Assessing workplace-based clinical education – paper presented at AVA 2013

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There was a wide variety of topics in the education stream in Cairns, both in the speaker sessions and posters, but particular focuses were supporting practices in providing extramural work experience for students and assessing the competence of students in those workplace settings. A following post will give more details on each presentation in the education section.

The focus on training and assessment of students in the workplace was perfect for Dr Meg Dietze and I. We spoke about our plan to use an adapted version of the Bondy scale, originally developed by Kathy Bondy for human nursing in the 1980s, in assessing clinical competency of veterinary nursing students. Below is a summary of our presentation although unfortunately I’m unable to share the slide deck.

Workplace-based clinical education: adapting the human nursing Bondy Scale

Meg Dietze and Rebekah Brown

Paper presented at Australian Veterinary Association conference, 28 May 2013

We began searching for an alternative to the two point scale (competent or not yet competent) commonly used in veterinary nursing teaching programs in Australia as we felt this approach limited the feedback and learning opportunities for students, and ignored the spectrum of learning that occurs until students gain independent professional competence in required skills. The scale we felt most closely fitted our needs was the Bondy scale.

The Bondy Scale for assessing competency

Similar to veterinary nursing, human nursing requires students to demonstrate competence in a range of skills prior to graduation. The Bondy scale, a five point criterion-referenced scale, is used by several nursing schools in Melbourne and across the world for clinical competency assessment and student feedback. The scale was developed by Kathy Bondy, a human nurse, in the 1980s in response to the perceived subjective and inconsistent clinical competence evaluation of student nurses (Bondy, 1983).

The Bondy scale appears attractive and practical for veterinary nursing and related clinical education as it offers a framework for objective assessment and provides the student with constructive feedback. There is evidence that rating scales increase in reliability as the number of points increases, an inherent advantage for this scale over the standard two point scale.

The rubric can be seen below.

Bondy_rubric_v2

 

 

 

 

 

Each competency is assessed using three different categories:

  1. Professional standards – did the student achieve the purpose of the task and do so safely and with appropriate behaviour?
  2. Quality of the performance – was the student efficient, confident and timely and display an appropriate completeness of knowledge?
  3. Assistance required – what level of guidance was required to complete the task?

The three criteria are observed simultaneously and assessed together to determine the student’s level of competency. The five levels of competency which students can be graded at listed at the left of the table:

  • Independent (I)
  • Supervised (S)
  • Assisted (A)
  • Marginal (M)
  • Dependent (D)

The assessor assigns the student the competency level which matches the lowest level of achievement in any of the three criteria areas.

Implementation training

Assessors will be trained using a wide range of educational videos demonstrating different levels of competence. As well as ensuring they apply the scale in a consistent and appropriate manner, assessors will be advised on how best to offer constructive feedback on strengths and weaknesses.  Students will also undergo preparatory training to ensure they understand how they will be assessed and that they can interpret and apply the feedback they receive to improve their performance.

Audience participation

As part of our implementation testing and in the spirit of active learning, we decided to use our audience to test the reliability of the scale. We made a video of a ‘student nurse’ booking a routine desexing surgery in which we included some deliberate errors and prompts. After viewing it, we gave our audience two minutes to discuss their thoughts with their neighbour and then award a level of competency for each of the three criteria and an overall competency level. For the quality of performance and assistance categories the level of competency awarded was relatively consistent across the group of approximately 40 people but for the professional standards category levels of competence awarded varied from supervised to marginal. This was not entirely a surprise as we had felt this would be the least clear cut of the categories. The experience of our audience testing has prompted us to plan further modifications to the rubric, a topic for future post. Thanks to the audience for participating in the review cycle, which will be ongoing.

Collaborators sought

A huge bonus from our presentation was that two Australian universities are now considering a trial implementation of the Bondy scale, further modifying it to suits their particular needs. We would absolutely welcome any other institutions who are interested in participating. If that includes you, please email me:  rebekah@rebekahmbrown.com or my colleague Meg: megandietze@nmit.edu.au

References

Bondy KM, Criterion – referenced definitions for rating scales in clinical evaluation. Journal of Nursing Education. 1983;22:376-38.

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About rebekahmcbrown

I am a veterinarian with a special interest in instructional design and developing eLearning in the veterinary and medical areas. I write teaching materials for both face-to-face and online learning as well as writing and editing articles.
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