Preceptorship
Denielle Beardmore, RN, Dip Project M’Ment, Ma Ed, Grad Dip Ed &
T, Grad Dip Onco/Pall Care, BA Nursing, Dip App Sci (Nursing), Cert IV
WAT
Director Nursing Education and Practice Development
Ballarat Health Services
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Acknowledgement
This project was possible due to funding made
available by Health Workforce Australia.
www.youtube.com/watch?v=fW8amMCVAJnoredirect=1
Come to the edge’, he said.
They said, ‘We are afraid’.
‘Come to the edge’, he said.
They came.
He pushed them…..
And they flew!
Giullaume Apollinaire
4
Objectives
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To provide an understanding of what
preceptorship is
To develop an awareness of what
characteristics and qualities one needs to
possess in order to be a successful
preceptor
To develop an understanding of the theory
as it relates the principle foundations of
adult learning
To develop knowledge in support strategies
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 Identify
methods of assessing
performance and providing
feedback
 How to create a positive learning
environment
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Flying Start Series
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http://glm.e3learning.com.au/
Defining Preceptorship
Preceptorship is not easily defined and is often interchanged in the
literature with the words “mentoring”, “clinical coaching” ‘budding”
or “clinical support” it is a word used to describe a means of
transition. It involves a paring of one or more experienced clinician
(preceptor) with a novice (preceptee). A novice could be an
“undergraduate, new graduate or clinician in transition to a new
facility or area of practice” (Wright, 2002)
For the purpose of the Flying Start Series we consider
preceptorship as:
.................a period of transition for the undergraduate student or newly
registered practitioner “during which time he or she will be supported
by a preceptor, to develop their confidence as an autonomous
professional, refine skills, values and behaviours and to continue on
their journey of life-long learning”
(NHS, Preceptorship Framework, 2009)
Defining Preceptorship
It is about.....................
“an individualised period of support under
the guidance of an experienced clinical
practitioner which attempts to ease
transition into professional practice or
socialisation into a new role”
(NHS, Preceptorship Framework, 2009)
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The preceptorship relationship is usually a
“short-term professional relationship with
a specific end date, it is often an assigned
relationship with preceptors and preceptees
seldom involved in the selection with whom they
will be paired………….it tends to focus primarily
on the development of clinical competencies
and involves some sort of judgement or
evaluation of the overall clinical performance”
(Yonge, Billay, Myrick, Luhanga, 2007)
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Preceptors are responsible for evaluating the
advancement of learners, ensuring they progress to
develop critical thinking skills and evolve into
confident and capable nurses
Preceptor is the title that is used to describe an
expert nursing or medical clinician who is a role
model to the learner, demonstrating and personifying
a competent nurse
The preceptor engages in one-to-one teaching in an
actual clinical setting where the information supplied
is practical rather than theoretical
The preceptor models the appropriate professional
behaviours and ensures the development of a safe
and competent learner (Baltimore, 2004)
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Preceptorship is therefore a framework to ensure
transition support processes meet best practice standards
in the form of “an educational relationship which is
intended to provide access to an experienced and
competent role model, a means by which to build a
supportive teaching and learning relationship” (Qld Health)
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Much of the literature on preceptorship implies that the
most appropriate preceptor is one who is experienced
however in many settings these choices are not available
therefore the Flying Start Series considers that newly
graduated practitioners can undoubtedly relate to the
experiences of adapting to a new role or workplace
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Therefore all levels of staff should be considered as
contributing to the preceptorship journey
Competent Clinician
Role Model
Problem solver
Teacher
PRECEPTOR
Communicator
Counsellor
Assessor
The role of the preceptor is multifaceted
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Small fish in a big sea
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The aim of preceptorship is to
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assist the novice practitioner to adjust to their
new role
provide supervision to novice clinicians
aide in the smooth transition of the preceptee to
effectively apply and consolidate knowledge and
skills delivered in educational programs
act as a role model and effectively manage the
identification and promotion of professional
behaviours, and
assist in the application of theory to practice with
a particular group of patients/clients
The work place as a learning
environment
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Differs from that of the classroom, it has an
added dimension………...the patient
‘Reality’ assists the novice to integrate their
knowledge into practice
The workplace is complex - The physical
environment, staffing levels, complexity of
patients, how the learners role is viewed, quality
of the supervision all have an impact
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Finding the right road
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Issues in the work place
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Limited number of clinical placements or
rotations
Quality and quantity of the preceptors
available
Current and recency of practice in the
speciality areas
Variability in expectations from wards,
students, staff and the University
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First Impressions count
The first hours a preceptee spends with you as a
preceptor sets the scene for the ongoing relationship
you wish to build, it is an important moment in time,
appreciate the benefits that can occur with well planned
time on the first day or shift.
Some practical ideas for making the preceptorship
relationship work might be:
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to identify when you can work together from a roster
point of view
Give the preceptee a tour of ward/dept or work area, go
through the routine, and let them know how things are
organised for the day
Discuss dress requirements
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Refer them to the location and check they have
access to your organisational policy and
procedures
Introduce the preceptee to key people in the
team/area
Discuss transport arrangements – can the
preceptee get to the workplace for all shift times?
Identify any resources the preceptee may require,
ask if they have any particular support needs
Ask what their concerns are if any with this
placement or experience
Ask them what their goals for this experience are
And be sure to discuss feedback processes of
how, when and what if any are the processes
should they not be satisfied.
So what’s in it for me?
There are a number of documented benefits for implementing
preceptorship some of your colleagues have said being a preceptor
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“challenges you” (CNS)
“It can help your professional development- the students question
you” (RN)
“you get to share what you know” (Grad)
“It eventually benefits patient care as working with a preceptee helps
you to reflect on your own practice and being asked more questions
helps you learn more” (CNS)
“(It) improves morale” (Grade 2 RN)
“it may sound a bit out there but….I do it because I can influence and
shape the type of professionals that are going to work here” (CNE)
“new staff see things through fresh eyes we should listen carefully to
their observations” (NUM)
“it helps to remind me of some of things I think are important in my
profession” (Medical Registrar)
Role of the Preceptor
To act as a facilitator, teacher, observer,
evaluator and role model
 Introduce the preceptee to other staff
members and inter department
personnel, to help integrate them into
the social structure of the nursing unit
 Teach and supervise in connecting the
theory to clinical practice
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 Assist
the preceptee to coordinate
patient care
 Share the expectations upon
which evaluation will take place
 Communicate concerns about
them to them in the first instance
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To be or not to be a
Preceptor ??????
