The Curriculum Development Process: Clinical Objectives & Competencies

1. The Curriculum Development Process: Clinical Objectives & Competencies Establishing a Clinical Evaluation Tool and Rubric that Reflect Level Competencies Sherry L Roper, PhD, RN Nursing Education and Curriculum

2. Objectives • Discuss the relationship among concepts, objectives, and competencies, from a clinical perspective • Examine strategies for the development of a robust clinical evaluation tool (CET) • Discuss validity and reliability of CET • Explore the use of rubrics as a CET

3. Curriculum Components Mission & Philosophy Concepts Outcomes & Competencies Course Descriptions / Objectives / Content Clinical Objectives & Evaluation Tools

4. Clinical Evaluation Process • The clinical evaluation process begins with identifying the concepts & competences expected of a student and drives the content and structure of the clinical experience. • Concepts shape outcomes/objectives • Outcomes/objectives shape competencies • Competencies are measurable “behavioral indicators” that cumulatively shape a competent nurse

5. Outcomes/Competencies • Outcomes • Student learning outcomes are broad statements of the characteristics students must possess upon completion of a level. • Competencies • Statements that describe the characteristics in the student learning outcomes in measurable terms • Student-focused/centered behaviors • Each outcome should have a minimum of one competency

6. Clinical Objectives • Clinical objectives • Written statements that describe what the learner is expected to be able to do upon successful completion of the clinical experience • May be similar to course objectives (broad statements of the characteristics students must possess upon completion of a level) but with a clinical focus • Clinical objectives provide the standards for the course that must be met

7. Clinical Competencies • Measurable statements of the KSAs a student must demonstrate in relation to the clinical objectives • Each clinical objective has related competencies that provide a more detailed and measurable description of the objective Example Clinical objective Competencies

8. Leveling Clinical Competencies • Demonstrate student progression in expected KSAs • Build on previous level/s • Advance in complexity and performance expectations • Integrate new knowledge • Demonstrate attainment of student learning outcomes

9. Leveling Clinical Competencies

10. Concepts, Objectives, and Competencies • Align clinical objectives with concepts • Utilize leveling of competencies to demonstrate progression in expected KSA outcomes/objectives

11. Concepts, Objectives, and Competencies

12. Clinical Performance Evaluation "The ultimate outcome for clinical performance evaluation is safe, quality care. Clinical performance evaluation provides information to the student about performance and provides data that may be used for individual student development.“ "From patient safety to student confidence as clinicians, getting the clinical evaluation correct is critical.“ (Billings and Halstead, 2012, p. 485)

13. Clinical Performance Evaluation Faculty have the legal and ethical responsibility to pass only students who are safe practitioners and meet the clinical objectives of the course.

14. Clinical Evaluation - Assumptions • “Evaluation is a process by which judgments are made about performance.” • Since nursing judgment is a subjective process based on data, it is important to remember that no matter how hard an educator tries--- • “Clinical evaluation is NOT objective.” • “The teacher’s values influence evaluation.” • Faculty need to establish a fair system to evaluate student performance: • Use tools that contain pre-determined objectives or competencies (Oermannand Gaberson, 2009)

15. The Clinical Evaluation Tool The clinical evaluation is dependent on the development of a reliable performance evaluation tool that measures student competency and safety

16. The Clinical Evaluation Tool • Contains competencies that support clinical objectives • Incorporates “behavioral indicators” - KSAs • KSAs reflect course and faculty expectations • For example: dress in professional manner as specified in the student’s dress policy; comes to clinical prepared . . . • Provides clear direction for clinical faculty (including adjunct, preceptors) • Incorporate qualitative and quantitative judgments about student performance • Provides a means to provide fair evaluations (Billings and Halstead, 2012)

17. The Clinical Evaluation Tool • Constructive and timely feedback • Formative: ongoing • Focuses on process of student development • Assists in diagnosing student problems and learning needs • Aids in determining the extent to which the student is achieving course objectives • Summative: terminal • Conclusion of a specified clinical activity • Assists in the assessment of competency attainment or meeting of objectives • Essential to accurately measuring learning in the clinical setting and to promoting growth and development of student competencies

18. The Clinical Evaluation Tool Formative Summative Strategies Observation Written Activity Clinical Journal Care Plan Example The instructor will: Observe and rate student performance at mid term and finalusing the clinical evaluation tool Issue a pass/fail or clinical grade Discuss the clinical evaluation with the student to provide constructive feedback about clinical performance • Strategies • Observation • Written Activity • Clinical Journal • Care Plan • Example • The instructor will: • Observe and rate student performance weekly using the clinical evaluation tool • Identify areas for student growth and development reflective of desired clinical competencies • Discuss the clinical evaluation with the student to provide constructive feedback about clinical performance

