INTRODUCTION
TO THE REPORT
The issue
of developing and implementing adequate assessment strategies for nursing and
midwifery education programmes has challenged both state bodies and educators
across the world for over fifty years.
The ACE project was set up to report on current experiences of assessing
competence in pre-registration nursing and post-registration midwifery
programmes. Nursing and midwifery
have undergone rapid and far reaching changes in recent years both in initial
educational requirements and in the demands being made on professionals in
their everyday work. It is
intended that the report will contribute to current developments in educational
programmes to shape the future of the professions to meet the increasing
demands being made upon them.
Decisions
are made at every level of the professions, at national, local and in
face-to-face practice with clients that affect both the quality of educational
processes and the delivery of care.
This report intends to contribute to the quality of educational decision
making at each of these levels.
For this reason the report provides both general analyses of structures
and processes directed towards policy interests and also concrete illustrations
of the issues, problems met and the strategies employed by staff and students during
assessment events.
CONTEXTUAL
INFORMATION ABOUT THE RESEARCH PROJECT
The
Setting Up and Operation of the Research
ACE was
funded by the ENB during the period July 1991 to June 1993. It was conducted as
a joint project between the School of Education of the University of East
Anglia, the Suffolk and Great Yarmouth College of Nursing and Midwifery and the
Suffolk College of Higher and Further Education.
The focus was on the
assessment of competence of students on pre-registration nursing courses
(Project 2000 (all branches) and non diploma) and 18 month post registration
midwifery courses (diploma and non diploma). The project conducted fieldwork in nine colleges of nursing
and midwifery and their associated student placement areas, in the three
geographical regions of East Anglia, London and the North East. Appendix A 1 provides full details of
the conduct of the fieldwork. In
brief, there were two phases and through a process of progressive focusing the
issues relevant to the current state of assessment of competence were explored.
During
the first phase, data was collected in all nine approved institutions to
identify issues of national importance operating in their local contexts.
Issues related to the whole of the assessment process were explored including
planning & design, assessment experiences and monitoring &
development. At the end of this
phase an interim report was written which provided a means of articulating
initial findings and of firming up the research questions for the second phase
which then directed the collection of relevant data in greater depth in a
smaller number of fieldsites. This
approach is generally known as 'theoretical sampling' which produces 'grounded
theory' (Glaser and Strauss 1967). [1]
Project
Aims
The ACE
proposal set out with the following aims:
1. To establish the effectiveness of current methods of assessing
competencies and outcomes from education and training programmes for nurses and
midwives.
2. To examine the relationship between knowledge, skills and attitudes
in the achievement of competencies and outcomes.
3. To establish the extent to which profiles from the assessment of
individual competencies adequately reflect the general perception of what
counts as professional competence.
4. To investigate the feasibility of simultaneously assessing
understanding, the application of knowledge and the delivery of skilled care.
5. To collect perceptions of the usefulness of the UKCC's interpretive
principles in helping nurse and midwife educators to assess competencies and
outcomes.
Upon
inspection it soon becomes clear that there is an overlap between each
aim. It is difficult to do one
without also doing the others.
However, they each have their individual stress.
Aim one
stresses 'effectiveness'. If a
mechanism is to be effective, then its intended event must occur.
Thus to be effective, if an assessment procedure designates someone as
being competent, then that person must actually be competent. This is quite different from concerns
with say, cost efficiency. A
system which produces 80 or 90 per cent of people as being competent may still
be considered cost efficient. It
is then a matter of the level of risk that is considered as being
acceptable. In an effective system
the level of tolerable risk is zero.
However, this may not be accepted as cost-efficient. It is the aim then of this project to
critique the assessment of competency from the point of view of
effectiveness. This has the
advantage of making both the risk and the cost or resource implications clear
in any discussion that may then take place on the issue of 'effectiveness' as
against 'cost efficiency'.
