Developing mentors to support students in practice, Part 6 Assessment and

Accountability; 1 – Assessment in practice.

Summary

Assessment in clinical practice is a complex issue and one that many mentors and practice

teachers struggle with. Therefore, a series of three articles will explore the complex areas of

student assessment in clinical practice and the theoretical concepts that relate to assessment

of learning and development. The first part initially will examine the importance of

assessment and the role of mentors and practice teachers in relation to assessment.

Definitions of assessment and purpose of assessment will be analysed along with the

differing assessments methods that are used in clinical practice which directly relate to the

third domain and outcomes of the Nursing and Midwifery Council (2008a) ‘Standards to

Support Learning and Assessment in Practice’ (SSLAP) named ‘Assessment and

Accountability’. This three part series is also part of a series of eleven which will provide

advice and a number of learning activities for new and existing mentors and practice teachers

that relate to the NMC (2008a) SSLAP. The series will enable them to develop within their

role as a mentor and practice teacher and assist in developing a portfolio of evidence that

meets the NMC (2008a) SSLAP.

Introduction

One of the major roles of mentors and practice teachers is to support learners in practice to

enable them to be successful and register or record their qualification with the NMC.

Registered nurses are required to be knowledgeable doers (Bradshaw and Merriman 2008).

According to Price (2012) the focus of assessment in the practice setting is the use of

knowledge, thus, mentors and practice teachers need to ensure that students are using the

right knowledge, translating this into practice and are confidently combining the differing

sorts of knowledge to good effect. Gopee (2011) purports that assessment is one of the most

fundamental functions of a mentor and practice teacher. The NMC (2008a) within the SSLAP

indicate that mentors and practice teachers must be competent to assess learning in order to

make appropriate judgments relating to the student’s proficiency for entry to the register or

for recording a qualification at a level above initial registration. Kilgallon and Thomson

(2012) view assessment as a key component of every healthcare practitioner’s role. They

went on to stress that assessments are needed to safeguard public protection by ensuring that

only those students who have met the required standard of achievement can register as a

nurse or midwife. Hand (2006) pointed out that assessment is also needed to maintain the

credibility of the profession. Thus, mentors and practice teachers are responsible and

accountable for some of the most critical and sophisticated assessments of a student’s

learning, therefore investment in time and attention to detail is essential (Price 2012). The

NMC (2008a) stipulate that mentors and practice teachers need to provide consistent and

honest evaluation of a student’s performance in the clinical setting because it is seen as a

critical part of a rigorous assessment. Mentors and practice teachers need to be aware that the

mentoring role may lead to role conflict (Hand 2006) due to mentors and practice teachers

often acting as a guide, supporter, facilitator as well as an assessor. This can be especially

problematic if there are prolonged periods of contact between the student and mentor or

practice teacher, which certainly is the case for practice teachers and their students. Thus

Price (2005a) emphasises that assessments in practice must be conducted transparently,

objectively, rigorously and fairly but he indicates that it is far from easy. For this to happen

mentors and practice teachers need to have a breadth of understanding of the many

dimensions of assessment strategies.

Learning Activity 1

Discuss with a colleague the significance and impact of assessments in

practice for mentors or practice teachers?

In practice students are required to have a minimum of 3 formal

assessments.

What is the purpose of the initial assessment, midpoint assessment and

final assessment?

What should happen within each of these assessments?

Now place your answers in the portfolio and map these against the

relevant domains and outcomes.

A breadth of understanding of the assessment strategies.

Definition and Purpose of Assessment

Assessment measures a student’s learning as a result of a teaching or a learning situation

(Sherwin and Muir 2011). However, Neary (2000) purports that assessment is a contentious

issue. Thus there are numerous definitions of assessment and many (Neary 2000, Cruzon

2003, Nicklin and Kenworthy 2000) suggest it is about judging or appraising or putting a

value on something. Walsh (2010) suggests it involves making a judgement about the level

and capabilities of a student’s progress and performance in terms of their competence of

knowledge and skills. Similarly, Kilgallon and Thompson (2012) purport that assessment is a

measurement and a process by which information about a student’s learning and clinical

practice is collected. Hand’s (2006 pg 48) definition combines the previous two suggestions

as she states that, ‘assessment is a means of collecting data to demonstrate an acceptable

standard of practice has been reached by a student on which a decision to declare a

practitioner competent can be made’. Price (2012) stresses that assessment of practice

learning is complex. Interpretation and views on assessment vary greatly in that it is

subjective, personal and emotive (Lee 2006). Walsh (2010) implies that no fully adequate

definition of assessment exists and that it is hard to define due to the many variables and

variations on what and who is being assessed. Now complete learning activity 1 below.