19. Developing a Robust CET • What is a “robust” CET • Captures the essence of the student learning outcomes • Reflects how concepts, outcomes, and competencies are threaded throughout curriculum • Incorporates competencies indicated as “critical” • Critical competencies must be achieved to “pass” the clinical experience • “Safety” • Critical competencies provide measureable data • Can be used to evaluate student learning outcomes - both level and program • Provides program evaluation data

20. Developing a Robust CET The development of robust evaluation tool begins with faculty collaboration

21. Developing a Robust CET • Establish standards through faculty discussion of: • Required performance of each competency --- what it “looks like” • Skills/behaviors to observe • Safe/unsafe practice (what constitutes) • Strategies for evaluating performance • KSAs reflective of course and faculty expectations • For example: dresses in professional manner; comes to clinical prepared; reports to clinical on time . . . (Billings and Halstead, 2012)

22. Developing a Robust CET • Establish standards through faculty discussion of: • Frequency of evaluation • Weekly • Formative • At a minimum at mid-term and final • Summative • Standards for clinical grade (quantitative data) • Satisfactory/unsatisfactory • Graded

23. Developing a Robust CET • Relationship between CET and curriculum

24. Developing a Robust CET • Faculty must evaluate inter-rater reliability and content validity • Does the CET measure what it is intended to measure? • Are the tools dependable, precise, predictable, and consistent? • Are faculty collecting and analyzing what they intend to measure? (Billings and Halstead, 2012)

25. Evaluating Student Performance: Rubrics An evaluation tool that delineates the expectations for a task or assignment Rubrics increase validity Tools dependable, precise, predictable, and consistent • Rubrics increase reliability • Relevance • Directly measures the outcomes/objectives • Accuracy • Precisely measures the outcomes/objectives • Utility • Provides formative and summative results that have implications for evaluation and improvement (Stevens & Levi, 2005)

26. Rubrics • Structure of Rubric • Thread concepts, objectives, and competencies throughout • Remember clinical objectives may be similar to course objectives (broad, general statements) but with a clinical focus • Align each objective with a competency • Level competencies to demonstrate progression in expected KSA outcomes/objectives • Rating Scale: Differentiate among levels of performance • Satisfactory - Needs Improvement - Unsatisfactory • Numerical Rating • Performance Level: Demonstrate level of dependence • Independent - Supervised - Assisted – Marginal - Dependent • Descriptions of expected outcome • Develop a template

27. Clinical Evaluation Tool & Rubric Clinical Objective Concept Competency Rating Level Rating Criteria

28. Formative Clinical Evaluation Tool & Rubric Clinical Objective Summative Competency Rating Criteria Level

29. Summative Evaluation

30. Developing a Robust CET Does your CET? • Describe required student performance (competency) • Provide leveled competencies for each outcome/objective • Advance in complexity • Observe Assist Independent • Demonstrate attainment of program outcomes • Demonstrate threading of concepts, outcomes, and competencies into the clinical experience • Trace back to the mission & philosophy

31. References American Association of Colleges of Nursing. (2010) AACN applauds the new institute of medicine report calling for transformational change in nursing education and practice. Retrieved April 25, 2011 from www.aacn.nche.ed/Media/NewsRelases/2010/iom/html Billings, D.H. & Halstead, J. A. (2012). Teaching in nursing: A guide for faculty (4rd ed.). St. Louis, MO: Elsevier Saunders. Keating, S. B. (2006). Curriculum development and evaluation in nursing (1st ed.). New York: Lippincott Williams & Wilkins. Oermann, M.H., & Gaberson, K.B. (2009) Evaluation and testing in nursing education (3rd ed.). New York, NY: Springer Publishing Company. Shipman, D. Roa, M., Hooten, J. & Wang, Z.J. (2012). Using the analytic rubric as an evaluation tool in nursing: The positive and negative. Nurse Education Today. 32(9), 246-249. Stevens, D.D., & Levi, A.J. (2005). Introduction to rubrics: An assessment tool to save grading time, convey effective feedback, and promote student learning.Sterling, VA: Stylus. Suskie, L. (2009). Assessing student learning: A common sense guide (2nd ed.). San Fransico, CA: John Wiley & Sons, Inc.

32. Questions?