Assessment of Initial Clinical Assessment of Initial Clinical Competence for NP Regulation: The Competence for NP Regulation: The

Development of an Objective Development of an Objective

Structured Clinical ExaminationStructured Clinical Examination

Marie Napolitano RN, PhD, FNPMarie Napolitano RN, PhD, FNPOregon Health & Sciences UniversityOregon Health & Sciences University

Chief Examiner, NP OSCEChief Examiner, NP OSCECollege of Registered Nurses of BCCollege of Registered Nurses of BC

Alison Roots RN, MHSMAlison Roots RN, MHSMProject Manager, NP OSCEProject Manager, NP OSCE

College of Registered Nurses in British ColombiaCollege of Registered Nurses in British Colombia

InnovationInnovation

First OSCE for NP regulation (licensure) in First OSCE for NP regulation (licensure) in the international communitythe international community

OSCEOSCE

Objective Structured Clinical ExamObjective Structured Clinical Exam Used in Canada by the disciplines of Used in Canada by the disciplines of

medicine, physiotherapy, midwifery and medicine, physiotherapy, midwifery and pharmacy to assess clinical competencypharmacy to assess clinical competency

Structured examination that “biopsy’s” or Structured examination that “biopsy’s” or samples a variety of clinical skillssamples a variety of clinical skills

College of Registered Nurses of College of Registered Nurses of British ColombiaBritish Colombia

Responsible for the licensure or Responsible for the licensure or registration of nurse practitioners in the registration of nurse practitioners in the province of British Colombia (BC), Canadaprovince of British Colombia (BC), Canada

Received approval of requirements for NP Received approval of requirements for NP licensure in 2005 – same time as new NP licensure in 2005 – same time as new NP programs were graduating first NPs in BCprograms were graduating first NPs in BC

Licensure for NPs in BCLicensure for NPs in BC

RequirementsRequirements Graduation from a CRNBC recognized NP Graduation from a CRNBC recognized NP

program or equivalent program or equivalent Pass score on an approved written examPass score on an approved written exam Pass on the OSCEPass on the OSCE

Objectives of the OSCEObjectives of the OSCE

Assess the capacity of NP Candidates to Assess the capacity of NP Candidates to provide health care services to a client provide health care services to a client from a holistic nursing perspectivefrom a holistic nursing perspective

To determine whether the minimum To determine whether the minimum standard to practice has been standard to practice has been demonstrateddemonstrated

To assess the candidate’s readiness for To assess the candidate’s readiness for independent safe practiceindependent safe practice

Development of the OSCEDevelopment of the OSCE

Official parties identifiedOfficial parties identified Project managerProject manager Nurse Practitioner Nurse Practitioner Examination Advisory Examination Advisory

GroupGroup Chief Nurse ExaminerChief Nurse Examiner Case (scenario) authors Case (scenario) authors ExaminersExaminers

Development of the OSCEDevelopment of the OSCE Writing case scenariosWriting case scenarios Creating checklists - observable behaviours Creating checklists - observable behaviours

specific to case scenariosspecific to case scenarios Determining checklists weighted scores and Determining checklists weighted scores and

minimum passing scores minimum passing scores Identifying critical incidentsIdentifying critical incidents Developing the global assessmentDeveloping the global assessment Training standardized patients (SPs)Training standardized patients (SPs) Orienting examiners Orienting examiners Orienting candidatesOrienting candidates

OSCE componentsOSCE components

Five minute scenarios – client interactive Five minute scenarios – client interactive PEPs (post exam probes) – written PEPs (post exam probes) – written

stations to accompany five minute stations to accompany five minute scenariosscenarios

Ten minute scenarios – client interactiveTen minute scenarios – client interactive

Focus of testingFocus of testing

Integration of holistic nursing approach with the Integration of holistic nursing approach with the clinical skills of diagnosing, managing and clinical skills of diagnosing, managing and prescribingprescribing

Client EncountersClient Encounters complete history complete history or or perform physical examperform physical exam oror Counsel / manageCounsel / manage

PEPS PEPS differential diagnosing, diagnostic tests, management differential diagnosing, diagnostic tests, management

plans, writing prescriptions or referral letters.plans, writing prescriptions or referral letters.

Examination CompetenciesExamination Competencies

Assess and diagnose client’s health and Assess and diagnose client’s health and illness statusillness status

Manage client health careManage client health care Promote health and prevent illness/injuryPromote health and prevent illness/injury Maintain professional responsibility and Maintain professional responsibility and

accountabilityaccountability

Case scenarios for FNPCase scenarios for FNP

Cover the lifespan Cover the lifespan Include common client problems and Include common client problems and

needs including prenatal & post natalneeds including prenatal & post natal Developed by experienced NPsDeveloped by experienced NPs

Global assessment rating scaleGlobal assessment rating scale

Relationship developmentRelationship development Clinical knowledge and competenceClinical knowledge and competence

CandidatesCandidates

Graduates of recognized NP programs in Graduates of recognized NP programs in BCBC

Graduates from programs that are Graduates from programs that are educationally equivalent to BC programseducationally equivalent to BC programs

Candidates determined to be educationally Candidates determined to be educationally equivalent by Prior Learning Assessment equivalent by Prior Learning Assessment and Recognitionand Recognition

ExaminersExaminers

RoleRole Criteria to be examinerCriteria to be examiner

Faculty in Master’s level NP program orFaculty in Master’s level NP program or Experienced NP preceptorExperienced NP preceptor

Need to use experienced NPs from Need to use experienced NPs from Washington and Oregon to beginWashington and Oregon to begin

Examination Scoring ProcessExamination Scoring Process

Passing score on a minimum number of Passing score on a minimum number of client interactive stations (scenarios)client interactive stations (scenarios)

Minimum overall competency scoreMinimum overall competency score Demonstrate no critical incidentsDemonstrate no critical incidents

Examination Advisory GroupExamination Advisory Group

Comprised of:Comprised of: Chief and Deputy Nurse Examiners, FNP from Chief and Deputy Nurse Examiners, FNP from

BC (passed OSCE on first run), Registered BC (passed OSCE on first run), Registered Nurses with education and evaluation Nurses with education and evaluation specialtiesspecialties

Role of the Examination Advisory GroupRole of the Examination Advisory Group Determine OSCE scoring and pass criteriaDetermine OSCE scoring and pass criteria Review overall performance of scenariosReview overall performance of scenarios Review performance of candidatesReview performance of candidates

Scoring Development ProcessScoring Development Process

Pre- exam minimum passing standard set Pre- exam minimum passing standard set for checklist and PEPfor checklist and PEP

Scenario field tested ( trialed)Scenario field tested ( trialed) Post field test – performance of scenario Post field test – performance of scenario

analyzed, minimum passing score analyzed, minimum passing score reviewedreviewed

Checklist, PEP questions & passing Checklist, PEP questions & passing scores revised as neededscores revised as needed

Changes since first trial runChanges since first trial run

Scenarios fine tunedScenarios fine tuned Reliability and validity improvedReliability and validity improved

Results of OSCE Results of OSCE

At this time, minimal number of candidates At this time, minimal number of candidates does not allow for release of resultsdoes not allow for release of results

Factors that play important role in Factors that play important role in successsuccess

Orientation to examination processOrientation to examination process Candidate preparednessCandidate preparedness

Future directionsFuture directions

Addition of adult and pediatric NP Addition of adult and pediatric NP examinations in 2006examinations in 2006

Use of Canadian NP examiners, case Use of Canadian NP examiners, case writers writers

Thank youThank you