Aim two
stresses the complex interrelations of knowledge, skills and attitudes. If the appropriate competencies and outcomes are to be achieved,
then educational and assessment strategies must be attuned to the development
of knowledge, skills and attitudes. None of these are simple categories for
study. They resist the kind of
observation that is appropriate for the study of minerals. Their observable dimensions are highly
misleading and the situation is rather like the iceberg that has nine tenths of
its bulk hidden. Human behaviour
is managed behaviour. That is to
say, it is not open to straightforward interpretation. Impressions are managed by individuals
to produce not only unambiguous communications but also multi-levels of
possible interpretations and deceptions.
What counts as knowledge to one person may not be considered knowledge
at all by another. This is as true
for scientific communities as it is for lay people (Kuhn 1970 , Feyerabend 1975).
Again, there is no easy distinction to be made between 'knowledge' and
'skill'. Knowledge may initially
be thought of as 'theoretical' as distinct from practical action or
skills. Yet, in professional
action, knowledge is expressed in action and developed through action. To analyse professional action into
'skills' and aggregate them into lists required to perform a particular action
may well do violence to the knowledge that encompasses and is expressed in the
whole action. To see professional
action as an aggregate of skills may thus lead to an inappropriate professional
attitude. Knowledge, skills,
attitudes and the processes of everyday action may in this way be regarded as
different faces of the same entity.
It is the aim of this project to begin with the experience of
professional action through which concepts of 'knowledge', 'skills' and
'attitudes' are expressed and defined in practice.
Aim three
stresses the relationship between the assessment process and what it purports
to assess. In short, are the
assessment profiles that result from the assessment process fit for their
purpose? In order to examine this
question it is essential that 'what counts as competence' has been
identified. It may not be that
there is a single 'general perception'.
Rather, there may be a range of acceptable variation in what is
perceived to be 'competence'. This
implies a debate of some kind. One
prime intention of this project then is to describe the debate and discuss the
extent to which assessment structures and processes fit the purposes that are
currently being debated. This in
turn refers the discussion back to questions of effectiveness and of the ways
through which 'knowledge', 'skills' and 'attitudes' are being identified and
defined.
Aim four
stresses the feasibility of assessing understanding and the application of
knowledge at the same time as delivering care. Effectiveness and feasibility are closely allied. It must be feasible for it to be
effective. In short, the aim is
directed towards the relationship between educational processes and care
processes. This may be seen as
presupposing a distinction between the two so that assessing would be an
additional burden to be carried at the same time as delivering care. The aim of this project is to explore
the professional process in terms of its dimensions of care and education: is the one aggregated to the other, or
are they indissoluble faces of the same coin?
Aim five
is different in kind to the preceding four. This aim has a survey dimension to it where the others are
interpretive and analytic in orientation. For ease of reference the UKCC's
interpretative guidelines are reproduced in appendix C 2. It is a straightforward matter of
asking a range of individuals in the participant institutions whether the
guidelines have been found to be useful.
Whilst the UKCC's interpretive principles acted as a focus of this aim,
it became apparent from interviewing that the inclusion of comments on the
usefulness of national guidance in general ( i.e. including ENB guidance)
provided a more comprehensive exploration of the issue. Consequently this wider perspective on
the usefulness of national guidance was pursued.
METHODOLOGY
A
Qualitative Approach for the Study of Qualitative Issues
The
project aims define the kind of methodology which is appropriate to their
achievement. For example, to
identify what counts as an effective method of assessing competencies and
outcomes, a structural analysis of cases considered to be effective is
required. Before one can begin
this, however, it is necessary to define what is to count as 'effectiveness'. This in turn requires the collection of
views as to what is to count as competence and as outcomes that signify
competence. The initial task then
is to conduct a conceptual analysis of these key terms as they are expressed in
the appropriate professions. Aim
two equally demands a conceptual analysis of the relationship between the key
terms 'knowledge', 'skills' and 'attitudes'. Once this has been established, then it becomes possible to
analyse the structural relationships between assessment procedures and
processes, and the real events in which competence is expressed as a
professional quality. With some
understanding of what is involved in the relationships between the performance
of assessment and the delivery of care then aim four can be explored. The methodology appropriate to
these aims is one which identifies those instances in which the necessary
features of the key terms are exhibited.