Assessment can be either; formative or summative, and according to Price (2005a) it is

important that mentors and practice teachers know the differences between these 2 aspects.

Formative assessment allows the mentor or practice teacher to advise the student on their

progress (Price 2005a) and the initial and midpoint assessment of a student in practice are

deemed as formative assessments. Formative assessment provides an evaluation of the level

of achievement so far. It is good for motivating a student, but it useful to help identify

learning needs (Kinnell and Hughes 2010, Gopee 2011). From this type of assessment the

mentor or practice teacher should then devise an agreed action plan with the student. They

should document the identified learning needs, what is required, how it will be achieved and

by when. Summative assessment is used to determine if the student has reached the desired

level of achievement against the set criteria (Walsh 2010). The summative assessment usually

follows after a period of formative assessment and occurs at a fixed time. The final

assessment in practice is classed as the summative assessment which again according to Price

(2005a) is designed to judge the competency of the student’s practice against stated

benchmarks. In most cases these benchmarks will be the relevant NMC’s (2001, 2004a,

2004b 2009, 2010) competencies that the student is working towards as part of their

educational programme. There are many reasons why we need to assess students in clinical

practice, (see box 1) but one of the main purposes is to help students to learn and progress.

Overview of the NMC Standards for Pre-registration Midwifery or Nursing Education

(2009 or 2010), the Standards for Specialist Education and Practice (2001) and

Standards of Proficiency for Specialist Public Health Nurses (2004a).

Before reading on complete the following learning activity 2

Learning Activity 2

Go to the NMC website and download the relevant Standards for Pre-

registration Midwifery or Nursing Education (2009 or 2010) or the

Standards for Specialist Education and Practice (2001) or the Standards

of Proficiency for Specialist Public Health Nurses (2004a) that to relate

to your student. Review the relevant standards that relate to the students

that you mentor.

Review the ‘Domains’ and ‘Standards of Proficiency or Competency’

How do these relate to your practice area and the practice assessments

you use to assess the students?

Locate the Essential Skills Clusters (ESC) (if applicable). How do these

relate to your practice area and the practice assessments you use to assess

the students you have in practice?

Which of these proficiencies or competencies and ESC can a student

achieve within your practice placement? State how you would assess a

student against these identified proficiencies or competencies and ESC.

Mentors and practice teachers need to be fully aware that the theory to practice ratio for all

students on an NMC approved programme is equally weighted and thus the practice

assessments contribute to a student’s progression and successful completion within the

programme. The Pre-registration Midwifery Programme must be compliant with the

standards to grade practice. Thus, assessment of clinical practice which must involve direct

hands on care is graded by the midwifery sign off mentor and counted as part of the academic

award. Midwifery students are required to meet the stated competencies and Essential Skills

Clusters (ESC) at the relevant points within the programme. Before continuing into the next

academic level midwifery students must achieve all the outcomes within the progression

point period and these need to be confirmed within 12 weeks of entering the next academic

level (NMC 2009). Therefore, it is important for mentors to work towards the given deadline

dates and plan the formative and summative assessments within the required timeframe. This

12 week time limit includes both theory and practice. Midwifery students must complete all

assessments successfully prior to completion of the programme before they can be entered on

the NMC register (NMC 2009). A student midwife must achieve these standards under the

supervision of a sign off mentor who is a practising midwife.

