The use of simulation for skills assessment and validation

1. The use of simulation for skills assessment and validation Mary Ann Cordeau PhD, RN

2. Outcomes • From participating in this presentation the participant should be able to: • Define assessment and validation as they relate to clinical simulation • Link evaluation to simulation learning outcomes • Describe the process of designing a scenario which incorporates skills validation

3. Evaluation • Skills assessment – evaluating student performance • Validation – confirming student’s ability • Formative – learners provided feedback and reflect on performance, experience shapes learning • Summative – end of learning period measures how learners met objectives

4. Outcomes of Clinical Simulation (Jeffries, Rogers, 2007 ) • How does evaluation link to: • Learning (knowledge) (objective) - learner is evaluated • Current knowledge • Knowledge gained • Skill performance (objective) learner is evaluated • Learner satisfaction (subjective) learner evaluates simulation, instructor • Clinical reasoning (objective and subjective) learner is evaluated • Self-confidence (subjective) learner evaluates)

5. What do you want to evaluate? • Cognitive skill – Critical thinking, Clinical Reasoning • Psychomotor skill – vital signs • Affective skill – how does student relate to patient? • Ability to maintain a safe environment • Patient care situation which incorporates affective, cognitive, and psychomotor skills • Didactic content- alternative testing • How do students work in group

6. Formulate learning outcomes • Should be appropriate for level of student • Should reflect the purpose of the clinical simulation experience • Learning Outcomes for Caring for a Client with Ischemic Stroke • Identify client developmental, physical, and environmental factors that may lead to accidents or injury • Implement nursing interventions for a client with impaired physical mobility related to an Ischemic Stroke • Implement nursing interventions to prevent the transmission of infection • Demonstrate therapeutic communication when caring for client • Implement critical thinking when assessing laboratory values in relation to medication administration • Administer medications using the five rights of medication administration • Provide necessary teaching related to illness management (stroke, diabetes, hypertension) • Self-evaluate care provided

7. Linking cognitive and psychomotor skills • Will depend on level of student (novice) • Major cognitive skill(s) - Assessment • Knowledge of illness management of a client with ischemic stroke/impaired mobility (independent reading) • Knowledge of illness management of a client with Insulin Dependent Diabetes Melitus (independent reading) • Knowledge of illness management of a client with Hypertension (independent reading) • Knowledge of vital signs and laboratory values related to medication administration (independent reading, drug guide) • Therapeutic Communication skills (view communication video, pre-hospital skills lab) • Knowledge of client teaching (NU 310 Learning Theories), independent reading • Major psychomotor skill(s) • Basic assessment • Vital sign assessment • Medication administration (Subcutaneous Injection) - Validation

8. Logistics: How do you incorporate skills validation • What skills are appropriate for the scenario • When will skill be taught – students should not be expected to be validated on a skill that they have not learned and practiced • Determine how much time it will take for scenario – needed for scheduling • Determine the needed realism with equipment • Provide orientation to scenario • Write the scenario • Pilot before running with entire class

9. Background information/practice • How much information about patient will student be given prior to experience • Depends on learning outcomes • Depends on level of student (novice) • How many practice opportunities will student have? • Depends on previous experience with clinical simulation • Opportunities to practice skills

10. Grading • Effect will grade have on progression • No grade • Letter grade • Number grade • % of a course grade • Pass/Needs Improvement • Number of opportunities for meeting outcomes

11. Grading consistency • All instructors should use same standards to evaluate students • Evaluating learner performance in clinical simulation is like evaluating learner performance in clinical practice; it is both objective and subjective • Validating psychomotor skills has less subjectivity • Critical care scenarios should be very objective • Evaluating therapeutic communication scenarios will be subjective and objective • Evaluating longer scenarios that incorporate critical thinking/clinical reasoning and psychomotor skills will be both objective and subjective

12. Grading Consistency • Establish criteria for a grade of Pass • On how many interventions can a student receive a N or NI and receive a grade of Pass? • Are there critical interventions that must be completed? • What if student notes errors/omissions during self evaluation and not during scenario? • Is safety the most important factor in passing? • Can student state what they learned? • Can student state what they would do differently? • Does student note areas that need more study/practice

13. Create grading rubric • Rubric should reflect learning outcomes • Rubric should reflect level of student • Rubric should be user friendly • Rubric should have space for objective and subjective evaluation data • Pilot • Revise as necessary

14. Clara Weeks