Through an analysis of those instances, the structures, mechanisms and
procedures through which effective assessment takes place can be identified and
described in order to facilitate future planning and design. This essentially fits the approach
known as 'theoretical sampling' [2]. It is not a quantitative approach and
thus does not result in percentages and tables which illustrates the
distribution of variables. Rather
it generates theoretical and practical understandings of systems.
The
methodology of the ACE project then, is qualitative, focusing upon structures,
processes and practices as these are revealed through documentation, interviews
and observations. A full
exploration of the methodology can be found in appendix B, but broadly, the
task has been to generate an empirical data base. By a process of comparison and contrast, key groups of
structures, processes and practices are identified as a basis for the more
formal analysis of events.
Alongside
the strategies for the gathering of data and their analysis have been
strategies to ensure the 'robustness' of the data and their
interpretation. These have
included the use of an expert 'steering group', dialogue and feedback with
participating staff and students, theoretical sampling, the application of the
triangulation of perspectives and methods, and reference to research output
from other projects. The
sensitivity of the methodology, with its emphasis on communication and personal
contact has been a feature, and attention to principles of procedure have
facilitated fieldwork relationships.
In summary, methods of
data collection were:
¥ In-depth interviews
(individual and group) with students, clinical staff, educators and other key
people in the assessment process. Recordings of interviews were transcribed for
analysis
¥ Observation of assessment related
events in clinical and classroom settings
¥ Creation of an archive of
assessment related documentation from approved institutions
The result was a large
text based archive constructed from interview transcriptions, observational
notes and documentation of courses, planning groups and official bodies. The method of analysis involved various
strategies of conceptual analysis employing discourse and semiotic approaches
to try to pin down the meanings of particular key terms employed by
professional and student discourse communities. This in turn provided a means of identifying the
institutional, local and national structures necessary for the construction and
delivery of assessment. Structural
analyses could be made of particular approaches to identify the roles and
associated mechanisms and procedures through which events (both intended and
unintended) are effected. These
events in turn were then analysed into their stages, phases and process
features in order to identify what counts as professional competence in action,
in situ.
Whilst gathering and
analysing the data was clearly impossible to understand the experiences of
professionals and students without having grasped the contemporary changes
taking place in nursing and midwifery.
There are thus discourses of reform, of innovation and of change
(whether or not perceived as being innovations or reforms) which act as the
context for the conceptual, structural and process analyses described
above. This context is the subject
of the next section.
THE CONTEXT OF REFORM
Professional and
Educational Change in a Changing World
By 1991, when the ACE
project started its work, a number of significant changes had taken place both
within nursing and midwifery education and within the structures of the
occupational settings of nursing and midwifery. These changes formed part of a
relatively long term strategy for NHS reform which was to continue to develop
and have impact throughout the life of the project. The field of study was and still is characterised by the
complexity of wide variation with differential pace of change across both
regional boundaries and local, internal boundaries. This complexity has been further compounded by the
regularity with which new demands have been made on participating institutions
as NHS reform gathered momentum and concepts such as the regulated internal
market (DoH, 1989a) were tested and
reformulated in the light of experience. Not only has this climate had an
impact on practice and education in nursing and midwifery, but it has also made particular demands
on the research methodology. A
field of study which is in constant state of flux and change demands the
contextualisation of any account of the assessment of competence.
The move of nurse and
midwife education towards full integration with Higher Education institutions
has added further complexity to the situational aspects of the assessment of
competence. Alongside the strategy for NHS reform there has been a parallel movement
towards educational reform which has encompassed the organisation and funding
mechanisms of all Higher and Further Education institutions (DES 1987, 1991). Throughout the study therefore, the fields of
nursing and midwifery education faced two challenges; firstly to prepare
practitioners for workplace environments which were themselves experiencing
major organisational and ideological change; and secondly, as they moved closed
to Higher Education, to contend with the structural changes occurring within
those institutions. Studying
nursing and midwifery education during this period has therefore inevitably raised
a number of issues which speak directly to the more general issues relating to
both the impact of NHS reform and the impact of education reform.