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Attributes of a Preceptor
Considerable literature exists listing the many attributes and characteristics of what
makes a successful preceptor, hopefully you will recognise yourself in some of the
following:
A Preceptor is
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willing to support others
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a problem solver
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a critical thinker
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patient
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motivated to contribute to the learning and development of others
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knowledgeable in the clinical setting
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enthusiastic
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committed to quality health care outcomes
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a promoter of learning
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able to display insight and empathy to situations
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an exemplary role model
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a talent spotter
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a reflective practitioner
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able to adapt different learning styles
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respectful of peers
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non-threatening and non judgemental
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able to use see the funny side of things
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conscience of the level of influence and privilege being a preceptor has
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Why be a preceptor?
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To help another person gain skills you
already posses
You think you have the personality and
enthusiasm to give it a go
To increase the number of staff able to
complete specific tasks
To develop your training and leadership
skills
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Dual roles
With all this in mind we also need to consider
that you will be juggling dual roles, although you
have offered to be a preceptor and you are
seen to be proficient and experienced in your
clinical role you will need to consider the
balance between the needs of your
patients/clients/residents and the preceptee.
Differences between a preceptor and preceptee
may arise when expectations, roles, learning
and communication styles are not made clear
Expectations
 You
are not expected to know
everything but that your role is to
assist the Undergraduate
students, or new staff
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Do you still
want to do
this?????
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Adult Learning
Principles
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The principles of adult learning apply a practical approach, with
assumptions based on a humanistic conception of self-directed
and autonomous learners with teachers as facilitators of learning.
The principles believe that:
 Adults need to know why they need to learn something before they
undertake it. Preceptors’ can facilitate the reasons for knowing things by
raising awareness and acting as role models.
 The role of the learner’s experience is important to use. As a preceptor
consider the volume and quality of the learners experience and background
including learning style, motivations, needs, goals and interests. Experiential
techniques such as group discussion, simulation, problem solving exercises
and case studies can be useful. Care should be taken to ensure that
experience hasn’t closed us off to new ideas/fresh perceptions etc. Using
preceptees own experience is important for their self-identify. Our
experiences contribute to who we are!
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Adults have a self-concept of being responsible for their own decisions and
lives. There is a deep need to be seen by others as being capable of self
direction Preceptors need to act as facilitators, guiding development rather
than considering the preceptees as empty vessel that need to be filled
Adults must have a readiness to learn this means we are ready to learn
things we need to know in order to function or cope with real life situations.
Preceptoring in the workplace does just this, it is learning in the context of
reality.
Orientation to learning – Children are subject-orientated and adults are life
centred, task-centred or problem-centred. We learn new knowledge, skills
and attitudes best in the context of real life application.
Adults respond better to internal motivators rather than external
motivators however these internal motivators like job satisfaction, selfesteem, quality of life, growth and development, may become blocked by
negative self concept, lack of resources and programmes that defy adult
learning principles.
 Learning
is facilitated when the preceptor has
sufficient experience and expertise within an
identified clinical practice area to feel confident and
competent in clinical nursing skills
 Learners prefer and learn best from preceptors who
understand and appreciate learning and continue to
be learners themselves
 Learning is enhanced by preceptors who
appropriately demonstrate empathy, non-possessive
warmth, respect for the learner and consistency in
their approach to the preceptor/learner relationship.
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Each learner is unique, therefore, learning can be influenced by
factors such as the individual’s emotional status, motivation and
cognitive ability
 Adults learn best if they are acknowledged as partners in the
learning experience, participating fully in the design,
implementation and evaluation of the experience
 Learners have expectations of the experiences to be provided by
the organisation by which they are employed
 Preceptors should ascertain what these expectations are and seek
to fulfil them
 Learners should take primary responsibility for their skill
development and take an active role in identifying areas of
competency and inability
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Learning Styles
Each person differs in their preferred learning
style and techniques. Learning styles generally
group common ways that people learn.
Everyone has a mix of learning styles. Some
people may find that they have a dominant
style of learning, with far less use of the other
styles. Others may find that they use different
styles in different circumstances. There is no
right way. Nor are your styles fixed. You can
develop ability in less dominant styles, as well
as further develop styles that you already use
well.
The literature talks about many different
definitions of styles in general the seven most
common styles can be considered as:
Verbal (linguistic) – you prefer using words, in both
speech and writing
Visual (spatial) – you prefer using pictures, images
and spatial understanding
Auditory – you prefer using sound and music
Kinaesthetic (physical) – you prefer using your
body, hands, and sense of touch
Mathematical (Logical/theorist) – you prefer using
logic, reasoning and systems
Social (interpersonal/activist) – you prefer to learn
in groups or with people
Solitary (intrapersonal/reflector) – you prefer to
work alone and use self-study
Consider your own learning style, what is
your preference when learning a new
skill?
In the first few days of working with your
preceptee consider their learning style/s,
by having some understanding of the
different styles or preferred style
Acquisition of professional skills
Preceptees will be continuously gaining skills and
knowledge by observing you as a role model however
sometimes your facilitation of their development will
need take on a more formal approach
Clinical skills they will need to master will vary from
simple to complex and preceptees will vary from
novice with a limited range of skills to experts who
have developed a wide range of skills
A clinical skill should bring together both theory and practice, it
is not just being able to do something, but also about
Understanding the rationale or theory that underpins the
intervention
Strategies for teaching skills
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The first thing to consider is what stage of development is
the preceptee at, ask questions like what course are they
undertaking, what year are they in, have they been in this
type of setting before, what skills and knowledge do they
already possess that you can build upon?
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Consider what resources you have available, what is essential
learning to achieve and what is desirable if it is available?