Nursing education across the United Kingdom (UK) needs to respond to the changing needs,

developments and priorities in health and healthcare. The NMC Standards for Pre-registration

Nursing Education (NMC 2010) has recently replaced the NMC (2004b) ‘Standards of

Proficiency for Pre-registration Nursing Education. These standards apply to all new pre-

registration nursing education programmes from September 2011. The NMC (2004b)

Standards of Proficiency remain current until at least 2014. Thus mentors and practice

teachers may well be supporting and assessing students on either the Standards of Proficiency

(NMC 2004b) or the Standards for Nursing Education (NMC 2010) depending on the year of

programme that the student is currently working towards. Mentors and practice teachers need

to be familiar with both of the pre-registration standards if this applies to them. However,

many of the Pre-registration Nursing Education standards (NMC 2010) are based on previous

rules, standards and guidance, whilst others have been introduced after extensive consultation

to incorporate the findings of the review ‘Nursing Towards 2015 (NMC 2010). Some of the

changes that mentors and practice teachers will note on reviewing the Pre-registration

Standards Nursing Education (NMC 2010) are the inclusion of two progression points

separating the programme into three equal parts. Mentors and practice teachers must become

familiar with the identified skills and professional behaviours that a student must demonstrate

by the first progression point (end of year one) and the minimum requirements that must be

demonstrated by the second progression point (end of year two). Much like the midwifery

standards discussed above, the requirements for each progression point must be demonstrated

by the student in order to progress to the next part of the programme. Mentors and practice

teachers should note that within the Standards for Pre-registration Nursing Education (NMC

2010) nursing students are working towards and must meet the generic and field specific

competencies as well as the stated ESC by the end of the programme. In order for the

students to meet the requirements for each progression point they are required to have a

minimum of a 4 week practice placement at the end of each year and undertake at least a 12

week practice placement towards the end of the programme. Thus, it is important for mentors

to be aware of the timeframes in which the assessments need to take place.

The Standards for Specialist Education and Practice (NMC 2001) is founded on common

principles that offer a common core preparation and common core learning outcomes

followed by specific learning outcomes for the area of practice that the student is working

towards, for example; community nursing or general practice nursing. Therefore, sign off

mentors or Practice teachers must become familiar with the core common standards and also

the specific learning outcomes pertaining to the area that the student is trying to achieve.

Students working towards any of these standards are required to exercise higher levels of

judgement discretion and decision making focusing on clinical practice, care and programme

management, clinical practice development and clinical practice leadership (NMC 2001).

The Standards of Proficiency for Specialist Community Public Health Nurses (NMC 2004a)

consist of ten key principles of public health practice and are grouped into four domains of

which the practice teacher must become familiar with in order to support and assess the

student in practice. Like other NMC programmes it involves 50% practice and 50% theory

across the whole programme with a consolidating period of practice equivalent to at least 10

weeks to consolidate their education and competence in the practice field.

Mentors and practice teachers must be aware that a student who is unsuccessful in passing all

elements of the defined assessment strategy approved by the NMC will not be eligible to

register as a nurse or midwife or record their qualification at the end of the programme (NMC

2001, 2004a, 2009 and 2010). However this must not sway their assessment decisions. Thus

mentors and practice teachers need to ensure the assessment strategies that are used in

practice are valid and reliable in order to support and justify their decisions.

Validity and Reliability of Assessments

Early and careful planning of assessment is imperative to ensure assessment of practice

proceeds in a systematic order to maximise learning and reduce the student from

experiencing undue stress (Gopee 2011). Walsh (2010) stresses that the process of

assessment must be robust in order to accurately assist the mentor or practice teacher in

making realistic judgments about a student’s level of competence to decide whether or not to

pass or fail them. Assessments need to be transparent (Price 2005a). Therefore students need

to be aware of the type of assessment methods that are to be used, when, how long they will

last, the criteria that they are being assessed against and the opportunities available to check

on their progress.

Hand (2006) stresses that mentors and practice teachers need to use more than one type of

assessment method in order to assess and be sure that the student has met all of the

knowledge and performance outcomes. According to Stuart (2007) this is known as, between

– methods triangulation and Hand (2006) confirms that this is a means of enhancing validity

and reliability. However, Redfern et al (2002) suggests that every method of clinical

assessment has its strength and weaknesses, but some lack adequate validity and reliability.