It is the intention here
to make explicit the main areas of change which were already having some impact
at the start of the project and to describe those changes which occurred during
the study period in an attempt to set the scene for the arguments and
recommendations raised in this report.
These areas of change will have inevitably shaped ideas about what
midwives and nurses do, what is expected of them, their educational needs and
the ways in which competence is defined and assessed.
NHS Reform
Since the publication of
the government white paper ÔWorking for PatientsÕ (DoH, 1989a), the pace of change within NHS service provision
has been relentless, and the impact of the subsequent legislation
inescapable. ÔWorking for
PatientsÕ arose as part of a major review of NHS provision and was to provide
the impetus for extensive NHS reform during the 1990Õs. The NHS and Community
Care Act 1990 was the statutory instrument which finally placed firmly into
legislation, reforms which were to have far reaching and on-going impact on
virtually all aspects of health service provision.
One of the central
stated arguments for reviewing NHS provision, structure and funding has been
the need to find economic and
ideological solutions to identified changes in health needs of the population. Demographic and
epidemiological trends (HAS 1982,
DoH, 1989b) have created new demands on
health provision and have influenced recent moves towards a demand-led rather
than service-driven health care economy.
ÔWorking for patientsÕ
attempted to address the challenge of creating provision on the basis of
population need rather than the presence of clinical expertise, by creating a
regulated internal market where Health Authorities purchase services on behalf
of their population from a range of potential service providers. The creation
of this market has rearranged local provision from a single resource into
several separate and semi autonomous units.
The period of fieldwork
undertaken in this study spanned two years of intense activity in relation to
the recommendations imbedded in ÔWorking for PatientsÕ. The first NHS Trusts
were approved in 1990 and throughout the study many of the clinical areas served
by colleges of nursing and midwifery had gained Trust status or had
applications in progress. This
separation of purchasing activity from
services and the division
of local provision not only
presented challenges for the management of the research especially in terms of
access to clinical areas, but was evidenced in the data in terms of concerns
about availability of student placement areas, workload of clinical staff and
the potential for even greater variation in the expectations about the outcomes
of nursing and midwifery courses.
The Changing Roles of
the Nurse and Midwife
Any change in the
demands which are placed on nurses and midwives within their occupational roles
will have an impact on what counts as professional competence and on the way in
which competence is assessed.
The Strategy for Nursing
(DoH, 1989b) described a range of strategic
targets for nursing and midwifery.
These responded to changes which had already occurred in service
provision and professional practice and anticipated the demands on nursing and
midwifery into the next century.
Already nurses and
midwives faced a number of initiatives over the previous decade which would
have direct impact on their role and practice. For example the Griffiths Report
(DHSS, 1983) had introduced general
management to the health service and the unquestionable right of nurses or
midwives to hold senior generic management positions in hospitals and the like
was gone. This left a major gap in opportunities for career advancement outside
clinical practice. 1988 saw the achievement of two major initiatives which were
intended to raise the value of clinical practice and provide opportunities for
career progression through, on the one hand, a new clinical grading structure
and on the other, Project 2000 and academic accreditation of nursing and
midwifery courses. These suggest a
trend towards a changing ideology and value base within nursing and midwifery
and a re conceptualisation of professional role and status in relation to other
health care workers. For
midwives in particular the last decade has seen continuation of the strong
movement away from their traditionally close identification with nurses and
nursing practice. It is a clear
reflection of the dynamic and changing nature of the field of study that by the
time the ACE fieldwork was complete, a major revision of the Strategy for
Nursing had taken place to take account of other fundamental changes within
service provision (DoH, 1993).
Other ideological
changes were taking root within nursing and midwifery practice. Throughout the
1980Õs increasing emphasis has been placed on community care (DHSS 1986, DoH,
1990) based on the notion that care in the
clients normal everyday surroundings is of greater benefit than
institutionalised care. For many community midwives this has meant less
emphasis on high technology births and more emphasis on the individual needs of
women and their families. Changes
in the location of care have had
significant impact on nurses and nursing practice. Under The NHS and Community
Care Act 1990, responsibility for community care was invested in Social
Services rather than the Health Service (DoH, 1990)
and questions are being raised about both the role and competence of nurses in community
settings, and the extent to which health care should, or indeed, could be
separated from social care. This
change in location of care has created different demands not just in relation
to the skills required by nurses in community settings, but also in the demands
on nurses in hospital settings where patients require acute care over shorter
periods.
