining Competency: Standards Must Be clear and understandable Identify the expected level of performance Be applied consistently

- O’Connor, 2006, p. 219

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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. 223-224

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Roles of the Clinical Teacher Coach Role Model Observer Evaluator

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Roles Coach

• Plans experiences• Monitors and makes adjustments• Provides collaboration• Guides actions• Supports and encourages

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Roles Role Model

• Demonstrates professional practice• Complements care that student cannot

incorporate • Maintains collegial relationships

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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

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Roles Observer

• “Written work” Clinical Documentation Written Assignments

• Use of Anecdotal Notes

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Roles Evaluator

• Compare to standards and expectations• Provide Feedback

Verbal Written

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Clinical Evaluation: Process Preparation Clinical Activity Documentation Interpretation - Adapted from: Bonnel, W., Gomez, D.A.,

Lobodzinski, S., Hartwell West, C.D. (2005), p. 534

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Confidentiality FERPA Private conference Maintain security of records

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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

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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. 263-264; Bonnel, 2005, 538-540

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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