Learning Activity 3

Look at the students assessment documentation used within your practice area.

Review the assessment criteria. What assessment methods would you use to

assess these? How valid and reliable are these assessment methods? Do they

measure the assessment criteria stated?

How practical are your assessment methods?

Cassidy (2007) purports that when using multiple sources of evidence to assess a student’s

competence mentors and practice teachers need to ensure that there is a clear legitimate audit

trail to accompany their accountability for the decisions they make.

Quinn and Hughes (2007), Hand (2006) and Walsh (2010) assert that there are several key

elements to the effectiveness of assessment in order to improve the quality and ensure

objectivity. These are known as the ‘four cardinal criteria’ of assessment; validity, reliability,

discrimination and practicality. Validity is the most crucial (Gopee (2011) as it refers to the

extent to which the assessment measures what it intends to measure. In other words does the

assessment actually measure the learning outcomes or the competencies it sets out to assess?

Complete learning activity 3

Setting the learning outcomes at the outset of the placement is crucial as it sets the baseline

(Hand 2006). Validity can be broken down into several components; Content, Predictive,

Face, Construct and Concurrent. Content validity refers to the material or curriculum being

assessed and whether it is appropriate to what is expected for the stage and level of the

student’s training. More importantly Hand (2006) suggests that assessment must also test a

student’s knowledge, their comprehension, application and their psychomotor skills;

Predictive validity relates to whether the assessment predicts a student’s future performance.

It is important that future performance of a student can be predicted in order for them to be

accepted onto the NMC register and also whether they can adjust their performance to

different practice settings (Gopee 2011); face validity relates to whether the assessment

appears to be relevant to what is being assessed and whether the student actually

demonstrates the complexity of the analytical, interpersonal and technical skills required for

competency (Gopee 2011); Construct validity refers to a student’s attitude, values and

behaviours which is key for any healthcare practitioner; especially in light of the Francis

report (2013); Concurrent validity refers to whether the assessment results correlate with

those of other assessments used at the same time and whether they give the same results.

However, an assessment cannot be valid unless it is reliable (Hand 2006, Walsh 2010, Gopee

2011). This term is used to indicate the consistency of results when repeated on different

occasions. According to Walsh (2010) a good assessment should always give the same results

no matter who is administrating it. To increase the reliability of an assessment is to make sure

that all those involved in the assessment use the same assessment criteria. One way this can

be achieved is to ensure that mentors and practice teachers utilise the student learning

outcomes from their practice placement documents along with the organisational protocols,

policies, procedures and guidelines.

Gopee (2011) explains that discrimination refers to the ability of the assessment to

differentiate between different levels of competency. A taxonomy of learning is used to

enable the differentiation of levels of competency, such as; Benner’s (1984) Novice to Expert

or Steinaker and Bell’s (1979) Exposure to Dissemination. As previously mentioned one of

the main purposes of assessment is to protect the public and therefore, assessments need to

Learning Activity 4

Look at the assessment documents you use in practice and identify which

framework is used to establish the standard expected for the level and

stage of training the student should be working and assessed against.

Look up this framework to gain a better understanding.

Now discuss this framework with the local link lecturer or practice

education facilitator.

Utilising this framework how would you assess your student (Pre-

registration or Post Registration) in relation to ‘Assessing and managing

the care needs for service users within your area of practice’.

differentiate between those students who are at the required level and those that are not

(Aston and Hallam 2011). Now complete learning activity 4.

Finally assessments need to be practical to administer in terms of ease, cost and time. It

should take into account the needs of the busy practice placement area and the team (Walsh

2010). Mentors and practice teachers must be realistic in ensuring that what they are

assessing is appropriate in terms of the timeframe that the student is allocated to the practice

placement (Kinnell and Hughes 2010). To ensure the quality and objectivity of assessment

strategies and to ensure the key elements to the effectiveness of assessments that incorporate

the four cardinal criteria of assessment, mentors and practice teachers need to utilise multiple

assessment strategies.

