Standardizing nurse practitioner student evaluation during high-stakes clinical examinations

Letter to the editor: ‘Implementation of facemask sampling for the detection of infectious individuals with SARS-CoV-2 in high stakes clinical examinations – a feasibility study’

Objective: The purpose of this study was to get students’ perceptions about changes made to the health assessment course delivery format from face to face to blended learning (BL). Health assessment is a foundational course in nursing undergraduate programs. Research has suggested that students have high levels of satisfaction with a blended learning format.Methods: A survey was used to gather students’ perceptions about changing a health assessment course from face-to-face delivery format to a blended learning format. All second year BSN students who were registered for the course (N = 88) were invited to participate in the survey at the end of the semester.Results: Most students in this study preferred face to face course delivery. Qualitative results were grouped together into themes: 1) Engagement, 2) E-learning tool, and 3) Confidence. Opinions were mixed concerning the e-learning materials that were used. Overall, students felt they were confident in their assessment skills as they prepared to enter the clinical environment.Conclusions: Findings from this study will impact methods of teaching health assessment and other nursing courses in the future.

Integration of visual thinking strategies to undergraduate health assessment course: A mixed-method feasibility study

The Northeast Team of the Ohio Action Coalition, composed of regional clinical and academic educators, identified a potential barrier for nurses pursuing a baccalaureate degree. Duplication of health assessment content was identified for some associate degree graduates enrolled in RN-BSN programs, thereby adding extra time and cost for attaining the baccalaureate degree. In response, the Northeast Team of the Ohio Action Coalition developed an assessment competency evaluation that, if successfully passed, would grant credit for the health assessment course. The assessment competency evaluation provided the opportunity for students to demonstrate competency in both health assessment and clinical judgment skills.

University of Florida College of Medicine

BackgroundIn response to the growing body of evidence supporting the need for expanded interprofessional education among health professions, an interprofessional education program, based on the Interprofessional Education Collaborative Core Competencies, was piloted with nurse practitioner and dental students. ObjectivesThe purpose of this pilot study was to evaluate a technology enhanced interprofessional education program focused on the oral-systemic health connection for nurse practitioner and dental students. DesignA two-group comparative study using cross-sectional data and a quasi-experimental one-group pre-test/post-test design were used to evaluate students' knowledge of IPE core competencies, attitudes toward interprofessional education and interdisciplinary teamwork, and self-efficacy in functioning as a member of an interdisciplinary team. Setting and participantsThis program was implemented with master of science in nursing students pursuing a primary care nurse practitioner (NP) degree and dental students at a large urban academic health sciences center. Cohort 1 (N = 75) consisted of NP (n = 34) and dental students (n = 41) at the end of their degree program who participated in a one-time survey. Cohort 2 (N = 116) was comprised of second-year NP students (n = 22) and first-year dental students (n = 94) who participated in the IPE program. MethodsStudents participated in a multi-faceted educational program consisting of technology- enhanced delivery as well as interactive exercises in the joint health assessment course. Data were collected prior to the initiation and at the conclusion of the program. ResultsNurse practitioner and dental students who participated in the program had better self-efficacy in functioning as a member of an interdisciplinary team than graduating students who did not participate. Students from both nursing and dentistry who participated in the program had significantly improved self-efficacy in functioning in interprofessional teams from pre- to post-test. ConclusionAn interprofessional education program can be a valuable addition to the health professions curriculum of nurse practitioner and dental students. Care must be taken to address logistical issues when working with students in different academic programs.

IntroductionThe ability to utilize the electronic health record (EHR) without compromising the doctor-patient relationship (DPR) is an essential skill of all physicians and trainees, yet little time is spent on educating or assessing learners on needed techniques. To address this gap, we developed a conventional OSCE station coupled with a simulated patient chart within the Epic program in order to assess our students' skills utilizing the EHR during a patient encounter.MethodsOf third-year medical students, 119 were given full access to the patient's simulated chart 24 hours in advance of their OSCE to review clinical data. During an in-person OSCE with a standardized patient (SP), students performed a focused history and physical, using the EHR to verify allergies and medications. Students completed an electronic patient note graded by faculty. SPs evaluated the students on communication and interpersonal skills with specific rubric elements. Faculty graded the students' notes to evaluate their expression of clinical reasoning in the assessment and plan.ResultsTraining SPs and faculty to assess students on EHR skills was feasible. After implementation of a comprehensive curriculum focused on EHR and DPR, there was a significant difference on EHR-related communication skills (M = 76.4, SD = 17.6) versus (M = 37, SD = 28.9) before curriculum enhancement t (117.9) = −12.4, p <.001.DiscussionThe EHR OSCE station provided a standardized method of assessing students' EHR skills during a patient encounter. Challenges still exist in the technological requirements to develop and deliver cases in today's EHR platform.

