Standardizing nurse practitioner student evaluation during high-stakes clinical examinations

Abstract

Nurse practitioners (NPs) require clinical competence in advanced health assessment skills to differentiate between normal, variations of normal, and abnormal patient findings. High-stakes clinical examinations, using live hands-on simulation scenarios and standardized patients (SPs) or other human role players, are accepted teaching and evaluation tools for NP students. Providing objective, valid, and reliable feedback to students during high-stakes clinical examinations is of considerable value for ongoing skill development. The study examined opportunities to improve the quality of student evaluation in simulation testing modes. A purposive sample of 17 video recordings of health students' comprehensive examination of an SP or physical examination teaching associate (PETA) from a nursing graduate level health assessment course was evaluated. Using a standardized rubric, students were scored live and after a comprehensive examination of a SP/PETA and via a secure web-based video platform by the faculty and an independent reviewer. Evaluator group examination score comparisons revealed that distributions of examination scores within evaluator groups were not similar. Median examination scores were significantly different between groups; faculty median examination scores significantly higher than SPs/PETAs. Efficiency of student evaluation may be increased by improving reviewer training, reducing checklist length, and adopting electronic scoring. Development of an exemplary teaching video providing explanation and detail for expected student skill performance will allow reviewers to practice and improve competence in reliable scoring, reduce time and effort of scorers, and increase accuracy of scoring.

Competency-based evaluation: Collaboration and consistency from academia to practice

“…Precepted practice is integral to competency-based education for APRNs, where clinical skills are developed and evaluated. However, judgments regarding students' clinical performance can be challenging and subjective because performance is determined primarily by observations (Keilffer et al, 2021). In addition, clinical evaluation is different across programs, supporting the need for standardized clinical evaluation tools (Ayvazian et al, 2021).…”

“…Using standardized scenarios, case studies, and simulations allows students to perform specific skills, interpret information, make clinical decisions, and communicate with patients and other team members (Hickey, 2021). Clinical skills are assessed in a series of simulated stations that may involve history collection, physical assessment, laboratory investigation, and treatment (Kieffer, et al, 2021). Simulated patient experiences are frequently used as a formative assessment for students and provide a common thread between academic evaluation and clinical competencies (Knopp et al, 2022).…”