Assessing learning for registration and beyond by utilising a breadth of assessment strategies that will contribute to the total assessment process as part of the teaching team.

Assessment Methods

The inclusion of multiple methods of assessments according to Quinn and Hughes (2007) can

help a student to integrate, synthesise and assimilate the theoretical components of the

learning outcomes with the clinical application in practice. One essential method of

assessment as advocated by the NMC (2008a) is that of continuous assessment.

Continuous Assessment

Assessments should begin early and include regular feedback, they need to be realistic,

understood and based on insights shared by other colleagues (Price 2012). Furthermore, Price

(2007) asserts that assessments need to be continued over time so that mentors and practice

teachers can assess for consistency of performance in varying situations. Moreover, Sharples

et al (2007) suggest that a student should be observed on a number of occasions over the

weeks to provide a better picture of their abilities to perform the task so that direct evidence

of competence can be collected. This is also suggested by Oliver and Enderby (2000) who

stress that no single final procedure is adequate for assessing clinical competence and

therefore, continuous assessment is essential. Dogra and Wass (2006) also concur that

assessment of clinical performance needs to accommodate the diversity of the service user in

order to make a judgment of a student in terms of their cultural sensitivity. In addition,

according to Hand (2006) continuous assessment allows a student to increase his or her

confidence before a final judgement is made.

Through the use of a mutually agreed action plan the mentor or practice teacher should work

with the student regularly to enable the student’s performance to be under scrutiny over the

duration of the placement. This will enable their day to day clinical practice to be observed

and judged, however, this can be very time consuming for the mentor and practice teacher

(Walsh 2010, Kinnell and Hughes 2010). It can also be seen as subjective and lead to more

favourable judgements due to the bond that may form between the student and the mentor or

practice teacher. From a student’s perspective, being observed continuously can create a

degree of stress and anxiety which may then influence the student’s achievement (Kinnell

and Hughes 2010). Nevertheless, according to Duffy and Hardicre (2007) continuous

assessment provides an avenue for providing a student with constructive feedback regarding

their strengths and weaknesses. This will then highlight the areas for development which in

turn can motivate a student through the fear of failure (Kinnell and Hughes 2010). Providing

feedback to a student regarding their progress is very important and should be given at

regular intervals. This should be given informally following an episode of care or at the end

of each shift and formally via the planned formative and summative assessments. For further

information on the importance of feedback refer to part two of this three part series and is

part 7 of this whole series named ‘developing mentors to support students in practice’

Assessment and Accountability 2; Importance of Feedback and managing failing students in

practice.

Observation of Practice.

Observation of a student’s practice is by far the most appropriate and widely used assessment

strategy in practice and certainly provides face validity. The NMC (2008a) stipulate that the

majority of assessments of competence should be assessed through direct observation in

clinical practice. Not only does it allow a student’s performance of skill to be reviewed but it

allows the mentor or practice teacher to observe a student’s attitude and ability to respond in

different situations (Walsh 2010). Sharples et al (2007) believe that if a student knows they

are being watched they will automatically improve. However, Hand (2006) warns that

mentors and practice teachers can never really know how a student will act when not under

scrutiny.

Observation of practice is not without its problems because observation alone captures a

student’s behaviour rather than reasoning (Price 2007). Mentors and practice teachers also

need to establish a student’s knowledge and the rationale for a student’s practice thus,

observation alone lacks content validity. Therefore mentors and practice teachers need to

develop the observations of practice into questioning, but at an appropriate time. This can be

achieved by having a question and answer discussion after (or as soon as appropriate) any

episode of care provided by the student. This should be somewhere private away from the

service user and a place where they cannot be disturbed.