You may like to identify core or essential skills pertinent to
the clinical area and the preceptees stage of development
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If there are any assessment requirements or achievement of
competencies these should be identified as a priority. Don’t
forget to enlist the assistance of your colleagues to achieve
these strategies.
Preparation for teaching skills
The first time a preceptee attempts a skills should
be as controlled as possible there will obviously be a level of
anxiety on their part and patients/clients should be informed
Consider if the skill can be attempted away from the
patient/client to reduce this stress often this is not possible as
a learning opportunity has presented itself
Encourage the preceptee to plan out loud, talk through the
activity they are going to undertake, can they recount the
steps of the process or procedure? This allows you time to
anticipate any problems or gaps and potentially correct any
errors
Preparation time is valuable if it can be made available for both
You and the preceptee.
Breaking down the skill
Although a skill has to be performed as a
whole, there are often many components
that you can break it into. Teaching the
components in parts gradually integrating
these into the whole allows the preceptee
time to master each component
Repeat practice
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Mastery within different settings is only
acquired with repeat practice; the
preceptee may have the opportunity to
simulate the clinical skill in a safe
environment which allows for correction of
technique and feedback away from the
patient or client
The urge to intervene
No doubt in your time as a preceptor you
will feel the urge to intervene this must be
resisted for reasons other than putting the
patient/client or others at risk
 The opportunity to make mistakes is a
valuable experience that can be used as a
positive point of discussion
 Feedback on this level of performance and
areas of improvement given consistently will
reduce the preceptees feelings of exposure,
vulnerability and anxiety
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A model for teaching clinical skills
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Peyton (1998) described a model for teaching clinical skills that can be used in
simulated learning environments and the clinical setting. It is known as the “4stage approach”
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Stage 1 consists of a demonstration of the clinical skill at normal speed with no
explanation. This allows the preceptee to see what the skill should look like in
real time
Stage 2 is repetition of the skill with clear explanation; the preceptee can ask
questions and clarify at any point
Stage 3 is where the preceptor (or another staff member) performs the skill
with the preceptee providing the verbal instructions the preceptor can ask
questions, clarify points, and challenge the instructions. The stage can be
repeated several times in the simulated learning environment or over several
days if in the clinical setting.
Stage 4 allows the preceptee to perform the skill under supervision
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Remember to consider the risks
As with any learning that occurs in a clinical setting the
risks associated with the activity need to be considered,
risks to patients/clients and others should be assessed
when implementing any teaching of clinical skills.
Patients/clients should be advised and given the
opportunity to renege on being part of the learning
event
 Peyton’s model may look time consuming and long
winded however opportunity to receive feedback,
reflect and practice ensures learning is grounded in best
practice
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Professional Socialisation
‘‘Who are you?’’ said
the caterpillar… ‘‘I – I
hardly know, Sir, just
at present’’, Alice
replied rather shyly,
‘‘at least I knew who I
was when I got up this
morning, but I think I
must have been
changed several times
since then’’
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The ‘in-betweenness’ that occurs when a
undergraduate student receives a formal
registration number or when a practicing
professional starts in a new area can be described
as a nonlinear process or journey that moves the
new person through developmental and
professional, intellectual and emotive, skill and rolerelationship changes, and contains within it
experiences, meanings and expectations
(Duchscher, 2008).
Building a learning culture
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Health care environments that support learning are essential if
preceptees are to be “effectively orientated, taught to work
safely, interact in a proactive manner and contribute to ideas
that benefit practice and health outcomes”
(Henderson, Walker, Creedy, Boorman & Cooke, 2010)
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The literature confirms that health workplaces need to be
accepting of different levels of staff with varying degrees of skill
sets. With this acceptance comes affiliation, two prerequisites
for learning. As a preceptor you can play a part in equipping
staff to connect with preceptees.
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Connections made between the preceptee and staff
in the work area can be promoted and fostered by
you in your preceptor role
Consider how you prepare your colleagues for the
arrival of the preceptee
Think of ways to ignite curiosity and interest,
discover what is known about the preceptee and
share it with the team
In the week leading up to the arrival of the
preceptee talk about what they can and can’t do and
what their scope of practice will be?
A learning culture
.................So what is a learning culture and how do you know if you have
one? These questions are often asked; the answers are complex and
subject to much debate and discussion.
 It was Peter Senge’s 1990 book The Fifth Discipline that brought him
firmly into the limelight and popularized the concept of the ‘learning
organization'. Since its publication, more than a million copies have
been sold and in 1997, Harvard Business Review identified it as one of
the seminal management books of the past 75 years.
According to Senge (1990) learning organizations are:
 …organizations where people continually expand their capacity to
create the results they truly desire, where new and expansive patterns
of thinking are nurtured, where collective aspiration is set free, and
where people are continually learning to see the whole together.
"There is nothing you can do to get another person to
commit. Commitment requires freedom of choice.“
(Peter Senge 1992)
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The basic rationale for such organisations is that in situations of rapid
change only those that are flexible, adaptive and productive will excel.
For this to happen, it is argued, organisations need to ‘discover how to
tap people’s commitment and capacity to learn at all levels’
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To become a learning organisation is to accept a set of attitudes,
values and practices that support the process of continuous learning.
Providing support in the form of preceptorship could be considered one
of the elements of such a process. Through learning, individuals can
re-interpret their world and their relationship to it
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A true learning culture continuously challenges its own methods and
ways of doing things
5 elements of a learning culture
Senge (1990) believes that the following five elements contribute to a learning
organisation:
 personal mastery – create an environment that encourages personal and
organisational goals to be developed and realised in partnership
 mental models – know that a person’s 'internal' picture of their environment
will shape their decisions and behaviour
 shared vision – build a sense of group commitment by developing shared
images of the future
 team learning – transform conversational and collective thinking skills, so that
a group’s capacity to reliably develop intelligence and ability is greater than the
sum of its individual member's talents
 system thinking – develop the ability to see the 'big picture' within an
organisation and understand how changes in one area affect the whole system.