BackgroundThe reliability in Objective Structured Clinical Exams (OSCEs) is based on variance introduced due to examiners, stations, items, standardized patients (SP), and the interaction of one or more of these items with the candidates. The impact of SPs on the reliability has not been well studied. Accordingly, the main purpose of the present study was to assess the accuracy of portrayal by standardized patients.MethodsFour stations from a ten station high-stakes OSCE were selected for video recording. Due to the large number of candidates to be evaluated, the OSCE was administered using four assessment tracks. Four SPs were trained for each case (n = 16). Two physician assessors were trained to assess the accuracy of SP portrayal using a station-specific instrument based on the station guidelines. For the items with disagreement a third physician was asked to review and the mode was used for analysis. Each instrument included case-specific items on verbal and physical portrayal using a 3-point rating scale (“yes”, “yes, but” and “not done”). The physician assessors also scored each SP on their overall performance based on a 5-item anchored global rating scale (“very poor”, “poor”, “ok”, “good”, and “very good”). SPs at location 1 were trained by one trainer and SPs at location 2 had another trainer. All SPs were employed in a high-stakes OSCE for at least the second time.ResultsThe reliability of rating scores ranged from Cronbach’s alpha of .40 to .74. Verbal portrayal by SPs did not significantly differ for most items; however, the facial expressions of the SPs differed significantly (p < .05). An emergency management station that depended heavily on SPs physical presentation and facial expressions differed between all four SPs trained for that station.ConclusionsVariation of trained SP portrayal of the same station across different tracks and at different times in OSCE may contribute substantial error to OSCE assessments. The training of SPs should be strengthened and constantly monitored during the exam to ensure that the examinees’ scores are a true reflection of their competency and devoid of exam errors.

Effects of three-dimensional holograms on the academic performance of nursing students in a health assessment and practice course: A pretest-intervention-posttest study

Health assessment skills are vital to professional nursing practice. Health assessment has traditionally been taught using lecture, teacher-developed tests, practice and live demonstration, and interactive and computer-based learning materials. Rapid advances in information technology during the past decade have greatly expanded distance learning options in higher education. Although much nursing education now uses the Internet, there has been limited use of the Web to teach psychomotor and clinical skills. This article describes how online instruction can be integrated into a health assessment course to teach physical examination skills. The development of instructional videos that can be digitally streamed onto the Web for ready and repeated access can also enhance online learning of technical and clinical skills. Student evaluation of this Web-enhanced course revealed that online assignments enabled them to pace their learning, thereby promoting greater flexibility and independence. Students were able to master the technical skills of working online with minimal difficulty and reported that working online was no more stressful than attending class. The most helpful aspect of the online course was the instructor-developed video that was digitally streamed online.

Clinical education is critically important because competency in practice ultimately will determine the future of advanced practice nursing. Skills taught in Health Assessment, the first in a series of clinical courses, exposed students to tools that form the basis on which other competencies are built. The availability of standardized patients, people who participate in enacting a simulated but seemingly "real life" clinical encounter in a realistic clinical setting for the benefit of student learning and/or evaluation, made this instructional development project possible. The underlying assumption of this project was that clinical advanced practice nursing student education is enhanced by using an authentic clinical environment, known as a simulation center, with standardized patients and by using one or more evaluation techniques with multiple evaluators (i.e., peer, self, faculty, standardized patient). The student clinical experience was expected to improve and overall learning to increase by this method. This improvement was reflected at the end-of-course evaluations and in the quality of the final videotaped physical examination, which was superior to previous years. Student and faculty satisfaction with this teaching-learning process exceeded all expectations.

REVIEW QUESTION/OBJECTIVE The objective of this review is to examine conceptual and/or theoretical frameworks that are relevant to nurse practitioner education. The specific review question is: What conceptual and/or theoretical frameworks are available that are relevant to the structuring of nurse practitioner education? INCLUSION CRITERIA Types of participants This review will consider studies that include nurse practitioners in any specialty or the education of nurse practitioners in any specialty at the graduate or post-graduate level. Phenomena of interest In this review, we will consider documents that describe or evaluate frameworks, maps or conceptual structures for NP education at the graduate degree or post-graduate degree level. Literature that presents a framework for the graduate education of students in other health care disciplines at the university level will also be considered for inclusion. Frameworks for utilization in other jurisdictions (e.g. Provincial and Territorial regulatory frameworks) and metrics that assist in measuring, describing and organizing key concepts required for nurse practitioner education will be examined. Outcomes of interest for this review will include framework components in either narrative or illustrative form. Context This scoping review will consider studies that have been conducted in the provision of graduate level education of students in health care disciplines. Specific contextual focus will be directed to identify frameworks for educational programming for nurse practitioner students. Frameworks for curriculum development and/or delivery in other disciplines will also be considered.

