EVALUATING NP STUDENT COMPETENCIES USING ENTRUSTABLE PROFESSIONAL ACTIVITIES
Background: Direct observation of nurse practitioner (NP) students in the clinical setting has been typically used to assess clinical competence. This method, however, is often discounted as not accurately reflecting true clinical competence due to uncontrolled variables such as: incongruous clinical placements, variation in case complexity, unpredictable patient presentation, faculty bias, and lack of agreement on indicators of acceptable clinical performance. Technological advances and innovations have expanded options for teaching and learning in NP education. Simulation, in the form of video-taped standardized patient (SP) encounters, provides the ability to create clinical experiences that encompass relevant data collection, generation of diagnostic hypotheses, and development of a management plan while simultaneously assessing embedded professional behaviors. These skills are essential to NP practice. SP encounters have enabled standardized evaluation of all students using consistent case scenarios under controlled simulation conditions. Investigation is needed to address the effectiveness of SP simulation methodology in nursing education and to develop instruments that measure development of clinical competence over the course of NP programs.
Entrustable Professional Activities (EPA) have been used in healthcare education to bridge the theory-practice gap. EPAs assist faculty to determine when it is clinically safe to make entrustment decisions, determinations that students are competent to assume specific clinical responsibilities without supervision. Clinical competence is translated into knowledge, skills, and attitudes that justify entrustment of specific activities to students. Competence-based education including EPAs can document transition milestones required before moving from supervised to independent clinical practice.
Methods: This study examines the relative effectiveness of using an existing grading rubric and an EPA-based instrument to measure clinical competencies. Data were retrieved from evaluative SP encounters involving 17 NP students in clinical management courses over one semester. Five expert clinical faculty members documented NP student competences using both instruments and outcomes were compared.
Results: There were significant, positive correlations between total scores on the existing rubric and EPA instrument as well as between all “SOAP” areas in each except “Assessment.” The area of “Assessment” encompasses the synthesis of history and physical exam findings with critical reasoning skills to formulate differential diagnoses and a diagnosis. Discovering no correlation between these instruments in the “Assessment” area suggests the more specific, refined ability of the EPA instrument to evaluate this area for student competency.
Implications: The ability to identify student lack of progress in a specific area over the course of an NP program enables nursing faculty to intervene early and provide additional educational experiences needed to ensure complete clinical competence. Additional psychometric investigation is planned with a larger sample of NP students over an academic year and throughout the NP program.