Validating the Preceptor Clinical Evaluation: Clinical Comptency Examination

Objective evaluation of FNP students’ clinical competency is a daunting task for faculty. Faculty are often forced to rely on preceptor appraisal of student clinical performance. Although preceptors are seasoned clinicians, they are often novice student evaluators. Each preceptor receives a handbook prior to the clinical rotation that outlines the preceptor role, student evaluation criteria, and includes a standard form to document the students’ evaluation. Preceptors are an invaluable and irreplaceable resource for NP programs. Aside from volunteering their time, preceptors risk wage reduction due to decreased productivity. Faculty hesitate requiring preceptors to volunteer additional time for student assessment training.

The responsibility for evaluation of student’s clinical competency belongs to the faculty. Each of our practicum courses conclude with a faculty observed and graded clinical competency examination. Students are randomly assigned a patient with a predetermined complaint. During a 20 minute timed encounter, the student must interview, assess, evaluate, and pose a treatment plan A mix of college students, staff, and non-NP faculty volunteer as patients and receive a nominal fee for participation. One or more faculty observes the encounter through one-way glass in a conjoined observation room. The encounter is recorded for future review and critique. After the exam, students have 30 minutes to document the encounter. If a student receives a 75% or less, they fail the examination, and they fail the clinical course. Over the past 12 years, seven students failed the exam and were required to repeat the course. In the event of a failing grade, faculty arrange for a second opinion and video review by an outside expert. Outside experts validated the faculty assessment on 7/7 occasions. The complexity of the patient encounter and the level of clinical competence expected increases with each course. There are 7 practicum courses, the first two finals focus on H&P skills. Clinical courses 3-7 advance students’ diagnostic reasoning, evaluation, management, education, and health promotion skills.

Pros:

Responsibility for competency evaluation belongs to faculty

Video allows student, faculty, and outside expert review

Minimal overhead

Preceptor spared time

Cons

Patients not standardized

Student anxiety may affect performance

Time consuming