Questions / Discussion

Questions enable mentors and practice teachers to ascertain a student’s level of knowledge

and understanding. According to Walsh (2010) if observation is the cornerstone of assessing

practice then questioning is the lynchpin of assessing a student’s knowledge base. Using

questions and discussion increases content validity. Questioning can provide formative and

summative feedback (Hand 2006). Quinn and Hughes (2007) advise that questions should be

kept short and stated in a language that can be easily understood. They went onto to stress

that questions should be geared at the appropriate level for the student, but at a level that

poses problems so that a student can consider a solution, however, they should not be too

ambiguous. Conversely, Quinn and Hughes (2007) cautions that questioning can be

intimidating and Hand (2006) also warns that this method can seem threatening to a student

and may make them feel humiliated. Nevertheless, observation alone is open to bias or errors

(Price 2007) and cannot judge a student’s knowledge and reasoning therefore, the need for

another method of assessment such as questioning is essential as well as gaining feedback

from colleagues. Now complete learning activity 5.

Learning Activity 5

Choose a learning outcome / assessment criteria that your current or

recent student is working towards.

Devise a number of open and closed questions to ascertain the student’s

awareness, understanding and knowledge in relation to your chosen

learning outcome / assessment criteria.

Feedback From Others / Testimonies

Price (2012) purports that consultation with a colleague is highly important as part of a

student’s assessment. Gaining oral and or written feedback from colleagues and other

professionals involved in the student’s learning enables the assessment to be fairer and more

objective, which in turn increases the validity and reliability (Walsh 2010). Hand (2006) also

suggests that it can reassure the mentor and practice teacher regarding their decisions. The

use of written feedback from others should be included in the student’s portfolio and the

mentor and practice teacher need to encourage the student to write a summary of how the

testimony relates to their outcomes (Walsh 2010). Walsh (2010) also suggests that the wider

the source of opinions and range of evidence the better. However, not all agree and Dolan

(2003) claimed that assessment of clinical competence can vary from person to person and

therefore judgments from others may be subjective. Nevertheless, Hand (2006) purports that

a way in which to make this type of assessment more reliable is for mentors and practice

teachers to share the assessment criteria with all those that will be involved in the assessment

of the student so that they are working to the same standard.

Criterion Referenced Assessments

Criterion referenced assessments is where there are predetermined criteria for a student to

meet, such as the NMC outcomes. By using criterion referenced assessments it can ensure

the assessment is more objective and strengthens the effectiveness of the assessment (Aston

and Hallam 2011). It will also ensure the student, mentor or practice teacher and colleagues

are clear on what is being assessed and therefore what they need to do (Walsh 2010).

However, many (Castledine 2000 and Duffy 2004, Walsh 2010) have stated that the NMC

outcomes and the practice placement documents are unclear, too broad and open to differing

interpretation. In spite of this they do provide the benchmark to what the mentor or practice

teacher can judge the student against. Furthermore, Walsh (2010) asserts that they can be

beneficial as it allows them to be adapted to different settings.

Self-assessment

According to Gopee (2011) self-assessment is the most valuable form of assessment for a

student and is a seen as a learning exercise that will enable them to own and control the way

in which they meet their needs. It can allow the student to identify gaps in their own

knowledge and this will enable them to identify their learning needs. Reflective practice is a

key factor to self-assessment (Walsh 2010) and mentors and practice teachers need to

encourage and provide regular opportunities for a student to do this. In a study of a group of

post registration students Gopee (2011) found that self-assessment inspires a conscious effort

to be honest and enables students to identify their own limitations of knowledge and needs. In

contrast, the student can also be too strict or lenient on themselves, and they may be unable to

gauge the effectiveness of own performance. In spite of this self-assessment can be a good

starting point for mentors and practice teachers at initial, midpoint and final assessments to

ascertain the student’s views on their own abilities.

Reflection

Students should be encouraged to analyse their practice situations and their involvement in it

to draw lessons to inform future practice (Price 2005b). According to Tilchen (2003) this can

help a student to continue on what is known as a learning journey. Price (2005b) went onto

warn though that students are expected to inform, discuss and show their reflective diaries

with their mentors or practice teachers regarding their experiences whether good or

problematic. The sharing of this information requires profound trust in their mentor or

practice teacher before access to this information is usually granted. Hand (2006) concurs

with this especially when learning from reflection is highly personal and thus they may not

want to share. Nonetheless, Hand (2006) purports that using reflection as an assessment

method can indicate insight into how a student can make sense and feel about their practice.