 The learning workplace culture is underpinned by the values and beliefs of
work and practices; it is how the culture is sustained and how individuals within
the culture respond to learning events.
Learning activity
How does your workplace meet the 5 elements if a learning culture?
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Personal Mastery: How can you as a preceptor create an environment that
encourages personal and organisational goals to be developed and realised in
partnership with the preceptee and team?
Mental Models: How can you as a preceptor discover a preceptees ‘internal’
picture of their environment and how this shapes their decisions and behaviour?
Shared Vision: How can you as a preceptor build a sense of group
commitment by developing shared images of the future for both the preceptee
and the team?
Team Learning: How does your organisation transform conversational and
collective thinking skills, so that a group’s capacity to reliably develop
intelligence and ability is greater than the sum of its individual member's talents?
System Thinking: How can you as a preceptor assist the preceptee to develop
the ability to see the 'big picture' within an organisation and understand how
changes in one area affect the whole system
Zero tolerance on bullying
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For many the transition experience is typified by
fear of failure, fear of responsibility and fear of
making mistakes. Clare (2002) reports that conflict
and bullying of graduates in the workplace remains
a national problem, with up to 25% of graduates
reporting negative experiences and a lack of
support from clinicians. Little wonder then that
attrition of new graduates remains a significant
problem in Australia.
Reality shock
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Working in health care is more stressful, intense and
technological than ever before and preceptees are expected to
cope, even as some of their more senior colleagues struggle.
The first three to six months is considered to be the most critical
time for professional adjustment and for creating a commitment
(Greenwood 2000)
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Kramer (1974) coined the term reality shock to describe the
discovery that school-bred values conflicted with work-world
values. More recently this has been cited as “transition shock”
and represents the most immediate, acute and dramatic stage
in the process of professional role adaptation.
Reality shock
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The elements of transition theory amalgamate reality shock,
cultural and acculturation shock, as well as theory related to
professional role adaptation, growth and development, and
change theory
Once in the health care environment, the preceptee is immersed
in a well entrenched, distinctively symbolic and hierarchical
culture that exposes them to dominant normative behaviours that
have been described as prescriptive, intellectually oppressive
and cognitively restrictive (Kramer 1966)
Many would say that in some workplaces this remains true,
existing knowledge suggests that preceptees experience role
performance stress, moral distress, discouragement and
disillusionment during the initial months (Duchscher 2008)
Transition shock
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Transition shock has emerged as the experience of moving
from the known role of a student to the relatively less familiar
role of practicing professional. Important to this experience for
the preceptee is the apparent contrast between the
relationships, roles, responsibilities, knowledge and
performance expectations required within the more familiar
academic environment to those required in the professional
practice setting
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Appropriate preceptorship models that allow for changing roles
and relationships between preceptor and preceptee, and that
correlate with the evolving stages of transition are more likely to
meet the dynamic needs of graduates and may enhance the
job satisfaction of seasoned professionals
(Rowe & Sherlock 2005, Coomber & Barriball 2006, Glasberg et al. 2007).
Recognising the organisation of
work
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Fundamental to understanding the essence of
health care work is to recognise the systems used to
deliver health care. What model/s do you use in
your workplace? Could it be defined as primary
nursing, task allocation, patient allocation, streams
or a matrix model, is it easily identifiable or
articulated to new staff, graduates or students. How
do the patients or the rest of the interdisciplinary
team know what your craft group does?
Preventing drowning
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Much of what you will do as a preceptor during the first few
weeks with the preceptee is crucial
The literature has compared this transition time to “jumping into
a pool at the deep end”
Preceptees are nervous, have anticipated adjustment, but
thrilled to finally be what they set out to be achieving
What they need to prevent them from drowning is you as a
preceptor to affirm them, be patience, show understanding, with
a mixture of challenge and a welcoming environment that
recognises them for the knowledge and skills they have acquired
Assessment
Blooms Taxonomy of Learning
 "Taxonomy” simply means “classification”, the well-known
taxonomy of learning uses the behavioural paradigm to
classify forms and levels of learning
 It identifies three “domains” of learning, each of which is
organised as a series of levels or pre-requisites. It is
suggested that one cannot effectively — or ought not try to
— address higher levels until those below them have been
covered
 As well as providing a basic sequential model for dealing
with topics in the curriculum, it also suggests a way of
categorising levels of learning, in terms of the expected
ceiling for a given programme
 This taxonomy is useful to consider when designing
assessment tools in that you need to consider what it is you
are wanting to assess and at what level of the domain are
you aiming
Cognitive Domain
This is the most-used of the domains, it refers to knowledge
structures (although sheer “knowing the facts” is its bottom
level). It can be viewed as a sequence of progressive
contextualisation of the material
Revised Cognitive Domain
Revised taxonomy of the cognitive domain
following Anderson and Krathwohl (2001)
 Note the new top category, which is about being able to
create new knowledge within the domain, and the move
from nouns
The Affective domain
Has received less attention, and is less intuitive than the Cognitive Domain. It is
concerned with values, or more precisely perhaps with perception of value of issues,
and ranges from mere awareness (receiving), through to being able to distinguish implicit
values through analysis.
Kratwohl, Bloom and Masia (1964)
Psycho-Motor Domain
 Bloom never completed work on this domain, and there have been several
attempts to complete it. One of the simplest versions has been suggested
by Dave (1975): it fits with the model of developing skills put forward by
Reynolds (1965), and it also draws attention to the fundamental role of
imitation in skill acquisition
Definitions
 Assessment is the judgement of performance in
relation to a criteria and/or standards, it is the
ongoing process of:
 Establishing clear, measurable expected outcomes
of the learners learning
 Ensuring that learners have sufficient opportunities
to achieve those outcomes
 Systematically gathering, analysing and
interpreting evidence to determine how well
learners learning matches our
expectations/outcomes
 Using the resulting information to understand and
improve learners learning
(Oxford English Dictionary, Macmillan Dictionary)
Types of assessment practices
Summative assessment
 Summative assessment is provided at the end of the
learning experience or cycle in order to gain a measure of
how well the learner has performed against the standards
of the intended learning outcome. Summative assessment
is the grading of learning.
