Developing a Tool to Better Evaluate Student Performance During Standardized Patient Encounters

Clinical excellence is the goal of all nurse practitioner programs, whether they are delivered in a traditional face-to-face format or on-line.  However, ensuring clinical excellence in a nurse practitioner distance education program can be challenging.  Having students located throughout the country creates significant challenges.  This University School of Nursing has devised a program incorporating formative evaluation by faculty at two points in the curriculum utilizing standardized patient visits to determine student progress and the need for any remediation.  While the use of standardized patients to evaluate student performance is not new, we believe we have refined the process to provide more objective and reliable determinations of student skills and progress.

Most, if not all, standardized patient programs utilize criteria-based tools to evaluate student performance.  Typically these consist of lists of history-taking and physical assessment skills with check boxes to indicate whether the skills were performed correctly, need improvement, or were omitted.  Often these tools are scored based on students’ performance of a percentage of the total skills listed.  Rarely are these tools weighted to provide numeric scores reflecting students’ ability to perform commonly used, or critical skills.  Further, the validity and reliability of performance checklists are rarely formally evaluated.

Fostering confidence in the fidelity of the evaluation process is critical for both faculty and students.  For this reason, the faculty developed and analyzed an evaluation tool employing weighted, numeric scoring for standardized patient encounters.  Use of this tool improved the faculty’s ability to provide immediate, focused feedback to students, and to employ validation techniques should students’ performance be deemed marginal.  Integrating this tool with video recording of the sessions provided an opportunity to evaluate faculty inter-rater reliability and a chance for students to objectively evaluate their own performance.