Reflection can provide opportunities for discussions about attitudes and values. It can

indicate self-awareness, knowledge, attitude and the ability to apply theory to practice (Walsh

2010). Price (2005b) also supports the use of critical reflection as it can enable the student to

transfer learning from one situation to another. However, Hand (2006) also warns that not all

students are able to reflect initially and most students require prompting to help them to move

beyond describing events and learn how to explore issues more broadly. Therefore, Cassidy

(2007) asserts that it is important that students reflect fully to include the artistry as well as

the science of nursing. He went onto to say that students may be involved in high quality care

but they may not automatically internalise the significance of their experiences. Similarly,

Kuiper (2002) purports that as mentors and practice teachers we should help students to

become ‘megacognitive’, thus to understand they have learned from their experiences about

their knowledge and emotions. Therefore, mentors and practice teachers should be

encouraging and providing opportunities for students to reflect on their experiences because it

is key to their learning. Reflection can be done informally following an episode of care or by

ensuring that there is time set aside at the end of the day to discuss the student’s experiences

with them. Alternatively mentors and practice teachers could encourage them to write a

reflective diary or reflective piece on an episode of care they encountered that day and to then

relate this to their competencies and learning outcomes (Walsh 2010).

Care Records / Plans or Other Documentary Evidence Made by the Learner

Students are involved in direct hands on care which includes the planning, assessing,

implementing and reviewing of the required care with many service users. An observation of

a student’s practice informs the mentor or practice teacher of the student’s abilities in

carrying out these activities. This, according to Neary (2000) credits the student with ‘merit’

of the intervention. Following any intervention that has taken place recording this in the

service user’s record is a legal requirement; therefore students will also be involved in

completing the relevant entries into these records. In addition when a student assesses,

implements and reviews the care for their service users this too should be reflected in the

changes made to the care plans (Stuart 2007). Any entries or changes made in the service

user’s records must be countersigned by the mentor or registered practitioner. Whilst reading

and countersigning the student’s entries the mentor and practice teacher can evaluate the

effectiveness of the care provided by the student and establish if they have taken the service

user’s needs into account. This will aid in assessing the student’s ability to solve problems;

make decisions about the service user’s needs; and work as a member of the multi-

disciplinary team (Stuart 2007). By reviewing this documentary evidence it will assist the

mentor or practice teacher in assessing the ‘worth’ of the interventions that the student has

undertaken with respect to the service user’s feelings and the student’s attitudes towards them

(Neary 2000). Neary (2000) explained that a good assessment decision cannot be made

without simultaneous consideration of both ‘merit’ and ‘worth’.

Service User Feedback

The NMC (2008a) advocate the use of service users and carers involvement in the learning,

assessment and providing feedback on the student’s performance. Mentors and practice

teachers need to explore ways in which service users and carers can be involved in this

feedback and provide evidence in the assessment of the student’s practice. Now complete

learning activity 6.

Learning Activity 6

Now consider the scenario below:

Scenario: You are mentoring a student in practice and you are required

to assess their ability to admit and plan the care for a new service user

admitted to your area of practice or case load.

Consider and discuss how you would use each of the assessment methods

discussed above, include, when, how and why you have used these

methods.

How can service users and carers contribute to this assessment?

One way in which mentor and practice teachers can ascertain if service users and carers are

satisfied with the care provided by a student is through observation of the interactions made

between the student, service user or carer. In addition, Gopee (2011) suggest that a mentor or

practice teacher can and should ask a service user or carer (providing they are able) regarding

the student’s abilities of the care they have provided, including their communication,

interpersonal skills and attitudes. They can ask the service user if the student showed

compassion, by treating them with respect and dignity, if the student has demonstrated

commitment and whether confidentiality was maintained in the presence of others. By using

the above multiple methods of assessments, including all the aforementioned strategies

mentors and practice teachers can strengthen and ensure that the assessments they undertake

are more robust, are fair and enable them to provide sufficient evidence in order to assist

them in making the most important decisions of passing or failing students.