 Activities associated with summative assessment result
assists you to make judgements about the learners
achievement at certain relevant points in the learning
process or unit of study they can be used to formally
measure the level of achievement of learning outcomes
and can also be used to judge programme, teaching and/or
unit of study effectiveness.
Formative assessment
 Formative assessment is predominantly used to provide formative feedback to learners on
their progress. Consequently, formative assessment happens during learning and is an
integral part of learning and teaching. It helps learners to identify:
 how they are learning
 if they are meeting the standards expected of them for intended learning outcomes
 if there are any problems or issues they are having in meeting intended learning outcomes
 any ‘incorrect’ learning of knowledge or skills
 Formative assessment usually takes place during day to day learning experiences and
involves ongoing, informal observations throughout the term, course, semester or unit of
study
 it is very applicable and helpful during early group work processes
 Formative assessment requires you to create a safe environment for learning in order for
learners to take risks in their learning and be able to admit to, and learn from, their
‘mistakes’.
 Activities associated with formative assessment do not result in an evaluation. Information
about what a learner knows, understands and is able to do is used by both the
teacher/facilitator and the learner to determine where learners are in their learning and how
to achieve learning goals. It is the practice of building a cumulative record of learner
achievement
Diagnostic assessment
 Although less common, there is another broad category of assessment
known as diagnostic assessment. This type of assessment involves
identifying the learner’s prior knowledge and skills about an area of
learning
 Often the diagnostic assessment is used to determine how to develop a
program that matches the learner’s needs with the intended learning
outcomes.
 Diagnostic assessment is frequently provided at the beginning of the
learning experience or cycle in order to allow you to develop a
curriculum program that builds on learner’s knowledge and skills
 A pre-course online test or quiz that learners complete prior to beginning
their course may be an example of a diagnostic assessment tool. You
would use this learner data to modify or update the curriculum program
to accommodate their learning gaps and/or strengths, or to help learners
monitor their own learning progress during the semester
Adapted from Sydney University 2012
Methods of assessment
 Assessment methods may also be known as
assessment approaches, assessment activities or
assessment strategies.
 Formative assessment has been recognised in most
university based curriculums; thus to establish good
assessment practices you should incorporate both
formative and summative assessment types as part
of the assessment strategy. Exams and
assignments are used widely within the
undergraduate and post graduate health disciplines.
Negotiated and simulated learning events (SLE) are
emerging approaches that are gaining interest
Methods/Types of assessment
 Once you have determined whether you require diagnostic/
formative/ summative assessment type, you should identify
appropriate assessment strategies and activities that will
support the learner to meet the intended learning outcomes
for program/course
 There are several assessment approaches that are used
some of which you will be familiar with others less so. You
will also find that you may tend to use one type more
readily than other. This may be due to your exposure to the
different types of assessment or your confidence with
developing tools using this method
 Different methods of assessment provide the means of
ensuring that learners are able to demonstrate the range of
their abilities in different contexts.
Selected response assessment Examinations
It is a common misconception that
examinations are a type of assessment
rather than an approach. An examination
defines the conditions under which
student's abilities will be tested. They
usually restrict the time and place where
the assessment task will be performed.
Selected response assessment –
Assignments
 Assignments are unsupervised pieces of work
that often combine formative and summative
assessment tasks. They form a major
component of continuous assessment in which
more than one assessment item is completed
within the semester. Restrictions in format, such
as word limits and due dates, are often put on
the assessment task to increase their practicality
Negotiated
Negotiated assessment involves
agreements between staff and learners on
issues associated with learning and
assessment
The most common negotiation method is
to develop a written learning contract that
outlines the conditions of assessment
Selected response assessment – short answer
 Slightly less structured than multiple-choice questions,
short answer questions are often used in examinations
to award a few marks as a "starter", followed by a
question which requires more writing. They are most
effective when there can be no disagreement about
acceptable answers.
 As with multiple choice questions, they are convenient
for use when a number of assessors will mark the
papers, and all alternatives can be considered. For
formative assessment, such questions are often used in
class questioning, or in simple informal tests to check
recall.
Selected response assessment –
Multiple choice questions
 Multiple-choice questions (MCQs) are sometimes referred to
as “objective” tests, although the only thing which is more
objective about them than other forms of assessment is the
standardisation of the marking scheme.
 They consist of a "stem", which usually takes the form of a
question. The learner then has to choose from a number of
"items", which are alternative answers. In most forms, one of
these is the correct answer (although there are variants
which allow for a number of correct answers), and the others
are "distractors".
 MCQ are useful for easy administration to large numbers of
learners, especially where marking is to be done by
assistants rather than the test-setter. They are effective for
testing sheer knowledge and memory, and for problemsolving in convergent subject areas, good MCQs are much
harder to design than you think
Essay response assessment
 An essay is a traditional form of assessment in relatively academic
and some professional areas. It takes the form of a piece of writing
specially composed by the learner to address a question or topic set
by the teacher, usually within a set word-limit. It is extremely flexible
and easy to set:
 Things to consider when using this method of assessment
 Essays require a wide range of skills, some of which may not be
relevant to what you need to assess
 Essays written outside of a class are particularly open to plagiarism
 Setting an essay at the beginning of a module of learning to be
completed by the end may mean that the learner focus solely on the
efforts to meet the topic rather than the content
 Learners usually put a lot of effort into their essays: they are entitled
to a reciprocal effort in feedback, unfortunately essays are easy to
set but very time-consuming to mark
Essay response assessment –
Problem sheets
 Problem/ work or example-sheets are traditional formative assessment devices in
maths and science disciplines, but are also found in professional disciplines such
as law, accountancy and health. Learners are issued with a list of examples to be
worked through in time for the next session. They may well be self- or peerassessed, and the teacher may or may not see them.
 Problem worksheets can be used with most programs or courses in which there
is a substantial element of intellectual skill involved, where this can be exercised
without recourse to complex equipment which learners may not be able to
access.
 The preparation of problem sheets is very time-consuming. They have to be
devised so as to focus only on the material covered to date, and yet to make use
of that material comprehensively. Take careful note of feedback about how long
such problems take the average learner: it is easy for the confident teacher to
under-estimate how long they will take the struggling learner.