In similar vein there
has been an increasing orientation within nursing towards holistic care, the
prevention of ill health and health education. Midwives have always worked predominantly with healthy women and as a result have
perhaps been better placed to reject a sickness oriented model of care and
adopt an approach centred on health, normality and education. This trend towards a health orientation
has mirrored a national concern for health and health promotion over recent
years. The Health of the Nation (DoH, 1992),
described the governments policy and strategic targets in these areas, and
reinforced the demand on nurses and midwives towards curricula which were
firmly based within a framework of health as well as ill health.
Changes have also
occurred in the delivery of care. For more than a decade the trend has been to
move away from task-based routinised systems of care to more individualised,
client centred approaches. Primary
nursing and team nursing started to spread throughout the country and the
publication of the Patients Charter (1991)
formally introduced the concept of the Ônamed nurseÕ for each patient. It can be argued that individualised
care, primary nursing and the concept of the named nurse have contributed
significantly to a shift towards a model of nursing and midwifery practice in
which judgement, assessment, care planning and reflective critical analysis are
becoming increasingly valued role components. Where role expectations and
values shift, so too should ideas about what counts as competence and how that
competence should be assured. A
major question therefore must be, to what extent have role expectations and
values embedded in those
expectations, kept pace with changes in policy and legislation? To what extent
do practitioners, managers and educators, hold onto role expectations which
have not yet taken account of major policy shift? The implication here for the
research is to uncover and explicate the relationships between role expectation
and policy implementation in order to inform possible mismatches between the
rhetoric of assessment documents and the realities of assessment experience.
Changes within
Education
Although apparently less
directly affected by the main thrust of NHS reform, professional education has
been in the process of a fundamental transformation. Major changes were taking place within nurse and midwifery
education both in terms of the nature and content of educational programmes and
in the structure and organisation of institutions. A subsidiary paper of
ÔWorking for PatientsÕ, ÔWorking Paper 10Õ, addressed the need to separate
education provision from service units and purchasing authorities by investing
the relationship between service and education with similar market
processes. What followed was a
wholesale review of nurse and midwife education across the country and
consequent major reorganisation. At the beginning of the ACE project most
education institutions had already undergone some form of rationalisation. All approved institutions involved with
the study were the products of the amalgamations of several small schools of
nursing and midwifery, which had traditionally been located on NHS hospital
sites into much larger colleges of nursing and midwifery. Most were therefore multi-site
institutions which were in various stages of incorporation.
Later, as the overall
intention to embed nurse and midwife education into a HE framework took shape,
colleges of nursing and midwifery were to begin the process of wholesale
integration with HE institutions. During the period of study, colleges were in
various stages of integration ranging from validation-only arrangements through
to full integration.
Clearly, given the
overall trend towards integration with HE, all fieldsites were experiencing
major upheaval in terms of both organisational structures and working
arrangements hard on the heels of one, if not more, previous periods of
re-organisation. In one college, senior staff were facing the prospect of re
applying for their jobs for the third time in a space of two years.
Concurrent with these
various strands of organisational restructuring, fundamental changes were being
implemented to the nature of courses. Project 2000 (UKCC 1986) and moves towards devolved continuous assessment
were having a dramatic impact on the nature of pre registration nursing courses
as were the increasing number of direct entry midwifery courses and the
accreditation of midwifery courses to the level of Diploma in Higher Education.
Project 2000 represents
a major move away from the apprenticeship style training of previous years. One
of its fundamental and over-riding stated aims is to provide nurses with the type
of preparation which will best meet the changing demands and expectations on
qualified nurses in changing contexts of health care delivery. If nurses are to cope with a working
environment characterised by its changeability and ideologically committed to the primacy of the individual,
then nurses will need new skills to be flexible and adaptable enough to manage
the unpredictability of individualised systems of care within a constantly
changing professional context.
