Competency Based Distance Nursing Education: Clinical Testing vs. Clinical Teaching

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Competency Based Distance Nursing Education
Clinical Testing vs. Clinical Teaching

• Mary Lee Pollard, PhD, RN
• Associate Dean
• Kim Hedley, MS, RN, CPHQ,
• Senior Program Director
• Excelsior College School of Nursing

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History of Excelsior College

• Founded in 1971 by New York State Board of
  Regents
• Chartered by the Regents as an independent
  institution in 1998
• Formerly Regents College
• Changed name in 2001 to Excelsior College

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History of the AD Nursing Program

• First faculty came together in 1970
• Purpose was to block this innovative model
• Once convinced of worthiness of the model,
  faculty made sure it was done right
• Faculty represented nationally known nurse
  leaders
• 40 year history of success
• Graduates exceeding 33,000

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Excelsior College Philosophy

• What you know is more important than where or how
  you learned it.

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Excelsior College Mission

• Expand educational opportunity with a particular
  concern for those historically underrepresented
  in higher education by focusing on the needs of
  the individual student and offering flexible,
  self-paced academic options.

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Competency Based Education

• Learner focused rather than teacher focused
• Documentation rather than assumption
• Outcome focused rather than process focused
• Competence rather than completion

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Competency Based Education is Based on Principles
of Adult Learning

• Treat the learner as an adult
• Learners have individual learning needs
• Learners are self-directed and motivated
• Learners are responsible for their own learning

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Competence and Competency

• Competence is defined as having the knowledge,
  skills and abilities required to perform the job.
• Competency is defined as the ability to perform
  required skills in accordance with established
  standards.

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Clinical Education Models

• Traditional- apprenticeship focus on process of
  instruction and repetition, faculty drive the
  teaching and evaluation
• Non-traditional- assessment, competency-based
  focus on outcomes of learning

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Traditional Clinical Evaluation Method

• Clinical grade equated with observed clinical
  competency
• Use formative evaluations to make judgments about
  practice ability
• Doesnt address the demand for accountability in
  higher education- measurable outcomes

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Competency Based Distance Nursing Education

• Challenges
• Changes way of thinking
• Need clear and specific language related to
  evaluation criteria
• Pilot testing and working out the glitches
  essential

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Competency Based Distance Nursing Education

• Opportunities
• Increase student and faculty satisfaction
• Increase objectivity and minimize bias
• Responsive to demands for more accountability

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Criticisms of Competency Based Education

• Grounded in behaviorist pedagogy (content driven
  curriculum with specific outcomes and objectives)
• Focus on work related knowledge and skills at the
  expense of broader analytical skills
• Difficult to justify liberal education in
  competency based model

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How Excelsior College Assesses Learning and
Competencies

• Criterion referenced
• -theory examinations that measure nursing
  knowledge
• -performance examination that includes the use
  of simulations and real-time performance
  appraisal

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Concepts and Perspectives

• Teaching versus Learning
• Theory versus Performance
• Evaluation versus Examination
• Assumption versus Documentation
• Completion versus Competence

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Concepts of Performance Exam vs. Traditional
Clinical Evaluation

• Examination versus Instruction
• Areas of Care versus Specific Tasks
• Critical Elements versus Steps in Procedure

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Concepts of Performance Exam vs. Traditional
Clinical Evaluation

• Objectivity versus Subjectivity
• Sampling versus Total Content
• Acceptability versus Ideal

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Concepts of Performance Exam vs. Traditional
Clinical Evaluation

• Consistency versus Variability
• Flexibility versus Rigidity
• Systematized Conditions versus Spontaneous
  Arrangements

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Clinical Performance in Nursing Examination
(CPNE)

• The capstone of Excelsior Colleges external
  associate degree in nursing program.
• Given over 2 ½ days in one of 21 testing sites
  throughout the country.
• Students must successfully pass
• 4 Nursing Simulation Laboratories
• 2 Adult Patient Care Situations (PCS)
• 1 Pediatric Patient Care Situation (PCS)

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CPNE Domain of Nursing Practice
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Nursing Process/Critical Thinking

• A problem solving that involves
• Assessment
• Analysis
• Planning
• Implementation
• Evaluation

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Areas of Care

• Clusters of nursing activities that incorporate
  similar principles or competencies.