 It is fairly common practice to make the examples more difficult as the learner
works through the paper. This ensures that there is something for everyone, you
can also gauge where the group is at. You could develop the sheet as a teaching
device, by building later examples on earlier ones.
Performance Assessment – Practicum
 This is the most obvious form of assessment: observe someone doing
something to see if they can do it properly. It is the recommended default
form for competency-based programmes such as NVQs (National
Vocational Qualifications, in Australia).
 For any area in which performance itself is not enough, direct observation
needs to be supplemented by other methods. NVQs recommend oral
questioning, to get at the rationale of performance.
 You will also need to consider how many observations will be
needed..........one is not enough; observation is an extremely expensive
way of assessing.
 Prior to observing clear assessment criteria will need to be developed:
reliability is only assured when everyone engaged in the assessment
process is perfectly clear about what is being looked for, and what
evidence is required to determine competence. Developing observation
protocols is not a trivial activity.
 One of the difficulties with assessing by direct
observation is that some topics are far more
complex than others and have multiple levels of
skills required to be demonstrated in context.
 Collection and retainment of evidence also
needs to be considered to remove the possible
problems or “he says she says”
 When evidence consists of check-lists, ensure
that the learner has a copy as soon as possible,
and that there is an opportunity for dissenting
views of a particular occasion of observation to
be recorded.
Performance Assessment – Reflective
Journals/Self assessment
 This type of assessment it is about getting learners to
develop the skills and judgement to assess themselves.
Clearly it applies mainly to formative assessment, but it is
none the less important for that
 Learners who are capable of assessing themselves are
already half-way to being reflective practitioners. It is part of
their development that they should no longer be entirely
reliant on their teachers to assess them.
 It is often thought that given the chance of self-assessment,
learners will always mark themselves more highly than their
teachers would. If the self-assessment is a short-cut to
passing a module or not, this might be the case, but their
judgements—even in the case of “immature” adolescents—
often prove to be remarkably accurate or even
conservative.
Performance Assessment – Simulation
 Simulations vary from the realistic emergency event
simulator, through the pared-down role-play, to the stylised
reconstruction of a clinical scenario on a power point. It is not
so much the external circumstances which are simulated, as
the decision-making, skill and practice of the practitioner
working with them. Simulations are special cases of games.
 Simulation is good to use wherever there is a need to move
closer to the reality of practice: where the text-based casestudy does not convey the urgency of decision-making,
where there is a need to move away from the reality of
practice because of risk or where there may be little
opportunity (one hopes) for direct real-life observation of
dealing with an aggressive client or patient, health or safety
emergency, or particular kind of equipment fault.
 Given that what you may want to simulate may be
something which is dangerous in real life, it should go
without saying that it will require special attention to
health and safety precautions
 The actual assessment, as ever, needs to be based on
clear principles, with established criteria. Is it enough, for
example, for the learner to produce the desired result, or
are there process issues to be observed as well? Should
the event be recorded on video, so as to have a record
that can be discussed later and feedback given?
Performance Assessment – Simulation
 There is more scope for the use of simulation than you might
think. Have you thought of:
 "In-tray" exercises, in which the practitioner is faced with a pile of situations,
events, situations of an everyday shift, and a set period within which to
prioritise them and respond appropriately? You could think about a
handover or prioritising care for a number of patients with competing
demands
 "Alternative history" exercises: the participant is presented with a (fabricated)
article or report which presents research findings which are at variance with
the conventional best practice on a subject: he then has to prepare a
response outlining how such evidence—if true—would impact on what we
already think we know about the subject?
 Decision Mazes in which everyone starts with a case-study, and several
alternative courses of action: each choice leads to a different outcome, which
is described together with further alternatives, and so on? This idea could be
used to build an algorithm for the actions and inventions required in a basic
or advanced lie support scenario.
Performance Assessment – Case
Studies
 Ranging from simple vignettes illustrating issues in the
practice of a discipline, through to complex sets of
documentation which may require analysis and research.
Questions may be short answer: "Was Anne within her
rights to insist on an appointment? What legislation governs
this situation?" to complex plans for changing practice, or
proposals for the redesign of a service.
 Case studies are excellent for assessment of application of
principles to real-world situations. They have the potential to
reach all the way up Bloom's original taxonomy to
"synthesis" and "evaluation".
 Case studies also provide useful information for formative
purposes, including diagnosis of problems, because
answering the questions or meeting the requirements is
often a multi-stage process.
Performance Assessment – Portfolios
 A Portfolio" covers a multitude of variations: from the
portfolio of pictures, to the assembled notes and reports of
a manager. What they have in common is being a
collection, usually of items which were prepared for a
purpose other than that of assessment. A portfolio is useful,
if not essential, for the Recognition of Prior Competency
(RCC). The portfolio consists of evidence assembled to
show how the learner can meet specified learning
outcomes or assessment criteria.
 The portfolio is most valuable for the assessment of
vocational or professional practice—including work
experience. Portfolios rapidly become enormous, and
finding one's way around them can be very difficult and
time-consuming
What is competency?
 The Australian Health Practitioner Registration Authority (AHPRA)
defines competency as “The combination of knowledge, skills, attitudes
and values necessary for the health practitioner to practise at a standard
acceptable to clients and others in the profession with similar background
and experience.
 Competent means ‘having the requisite abilities or qualities’.
 Competency is a broader concept than the ability to perform individual
workplace tasks and comprises the application of all the specified
technical and generic knowledge and skills relevant for an occupation.
Particularly at higher qualification levels, competency may require a
combination of higher order knowledge and skills and involve complex
cognitive and meta-cognitive processes such as reflection, analysis,
synthesis, generation of ideas, problem solving, decision making, conflict
resolution, innovation, design, negotiation, strategic planning and selfregulated learning)
Australian Govt Website (DEEWT)
How do we know someone is
competent?