These are the skills most frequently associated with HE. Colleges of nursing have therefore been
required to form collaborative links with HE institutions in order to develop
and validate Project 2000 courses.
The process of conjoint validation between nursing professional bodies
and HE institutions placed
different and sometimes competing sets of demands in relation to course
assessment strategies. On the one
hand professional bodies were concerned that assessment strategies were
sensitive to the demands of professional practice and on the other the HE
institutions concerns focused on academic credibility and the extent to which
the assessment design was adequately sensitive to intellectual competence.
Although midwifery
education remains separate from Project 2000, a number of direct entry midwifery programmes share
components with the Project 2000 Common Foundation Programmes. Even where Project 2000 has not had
such a direct impact on midwifery education, there has been a parallel trend
within midwifery to incorporate some of the more generic educational principles
of Project 2000 within their own curricula.
Project 2000 and diploma
level midwifery education are only one aspect of a broader set of educational
initiatives which challenge traditional expectations of what nurses and
midwives do, how they interpret their roles and how they should be prepared for
practice. PREPP (UKCC, 1990) and the ENB
framework and Higher Award (ENB, 1990)
address the increasing concern for opportunities for lifelong learning. They imply a distinct move away from a view that nursing or
midwifery can draw on discrete, finite and stable sets of knowledge and understanding and move towards the
notion that maintaining professional competence is more to do with providing
skills for continual self development.
Central to these initiatives is the need to demonstrate evidence of
continual progression and learning in order to be considered fit and competent
to practice.
Changes to the
structure, content and philosophy of nurse and midwife education were not
occurring in isolation from wider changes which were impinging on HE and FE
throughout the period of study (DES, 1987, 1991).
Recent legislation, (DES, 1992) has brought about a number of changes in the
Higher Education institutions into
which nurse and midwife education continues to integrate. These changes were heralded by the
government as:
far reaching reforms
designed to provide a better deal for young people and adults and to increase
still further participation in further and higher education.
(Lord Belstead,
Paymaster-General, Hansard, H.L. Vol. 532, col. 1022)
Changes to HE included a
new system of funding (DES, 1988), which
merged the functions of the old Polytechnics and Colleges Funding Council and
the Universities Funding Council to form the Higher Education Funding Council.
The intention behind this was to introduce greater competition between HE
institutions for both students and funds in order to achieve greater cost
effectiveness. The act also created opportunities for a wider range of HE
institutions to award their own degrees and to include the term
'university' in their titles. The impact on some institutions was
experienced as a series of priority changes as the pace of these changes gathered momentum throughout
1992. For institutions seeking to
meet the criteria set by the Privy Council to gain university status, the main
priority was experienced as a pressure to develop, market and deliver HE
courses to increasing numbers of students. Once achieved, many 'new
universities' faced new demands for increased research activity in order to
benefit in any substantial way from the research assessment exercise which was
to determine the allocation of university research moneys.
Although the effect of
these changes on the project fieldwork was not as direct nor dramatic as the
effect of NHS reform, several colleges involved with the study had HE partners
who were undergoing fundamental changes as a direct consequence of the above
legislation. Some colleges
involved in the study started
their integration process with polytechnics who have since gained university status. For colleges of nursing and midwifery
these changes were not just about nomenclature but were also about the nature,
structure and expectations of their relationships with HE validating body and
partner.
In summary, during the
period of study a number of pressures upon both understandings and
administration of assessment of competence were in operation and which can be
categorised into the following groups:
¥ changes in population
health needs
¥ values about health
care and service provision
¥ political/ideological
changes (structural changes)
¥ educational reform
Each category exerts its
own distinct range of changes and pressures upon individuals and groups
involved in the assessment process on both personal and professional levels,
affecting what counts as competence and the means by which it should be
assessed. Consequently this
section concludes with a selection of extracts from the data which articulate
some experiences of the changing context. Further examples can be found
throughout this report.
