TABLE 3 Narrative Report on Competency - Review of Evidence and Process (Date as reviewed)


The Evaluator reviews the process presented as evidence of:  Participation  Comprehension  Performance


The evidence must allow for the evaluation of the following domains and performance indicators: Performance Criteria  The reviewed individual consistently shows evidence of creativty and innovation


 Reviewed process shows evidence of the generation of options and solutions and assays of alternatives


TABLE 4


Testing time in hours


1 2 4 8


Number of cases


2 4 8


12


Same examiner for all cases


0.31 0.47 0.47 0.48


The Narrative Component The literature pertaining to assessment of staff suggests that the degree of performance on one problem does not accurately predict performance on another. This is one reason why the large bulk of skill-based competencies were reduced at Rashid Hospital following an extensive review in 2009. Furthermore, the literature suggests that performance during testing, both through an Objective Structured Clinical Examination [OSCE] type approach, and through multiple choice questions and case study examinations are unreliable if they test fragmented skills in isolation. Against this, global rating scales do well in terms of their reliability for identifying the ‘competent practitioner’ across all groups with differing levels of expertise (table 3). Reliability studies point to eight hours


of evaluation being broken up into 12 sessions with two different evaluators used accurately reflects the judgments being evaluated. This has been elucidated by Govaerts et al [2007] as only one observer tends to be inflated and ‘simple’ quantitative testing stands up poorly against qualitative/ narrative information described by several examiners in terms of reliability or its ability to truly reflect the nurse’s abilities. From table four it can be extrapolated


that a variety of evaluation methods are required provided they are applied over a considerable length of time. However we can never hope to have the resources to apply eight hours of evaluation for each competency using different evaluators. It is suggested therefore that on-going


evaluation as a method of competency performance maybe required and that


170 www.lifesciencesmagazines.com


New examiner for each case


0.50 0.69 0.82 0.90


Two new examiners for each case


0.61 0.76 0.86 0.93


recording of this testing may also be an extended event.


SUMMARY OF COMPETENCY EVALUATION  Work-based assessment cannot replace standardised evaluation and no single measure can do it all  Direct assessment of domain knowledge [that knowledge which we can test] will remain vital, therefore evaluation of all competence should continue for very obvious reasons. Furthermore, there is also certainly a correlation between practice performance and content performance.  If we wish to address the question of impact of education on patients and if we


accept that much of what is learnt is work in the workplace is from peers and by reflection on practice, then we still need to try to address validation of knowledge in the workplace.  Furthermore, whilst formal education can address problems of domain specific knowledge deficit [tasks] very well it performs very poorly when trying to give participants ‘domain independent’ skills and these are the skills that nurses use when things go wrong. They are the skills we often bracket under ‘critical thinking’ but they are also the skills that allow for transference of knowledge from one application or task to another.  Assessment of these skills must therefore be made, and perhaps taught, ‘in vivo’ in the workplace. This approach however relies heavily on expert judgment and is best recorded using qualitative information. Given what has been discussed above,


a dual approach to evaluation using both a skills and narrative approach seems the most effective at evaluating a nurse’s performance holistically. Evaluation must also take place continuously throughout a nurse’s employment despite it being formally documented through appraisal on an annual/bi-annual basis. ■


AH


 REFERENCES References available on request (magazine@informa.com)


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