 After completing a competency based assessment. Just as
a learner-driver must demonstrate they can drive a car by
actually taking the examiner for a drive, so too must other
learners demonstrate that they are competent by
undergoing an assessment process
 Assessment may involve a practical demonstration of skills,
some form of written assessment, such as a test or
preparation of a report, or a presentation or interview
 An individual can be assessed during their training, at the
end of their training, or without even undertaking any
training (for example if they believe they are already
competent)
 The method and timing of assessment will vary depending
upon the assessor, the learner and the competency being
assessed.
What standards are candidates assessed against?
 In order to assess whether a learner is competent,
they are judged against established standards
(also known as benchmarks)
 These standards have been developed by industry
and are called competency standards.
Competency standards may also be referred to as
units of competency
 Competency standards are documents that define
the competencies required for effective
performance in the workplace in specific industries
 Competency standards include the essential
information needed to assess a learner
Competency and time
 Competency is the consistent application of knowledge and
skill to the standard of performance required in the
workplace. It embodies the ability to transfer and apply skills
and knowledge to new situations and environments
 Competency is demonstrated to the standard required in
the workplace and covers all aspects of workplace
performance including:
 performing individual tasks;
 managing a range of different tasks;
 responding to contingencies or breakdowns; and
 dealing with responsibilities of the workplace, including working with
others.
 Competency requires not just the possession of workplace
related knowledge and skills but the demonstrated ability to
apply specified knowledge and skills consistently over time
in a sufficient range of work contexts
What is Competency Based
Assessment (CBA)
 Competency-based assessment is commonly linked to
competency-based training and forms the basis of the
Vocational Education and Training (VET) system in
Australia
 The catalyst for the shift to competency-based assessment
was the need for a system which focused on industry
determined benchmarks (competency standards) and
promoted national consistency across the training sector in
Australia (Bridge 1997)
 In 1995, national arrangements for assessment for the
purposes of issuing qualifications under the Australian
Qualifications Framework (AQF) were agreed to
 These arrangements assist organisations to determine
whether or not a person has achieved a level of
competency required by industry
Education Network Australia
 Assessment under a competency based
approach, is the process of collecting evidence
and making judgments on
the nature and extent of progress towards the
performance requirements set out in a standard
(VEETAC cited in ACTRAC 1994, p.1)
 Assessment is based on the actual skills and
knowledge a person can demonstrate in the
workplace
 Where competency standards for an
industry/occupation do not exist, performance
can be assessed against a set of criteria such as
award classifications, standard operating
procedures and performance agreements
Features of competency-based
assessment
The notable features in competency-based assessment are:
 competency-based assessment is criterion based - a person is assessed not in
competition with others but against standard criteria or benchmarks;
 competency-based assessment is evidence based - decisions about whether a person is
competent are based on the evidence they provide to the assessor; and
 Competency-based assessment is participatory - the person being assessed is involved
in the process of assessment and has the scope to negotiate with the assessor the form
that assessment activities take.
In addition, competency-based assessment does not have to be limited to a narrow set of
methods. A range of assessment tools or instruments can be used as long as the person has
the opportunity to demonstrate their competence in relation to a work role/task. For example,
assessment activities may involve:
 observation in the workplace;
 practical demonstration and questioning;
 written tests and essays;
 projects; and
 simulations and role plays
(Education Network Australia, 2010)
Key features of CBA
 Regardless of the method used there are four key
features of competency-based assessment that hold
paramount
 These are: validity, reliability, fairness and flexibility
 In keeping with these four features, competency-based
assessment should always use an integrated approach
which covers all aspects of work performance including:
 task skills (being able to perform individual tasks);
 task management skills (being able to manage a number
of different tasks);
 contingency management skills (being able to respond to
problems/irregularities that arise); and
 job/role environment skills (being able to work with
others
CBA and Validity
Validity in a competency-based system
refers to assessments that cover a range
of skills and knowledge and integrate them
with their practical application. Judgments
to determine competency should be based
on evidence gathered on a number of
occasions and in a variety of contexts.
Reliability
 Means that assessment practices should be regularly
monitored and reviewed to ensure that there is
consistency in the interpretation of evidence
 It should also be noted that if competency is being
assessed for the purposes of issuing qualifications under
the AQF, then assessors must be:
 competent in the national competency standards for
assessment;
 have been deemed competent in the standards being assessed;
and
 must have a detailed understanding of the standards and their
use as benchmarks within the context and culture of the
workplace/sector/industry.
(Community Services Training Package 2010
CBA and Fairness
Fairness relates to practices and methods
that are equitable to all groups being
assessed. Provisions must be made for
assessee to challenge assessments if they
are unsatisfied with the process or the
outcomes.
CBA and Flexibility
 Flexibility in assessment refers to processes that
provide for the recognition of competencies
regardless of where they have been acquired.
For example, competencies can be achieved:
 through formal or informal training;
 through work experience;
 through general life experiences; or
 through any combination of the above.
(Community Services Training Package 2010)
KISS PRINCIPLE
99
4 Domains
Professional Practice
Provision & Coordination of
Care
Critical Thinking & Analysis
Collaborative & Therapeutic
Practice
10 Competency Units
1.
Practices in
accordance
with
legislation
affecting
nursing
practice
health care
2.
Practises within
a professional
and ethical
nursing
framework
3
Practises
within
evidencebased
framework
4. Participates
in ongoing
professional
development
of self and
others
5.
Conducts a
comprehensiv
e and systemic
nursing
assessment
6.
Plans nursing
care in
consultation
with
individuals/gr
oups,
significant
others and the
interdisciplina
ry health care
team
7.
Provides
comprehensiv
e, safe and
effective
evidencebased nursing
care to achieve
individual/
group health
outcomes
8.
Evaluates
progress
towards
expected
individual/
group health
outcomes in
consultation
with
individuals/
groups
significant
others and
interdisciplina
ry health care
team
9. Establishes,
maintains and
appropriately
concludes
therapeutic
relationships
10.