Portfolio Development

To become or remain a mentor or practice teacher on the live register a requirement from the

NMC (2008a) is that mentors and practice teachers are required to demonstrate they have met

the NMC (2008a) SSLAP of stage 2 or stage 3 of the framework through the development of

a portfolio. The third domain of these standards includes ‘Assessment and Accountability’

(Box 2). Working through the ‘learning activities’ included in this article the work produced

will now provide appropriate and relevant evidence towards this domain and outcomes. In

addition, if you have had the opportunity to assess a learner in practice further evidence will

be generated. Providing the student gives consent, take a copy of the student’s University

documentation which includes the initial assessment, midpoint assessment and the final

assessment. Ensure you remove the student’s name thus ensuring anonymity is maintained

for confidentiality (NMC 2008b). If during your experience you have completed any other

action plans or other documentary evidence this too will be fruitful. Moreover, if you reflect

on the assessment process that has taken place for a recent student this also provides relevant

evidence towards this domain. Furthermore, through the student’s own evaluation of their

experience of the assessment process that has taken place and the development of an action

plan by the mentor and practice teacher will to also prove valuable in meeting this particular

domain. These activities and pieces of evidence should now be placed in the portfolio once

completed. It is advisable that the evidence generated is mapped and cross referenced against

the relevant NMC (2008a) SSLAP (see box 3) as the evidence will not only meet the domain

‘Assessment and Accountability’ but they may also meet any of the other eight domains, such

as; ‘Facilitation of Learning’ ‘Creating an Environment for Learning’ Evaluation of

Learning’ and Context of Practice.

Summary

Assessment is one of the major roles required of mentors and practice teachers in the practice

setting, not only to enable a student to progress but also to protect the public. Thus, in order

for them to be prepared for this crucial role there are many dimensions of assessment that

mentors and practice teachers need to be aware of, such as, ensuring that the assessment they

use are valid and reliable by utilising multiple assessment strategies in practice. This article

has provided a brief overall of these dimensions. By identifying, reviewing, reflecting on the

assessment methods and the process used in practice, mentors and practice teacher can ensure

the assessment process is more robust. The next two issues of ‘developing mentors to support

students in practice’ will continue to look at Assessment and Accountability in particular part

7 will consider the importance of feedback and managing failing students in practice and part

8 reviews the accountability of mentors / sign off mentors and practice teachers in relation to

the decisions they make regarding student performance.

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Box 1

Purpose of assessment (Walsh 2010)

To monitor student progress

To give feedback

To uncover learning needs

To motivate students

To assess level of competence

To measure the effectiveness of teaching

To safeguard the patient and protect the public

Box 2

NMC (2008a) SSLAP

Domain 3 – Assessment and Accountability

Stage 2 - mentor

• Foster professional growth, personal development and accountability through

support of students in practice

• Demonstrate a breadth of understanding of assessment strategies and ability to

contribute to the total assessment process as part of the teaching team.

• Provide constructive feedback to students and assist them in identifying future

learning needs and actions. Manage failing students so that they may enhance their

performance and capabilities for safe and effective practice or be able to understand

their failure and the implications of this for their future.

• Be accountable for confirming that students have met or not met the NMC

competencies in practice and as a sign-off mentor confirm that students have met or

not met the NMC standards of proficiency and are capable of safe and effective

practice

Stage 3 – Practice teacher

• Set effective professional boundaries whilst creating a dynamic constructive

teacher –student relationship

• In partnership with other members of the teaching team use knowledge and

experiences to design and implement assessment frameworks.

• Be able to assess practice for registration and also at a level beyond that of

initial registration

• Provide constructive feedback to students and assist them in identifying future

learning needs and actions, manage failing students so that they may enhance their

performance and capabilities for safe and effective practice or be able to understand

their failure and the implications of this for their future.

• Be accountable for conforming that students have met or not met the NMC

standards of proficiency in practice for registration at a level beyond initial

registration and are capable of safe and effective practice.

Box 3

Domains (NMC 2008a)

Establishing effective working relationships

Facilitation of learning

Assessment and accountability

Evaluation of learning

Creating an environment for learning

Context of practice

Evidenced based practice

Leadership.