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Clinical competence assessment has been a feature of nurse education in the United Kingdom for about 20 years but has really moved to centre-stage since the nurse education reforms of 1999. Clinical competence is a controversial issue and there are problems with assessment and the relationship between the practical and educational aspects of nurse education programmes. The present paper explores the origins of clinical competence assessment, presents some of the problems associated with the adoption of clinical competence in nurse education and reviews some literature in this area. In so doing the paper refers to two research studies commissioned in the United Kingdom into the educational preparation of nurses in which the measurement of clinical competence has been an issue. This paper is based on the Winifred Raphael Memorial Lecture delivered by the author on behalf of the Royal College of Nursing Research Society at the Royal College of Nursing Congress in Harrogate, England on 23 May 2001. The views expressed are those of the author and not necessarily, those of the Royal College of Nursing or the Royal College of Nursing Research Society.
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The relationship between the clinical competence of general practitioners and the degree of peer consultation about diagnostic and therapeutic problems was studied. Three aspects of clinical competence are discerned: attention paid to somatic aspects, patient-orientation and risk of unnecessary harm of the management. Clinical competence has been measured by a written simulation of patient-doctor encounters using five patients and assessment procedures in a study with a correlational design. For this study 49 subjects were selected from a population of 184 GPs who completed their vocational training in general practice at the University of Utrecht between 1975 and 1980. They were selected from those who consult their colleagues frequently and systematically about a variety of patients' problems and from those who do so little or not at all. The 49 subjects did not differ from the remainder in several relevant aspects such as practice setting, subscription to medical journals, etc. The 49 GPs are relatively consistent in the quality of attention they pay to somatic aspects. The consistency with regard to the two other aspects is rather low, especially regarding the risk of unnecessary harm. Attention paid to somatic aspects is connected with patient orientation. The latter is also connected with risk of unnecessary harm, but the former is not. The three aspects are more or less separate aspects of clinical competence. Peer consultation has a direct relationship with quality of attention paid to somatic aspects; GPs who do not consult among peers anyway display a lower quality of attention to somatic aspects in comparison to those who do so.(ABSTRACT TRUNCATED AT 250 WORDS)
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We compared the Accreditation Council for Graduate Medical Education (ACGME) Outcome Project to the long-standing requirement of the American Board of Anesthesiology for a Clinical Competence Committee Report. There are many similarities between these two systems of resident evaluation. However, the ACGME Outcome Project requires the use of more numerous and diverse metrics when compared with the traditional global evaluation alone. In addition, the Clinical Competence Committee Report is primarily a summative evaluation for the purpose of assigning credit for training. The ACGME Outcome Project may be used as a component of a summative evaluation, but the primary emphasis is on formative assessment.
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This study investigated the effect of clinical targets on clinical productivity and perceptions of clinical competency of final-year undergraduate dental students. Students were randomly divided into two equal groups. One group was set annual numerical clinical targets while the other had no targets. All final-year students and final-year clinical teachers were asked to complete a questionnaire rating six different aspects of student clinical competency at the end of semester 1 and semester 2. Changes in perception of clinical competency by students and clinical teachers were compared between the target and no-target groups and between students and clinical teachers. The clinical output of both groups was measured. There was no significant difference in performance between the target and no-target group as assessed by clinical teacher or by student self-assessment. However, by the completion of the study the clinical teachers scored the students (irrespective of group) significantly lower for clinical competency than students assessed themselves. There was no significant difference between the productivity of the two groups. The setting of clinical targets had no measurable effect on the perceived clinical competency or productivity of this group of undergraduate dental students.
The study of clinical competence in physical therapy (PT) to date has focused primarily on a definition of the knowledge, skills, judgements, and attitudes that must be acquired by PT students for a satisfactory performance on entry into professional practice. Concomitant with this emphasis on defining clinical competence is the need for an accurate evaluation of the students' clinical competence during clinical practice. This study was designed to develop a tool for the evaluation of the clinical competence of PT students and to contribute to the definition of a construct of clinical competence. Three steps were involved in developing the evaluation tool. First, the clinical competencies required for PT practice were identified from a survey of the PT literature and professional documents. The identified clinical competencies were then validated through the analysis of a questionnaire completed by 121 physical therapists working in Edmonton, Alberta. The questionnaire results also provided a basis for determining the standards of performance by which to assess these competencies. Subsequently, an Evaluation of Clinical Competence (ECC) was designed as a behaviourally-anchored rating scale to determine, according to four standards of performance, whether a PT student could adequately perform the clinical competencies necessary to practise the profession.
Clinical Competencies of new graduates from baccalaureate programs have periodically been criticized by employers of new graduates. In an effort to understand the levels of clinical preparation for new baccalaureate graduates, three hypotheses dealing with the cognitive, affective, and psychomotor domains were tested. A review of the literature reveals that most exploration and work has been done relative to the cognitive domain. Sixty-four NLN accredited baccalaureate programs responded to a request that they provide all of the clinical objectives used in their program. Findings revealed that there were clinical evaluation criteria written at all levels of the three domains; however, most schools did not have objectives at each of the levels of the three domains. A disproportionately large number of clinical objectives are written at the cognitive domain. The study raises the question as to the abilities of students to be clinically proficient upon graduation when there are relatively few evaluation criteria written in the psychomotor domain.