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How to Assess Learners

Assessment demonstrates the level of competence achieved by a learner at a given point. It is undertaken at the end of training to be sure they are competent and safe. Assessment is also used during training, to check progress and feed back to the trainee.
Image shows nurse with three face icons, happy, straight and frown. She is pointing at the happy icon.
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Assessment demonstrates the level of competence achieved by a learner at a given point. It is undertaken at the end of training to be sure they are competent and safe. Assessment is also used during training, to check progress and feed back to the trainee.

Summative Assessment

In this step we look at assessment carried out at the end of training, known as ‘Summative’ assessment (the ‘sum’ of a trainee’s learning).

What Does Assessment Measure?

When carried out at the end of training, assessment measures learning outcomes. There are four stages of progression in healthcare training; ‘Knows that’, ‘Knows how’, ‘Shows how’ and ‘Does’.

When assessment takes place at the end of training it usually measures ‘Shows how’. (Appraisal and clinical supervision will measure ‘Does’ later).

Outcomes are written in a form that describes an observable behaviour. It is that observable behaviour that will be measured in the assessment. For this reason, the assessment should be similar in content and level of difficulty to what was described in the outcome.

Diagram of a level seesaw. Balance is provided by outcomes on one side and assessment on the other

In this way, both trainer and trainees know from the start what is required and what will be assessed when training is completed.

Assessment Using a Real Situation

Example 1: Be able to teach a patient to use a walking aid.

The learning outcome and assessment are created as shown below:

Outcome Assessment
Be able to teach a patient how to use a newly issued walking aid, covering all items in the department safety checklist Under observation, teach a patient how to use a newly issued walking aid. All essential points from the checklist must be present.

Ultimate Learner Assessment – Test the Skills

Once her training has been completed, a date and patient who needs a walking aid are chosen. The supervisor explains the situation to the patient and obtains his consent. The assistant then undertakes the task of teaching him how to use the aid. Her supervisor watches and checks her competence in each step.

Example 2: Ambulance emergency driving skills

On an Ambulance Service Driver Training course, Emergency Response driving skills are assessed on real streets. The instructor enters the call details and location into the vehicle Satellite Navigation system. The trainee then drives to the set location using visual and audible warnings, exactly as they would if it were real emergency.

Emergency Ambulance driving in a city

In this way, both trainer and trainee know that the latter is competent and safe to drive to a real emergency because they have been seen to do so.

Assessment Using Simulation

Many skills cannot safely be assessed with real patients or are simply not possible to arrange. In these circumstances, trainers create a simulation which tests the required skills and knowledge.

For example, in Objective Structured Clinical Examinations (OSCEs), trainees take a history from simulated patients while watched by an assessor. These patients (also known as ‘standardised patients’) have learned the symptoms and respond as a real patient would. They are able to repeat this performance with a sequence of candidates.

Advanced Life Support candidates need to be assessed in their ability to lead a cardiac arrest team through a scenario. It is clearly not possible to arrange for a real cardiac arrest to take place, so manikins are used which can replicate signs such as an ECG trace.

Junior doctor leading a team of fellow learners in a simulated cardiac arrest

Simulation is by definition not real. But when prepared and facilitated well, learners respond to simulations as though they were real. As a result, their responses can be taken as a reliable indication of skill level.

Pass, Fail or ‘Further Practice Required’?

In healthcare training, we want everyone to achieve the outcomes and be able to perform to the required standard. A learner who experiences difficulty with an element of training, or who appears unready for assessment, should be provided with additional support and practice. The purpose of a summative assessment is to confirm the learner can perform well. Its role is not to highlight problems for the first time.

For example, learners on a Drug Calculations course practice with past examination papers during the training in order to highlight any areas that require more support. The trainer is then able to work through these areas with the learner. When the test is finally taken, they learner demonstrates competence developed through extra practice.

Patient Safety

Trainers are custodians of patient safety in the subjects they teach. If a learner requires more time to reach the required standard, a trainer must address this. This is not always appreciated by trainees and may require some sensitive communication. However, this approach is much safer than signing someone off as competent, in the hope that they will reach the standard at some point in the future.

Talking Point

  • For training you are involved with, how closely do assessments measure the learning outcomes?
  • Do you have experience of assessment via a form of simulation? How effective did you find it to be?
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