Collaborates
with the
interdisciplina
ry health care
team to
provide
comprehensiv
e nursing care
Competency Elements
3
7
5
4
3
4
8
2
5
4
Guiding Cues
100
Professional Practice
1. Practices in accordance with legislation
affecting nursing practice health care
1.1 Complies
with relevant
legislation
affecting nursing
practice and
health care
1.2 Fulfils the
duty of care
2. Practises within a professional and
ethical nursing framework
1.3
Recognises and
responds
appropriately to
unsafe or
unprofessional
practice
2.1 Practices
within a
professional and
ethical nursing
framework
Cues
101
Critical Thinking & Analysis
4. Participates in ongoing professional
development of self and others
3. Practises within evidence-based
framework
3.1 Identifies
the relevance of
research to
improving
individual/
group health
outcomes
3.2. Uses best
available
evidence,
nursing
expertise and
respect for the
values and
beliefs of
individuals/
groups in the
provision of
nursing care
3.3
Demonstrates
analytical skills
in accessing and
evaluating
health
information and
research
evidence
3.4 Supports
and contributes
to nursing and
health care
research
3.5 Participates
in quality
improvement
activities
Cues
4.1 Uses best
available
evidence ,
standards and
guidelines to
evaluate nursing
performance
4.2 Participates
in professional
development to
enhance nursing
practice
4.3 Contributes
to the
professional
development of
others
4.4 Uses
appropriate
strategies to
manage own
responses to the
professional
work
environment
102
Provision & Co ordination of care
6. Plans nursing care in consultation with
individuals/ groups and the
interdisciplinary health care team
5. Conducts a comprehensive &
systematic nursing assessment
5.1 Uses a
relevant
evidence-based
assessment
framework to
collect data
about the
physical sociocultural and
mental health of
the individual/
group
5.2 Uses a
range of
assessment
techniques to
collect relevant
& accurate data
5.3 Analyses &
interprets
assessment data
accurately
6.1 Determines
agreed priorities
for resolving
health needs of
individuals/
groups
Cues
6.2 Identifies
expected &
agreed
individual/
group health
outcomes
including a time
frame for
achievement
6.3 Documents
a plan of care to
achieve
expected
outcomes
6.4 Plans for
continuity of
care to achieve
expected
outcomes
103
Provision & Co ordination of care
7. Provides comprehensive, safe & effective
evidence-based nursing care to achieve
identified individual/group health outcomes
7.1 Effectively
manages the
nursing care of
individuals/
groups
7.2 Provides
nursing care
according to the
documented
care or
treatment plan
7.3 Prioritises
workload based
on the
individuals'/
group’s needs
acuity and
optimal time for
intervention
7.4 Responds
effectively to
unexpected or
rapidly
changing
situations
7.5 Delegates
aspects of care
to others
according to
their scope of
practice
Cues
7.6 Provides
effective and
timely direction
and supervision
to sure that
delegated care
is provided
safely and
accurately
7.7 Educates
individuals/
groups to
promote
independence
and control over
their health
7.8 Uses health
care resources
effectively and
efficiently to
promote
optimal nursing
and health care
104
Provision & Co ordination of care
8. Evaluates progress towards expected
individual/group health outcomes in consultation
with individuals/groups significant others and
interdisciplinary health care team
8.1 Determines
progress of
individuals/
groups toward
planned
outcomes
8.2 Revises the
plan of care and
determines
further
outcomes in
accordance with
evaluation data
Cues
105
Collaborative & Therapeutic
Practice
10. Collaborates with the interdisciplinary
health care team to provide comprehensive
nursing care
9. Establishes, maintains & appropriately
concludes therapeutic relationships
9.1 Establishes
therapeutic
relationships
that are goal
directed and
recognises
professional
boundaries
9.2
Communicates
effectively with
individuals/
groups to
facilitate
provision of
care
9.3 Uses
appropriate
strategies to
promote an
individual’s/
group’s selfesteem, dignity,
integrity and
comfort
9.4 Assists and
supports
individuals/
groups to make
informed health
care decisions
9.5 Facilitates a
physical,
psychosocial,
cultural &
spiritual
environment
that promotes
individual/
group safety &
security
Cues
10.1
Recognises
that the
membership
& roles of
health care
teams &
service
providers will
vary
depending on
the
individual’s/
group’s needs
& health care
setting
10.2
Communicates
nursing
assessments &
decisions to the
interdisciplinary
health care team
& other relevant
service
providers
10.3 Facilitates
coordination of
care to achieve
agreed health
care outcomes
10.4
Collaborates
with the health
care team to
inform policy &
guideline
development
106
Assessing: Use your head not your heart
107
Is making a bed a competency or a skill?
108
Competency vs. Skill
• Competency is broad
• Encompasses skills & knowledge
• May require more than one skill to achieve a
competency
109
ANMC
Competency Based Evaluation Legend
Criteria
Competency
Rating
Independent
Proficient
Advanced Beginner
Novice
Practices in a safe, accurate, coordinated and effective manner.
Practices in a safe, accurate, coordinated and effective manner little need for
guiding cues.
Practices in a safe, accurate and coordinated manner most of the time, with some
guiding cues required.
Practices in a safe manner when frequent guiding cues are given.
Unsatisfactory
Unable to demonstrate safe practice, adequate knowledge base and/or
appropriate professional behaviour.
Not Applicable
Not observed, not applicable or unable to assess.
(Adapted from Benner & Bondy) 110
MINIMUM COMPETENCY RATING
YEAR 1
YEAR 2
YEAR 3
YEAR 3
Preceptorship
Advanced
Beginner
Proficient
Proficient
Independent
CRITICAL THINKING
AND ANALYSIS
Novice
Advanced
Beginner
Proficient
Proficient
PROVISION AND
COORDINATION OF
CARE
Novice
Advanced
Beginner
Proficient
Proficient
COLLABORATION AND
THERAPEUTIC
PRACTICE
Novice
Advanced
Beginner
Proficient
Proficient
DOMAINS/
COMPETENCY UNIT
PROFESSIONAL
PRACTICE
This tool is to be used in conjunction with: ANMC: National Competency Standards for the Registered Nurse 2006 and Principles for
111
the assessment of National Competency Standards.
“We must become the change we want to
see in the world.”
Mahatma Gandhi (1869 – 1948)
112