Should we accept mediocrity?

This paper reports findings from a study funded by the National Board for Nursing, Midwifery and Health Visiting for Scotland to test selected nursing and midwifery clinical competence assessment tools for reliability and validity. The study, which took place over two years from July 1997, involved comparing items in the selected tools with statutory competencies for nurses and midwives, collecting assessment data from a sample of 257 nursing and 43 midwifery students in four educational institutions and administering additional assessment measures (the Nursing Competencies Questionnaire (NCQ) (Bartlett et al., An evaluation of pre-registration nursing education: a literature review and comparative study of graduate outcomes, Oxford Centre for Health Care Research & Development, Oxford Brookes University, Oxford, 1998) and the Key Areas Assessment Instrument-KAAI) to the total student sample (and to their lecturers and practice assessors) at two time points which were six months apart. Our focus was the programme-specific clinical competence assessment tools but by testing these tools we also provide evidence on the validity of other methods of competence assessment. Validity of the methods was assessed, primarily, by calculating multivariate and univariate correlation coefficients between them. The NCQ and KAAI were analysed for internal consistency. The NCQ and the versions of KAAI for lecturers and practice assessors were found to have good internal consistency. The version of the KAAI tool developed for students showed reasonable internal consistency for nursing students, but less consistency for midwifery students. Correlational analysis of data collected on students showed that there is little or no relationship between most of the clinical competence assessment methods in current use, or between these methods and those introduced by the research team. This finding supports previous research, particularly in medical education and confirms that the different methods address different abilities.A clear finding from this study is that no single method is appropriate for assessing clinical competence. A multi-method UK-wide strategy for clinical competence assessment for nursing and midwifery is needed if we are to be sure that assessment reveals whether or not students have achieved the complex repertoire of knowledge, skills and attitudes required for competent practice.

Clinical Competence↗

PubMed2002

A practice-profiling system for residents.

Providers are increasingly evaluated and measured as part of quality, credentialling, and reimbursement programs, an approach often used by managed care organizations. However, these evaluations are rarely used in residency training, meaning that physicians entering practice have little experience or understanding of these measures. To address this issue, in 1998 the authors successfully developed a three-part practice-profiling system for internal medicine residents at their institution that includes measures of patient satisfaction, disease-management profiles for diabetes and hypertension, and an Internet-based faculty-evaluation program. The patient-satisfaction profile utilizes a ten-question patient survey that emphasizes physician-patient communication issues. The diabetes and hypertension disease-management profiles use the resident's own patients to profile process and outcome measures for common chronic ambulatory conditions. The faculty-evaluation profile is conducted over the Internet, and allows the resident to compare faculty evaluations with those of his or her peer group. Residents receive the profiles as a packet in a scheduled session with a faculty supervisor twice each year. A total of 120 residents are profiled annually for the above measures. Residents rated the program very highly, and found the profiling program to be instructive and effective feedback. As payers and regulators increasingly use physician profiling, residents will benefit from learning the strengths and weaknesses of profiling systems early in their training.

Clinical Competence↗