Nurse Practitioners in Emergency Care

Objective To explore the application effects of Flipped Classroom based on micro-lecture in the teaching practice of health assessment for nursing undergraduates. Methods Nursing undergraduates in the natural class of grade 2016 in Xi'an Creation College of Yan'an Universitywas randomly selected as the control group. A total of 55 students, with an average age of (20.22±1.13) years, were enrolled in the study. Another nat-ural class was chosen as the observation group, with a total of 54 students, with an average age of (20.37±1.21) years. Results At the end of the course, the students of the two groups received the course examination. The training scores of the control group were (80.13±1.73) and the observation group (90.67±1.53), while total score was (76.36±2.05) and (84.21±1.66) respectively. There were significant differences in the training results and the total score between the two groups (P<0.01). Comparing the results of teacher-student satisfaction test, 89.09% of the teachers were satisfied, 98.15% of the observation group while 94.55% of the students were satisfied, and 98.15% of the observation group. There was significant difference between the two groups (P<0.05, P<0.01). The satisfaction of teachers and students in the observation group was significantly higher than that in the control group, and the questionnaire survey showed that more than 90% of the students in the observation group were satisfied with the teaching effect. Conclusion The Flipped Classroom teaching based on micro-lecture could promote the students' mastery of the theoretical knowledge and practical skills of the health assessment course. Key words: Micro-lecture; Flipped Classroom; Health assessment; Practical teaching

본 연구는 표준화 환자를 활용한 호흡기계 환자 시뮬레이션 기반 교육을 보건계열 학생에게 적용한 후 학업만족도와 자기효능감, 임상수행능력에 미치는 효과를 기존의 시뮬레이션 교육과 비교 검증하기 위해 시도되었다. 비동등성 대조군 전후설계를 적용한 유사 실험연구로서 J시에 소재한 D대학 보건계열 3학년 학생 50명이 참여하였다. 실험군 25명에게는 표준화 환자를 활용한 호흡기계 환자 시뮬레이션 교육과 평가를 진행하였고 대조군 25명에게는 전통적인 시뮬레이션 교육과 평가를 실시하였다. 2013년 11월부터 180분간 주 1회씩 총 2회의 교육과 1회의 평가로 실시되었으며 수집된 자료는 SPSS/Win 18.0을 이용하여 실수와 백분율, t-test로 분석하였다. 본 연구 결과 표준화 환자를 활용한 호흡기계 환자 시뮬레이션 교육을 시행한 실험군에서 학업만족도와 자기효능감, 임상수행능력이 통계적으로 유의하게 높았다. 이상의 연구결과를 종합한 결과, 표준화 환자를 활용한 호흡기계 환자 시뮬레이션 기반 교육은 보건계열 대학생의 학업만족도와 자기효능감, 임상수행능력 향상에 기존의 시뮬레이션 교육보다 효과적임을 확인할 수 있었다. 따라서 다양한 분야에서 표준화 환자를 활용한 시나리오를 개발하고 시뮬레이션 교육과정에 적용하여 보건계열 학생들의 전문직 역량 강화를 위해 활용할 것을 제안한다. 【This study was conducted to examine the effects of a simulation-based learning scenario using standardized respiratory patients regarding emergency care on learning satisfaction, and self efficacy, clinical skill competency of health related department students. A quasi-experimental non-equivalent control group pre-post test design was used. A total of 50 students, 25 students for the experimental group and 25 students for the control group, The experimental group received the 2 educations sessions and 1 evaluation session with 180 minutes for each session. It was implemented in November, 2013. Data were analysed using frequency, ratio and t-test by the SPSS/Win 18.0. The experimental group who had the simulation-based learning scenario using standardized respiratory patients showed significantly higher learning satisfaction and self efficacy, clinical skill competency compared with the control group who had a traditional simulation education. Through this study, simulation-based learning scenario using standardized patients was verified to be an effective teaching method to be grow up on professional competency of health related department students. Also the simulation-based learning scenario using standardized patients should be developed in the various fields.】