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Areas of Care (cont)

• Overriding Areas of Care Tested during the
  Patient Care Situations (PCS) and the Nursing
  Simulation Laboratory
• Required Areas of Care Tested in every PCS
• Selected Areas of Care Sampled throughout the
  PCSs. Medication administration must be tested
  at least once during the PCSs
• Each Area of Care is comprised of critical
  elements

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Critical Elements

• Single, discrete, observable behaviors used in
  measuring the students performance
• Minimum requirements for beginning RN practice

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CPNE Roles Clinical Associate (CA)

• Coordinates and supervises the administration of
  the CPNE
• Ensures the CPNE is conducted in a manner
  consistent with the information published in the
  CPNE Study Guide
• Reviews and verifies failures

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CPNE Roles Student

• Performs in a manner consistent with expected
  standards for ethical and professional practice.
  
• Complies with the Academic Honesty Policy
• Perform all aspects of the simulations and
  nursing care under the direct observation of the
  Clinical Examiner

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CPNE Roles Clinical Examiner (CE)

• Promotes a collaborative relationship with
  nursing staff
• Orients the student to the nursing unit and
  equipment necessary to complete the PCS
• Selects patients according to established
  guidelines
• Acts as a silent observer.
• Observes students performance at all times.
• Promotes positive neutrality
• Acts as a Patient Advocate

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Clinical Examiner (CE) Training

• Clinical Examiners undergo the same rigorous
  training, retraining and evaluation geared
  towards controlling bias and maximizing equitable
  treatment of the candidates.
• Masters prepared nurse educators, experienced in
  performance assessment and the administration of
  the CPNE, conduct the training.

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Clinical Examiner Training (cont)

• Training in offered in 3 phases and the CEs
• Are grounded in the principles of performance
  assessment.
• Learn the administration protocols for the NSL
  stations and PCS.
• Learn to differentiate between clinical
  evaluation (focus on learning) and clinical
  performance assessment (systematic data
  collection via testing)

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Clinical Examiner Training (cont)

• Learn the function and accurate use of the
  scoring tools.
• Learn to provide neutral and consistent
  communication
• Learn the expectations for dealing with both pass
  and fail circumstances.
• CEs and CAs participate in the Annual Update
  during which changes in examination structure or
  process are reviewed and issues or concerns from
  test sites are discussed.

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Excelsior College Outcomes

• Higher than average NCLEX first time pass rate
• for 2004-2008
• National average 86.34
• Excelsior College 87.85
• Students perceive the program as rigorous yet
  very workable it fits their lifestyle and they
  develop a strong sense of self-confidence as a
  result of their efforts

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Costs/Benefits to a Competency Based Model of
Evaluation

• Costs
• -training of faculty examiners
• -quality assurance measures
• -ongoing research
• -letting go of what is familiar and
  comfortable and doing things differently

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Costs/Benefits to a Competency Based Model of
Evaluation

• Benefits
• -addresses issues of limited clinical
  placements
• -addresses issues of faculty shortage
• -valid and reliable minimizes opportunity for
  bias
• -student satisfaction

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Summary- Competency Based Distance Nursing
Education

• Competency based curriculum
• Derived using expert educators and practitioners
• Focus on outcomes
• Clearly articulated competencies

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Summary- Competency Based Distance Nursing
Education

• Publicized expectations of learners
• Criterion referenced evaluation methods
• Remediation cycle
• Learner centered

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What Does the Research Say?

• The large majority of nurse supervisors surveyed
  rated the overall clinical competence of
  Excelsior College AD nursing graduates as the
  same or higher than other associate degree nurses
  (Gwatkin, Hancock, Javitz, 2009).

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What Does the Research Say?

• Mentor/preceptors rated the overall clinical
  competence of Excelsior College AD nursing
  graduates as slightly higher compared to other
  associate degree graduates (Darrah, Humbert,
  2009).

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both studies available via www.excelsior.edu/exc
elsior_college/publications

• Darrah, M., Humbert, R. (2009). Excelsior College
  final evaluation report. ProEvaluators.
• Gwatkin, L., Hancock, M., Javitz, H. (2009). As
  well prepared, and often better Surveying the
  work performance of Excelsior College associate
  degree in nursing graduates. SRI International.