THE EFFECTS OF CHANGE
ÔON THE GROUNDÕ
Individual
Experiences of Change
The research examines
the assessment of competence in nursing and midwifery education within the
changing context described above. It does so from the perspective of the
individuals who deliver the service, upon whom these changes impinge directly,
but who also, as members of a body which has campaigned for a considerable time
for the changes, the motivators of the continuing developments. As affectors
and affected, people experience change with mixed feelings, which the research
has set out to capture. For some, the effects of changes within educational and
health care environments are experienced as a continual break on educational
planning:
The Health Authority was in a state
of flux and there was a lot of change going on. First we amalgamated with another Health Authority and then
second we amalgamated as one college of nursing with other schools of nursing. So every time you thought,
"Now we've got some ideas coming on paper," you had to stop and
re-evaluate because you got new schools joining and then you had to look at
what they were doing.
Organising and
guaranteeing a range of clinical experience for students on placements is also
difficult in some instances:
I find the clinical
areas are changing their speciality month by month. You know you have one area that's doing so and so (...) and
then you find that they're no longer doing that because some other consultant
has actually gone in there and they're doing something else. It's a constant battle, it really is. (educator)
A prevailing climate of
uncertainty makes long term planning difficult and unsettling in many
instances:
The whole future's up
for grabs. The college may become
an independent (...) it may become completely separate, someone may take on a
faculty of nursing in Middletown.
The next six months should give some indication of...politically...of
how things go. (educator)
The cumulative effect of
change was highlighted by one educator:
I think it's...not
just how it's changed, it's the speed of change. There is more coming on, you just get one set of initiatives
finished and then there's another set going through, and another set. And on top of that there's changing the
curriculum...there's changes, it's the speed of change. Change has always been there but
there's been more time to assimilate it, to take it out there to work out there
to change it. Now it's so hard to
keep up with the change and take it out there. And a lot of people out there in
the clinical field are not really sure what is going on.
Those involved in
education are keen to ensure that colleagues in patient care are kept up to
date with educational change.
Likewise the need to share understandings about developments occurring
in service is recognised, but remains a difficult task in a climate of
competing demands:
...I think our staff
here don't always recognise all the great changes that are happening in
education, they see their own changes, changes in technology, the way we're
pushing patients through, reducing patients' stays, the way we are changing our
structures and our ways of working and contracting, and income comes in and goes out. We don't get a budget any more, we have
to earn out income through so many patients we see, and they don't see that the
college have got their own stresses and strains. What the college don't see is perhaps the speed at which
we're moving forwards and the new language. I'm not convinced that my college friends really have an
understanding and grasp of the new NHS.
They have not got a grasp of contracts and earning income through
numbers of patients. (nurse manager)
The report offers a
detailed record of individual perceptions of change and provides an account of
the manner in which these have affected, and are likely to continue to affect,
the implementation and further development of structures, mechanisms, roles,
and strategies for devolved continuous assessment.
CHAPTER
ONE
ABSTRACT
Assessment in general has a
range of purposes, including the formative ones of diagnosis, evaluation and
guidance, and the summative ones of grading, selection and prediction. It is
expected to be reliable, valid, fair and feasible, and to offer what is usually
called, somewhat mechanistically, ÔfeedbackÕ. The assessment of professional
competence has additionally to be able to evaluate practical competence in
occupational settings, and to determine the extent that appropriate knowledge
has been internalised by the student practitioner. Approaches to assessment
which lie within the quantitative paradigm, including technicist and
behaviourist approaches as well as quantitative approaches proper, are suitable
for collecting information about outcomes within highly controllable contexts,
and for collecting information which can be measured, or recorded as having
been observed. Such approaches are inappropriate for assessing the degree to
which the student professional has developed a suitably flexible and responsive
set of cognitive conceptual schema that facilitates intelligent independent
behaviour in dynamic practical situations. Neither do they take account of the
fact that contexts of human work themselves continue to evolve and change, and
that therefore the individualÕs ability to blend knowledge, skills and
attitudes into a holistic construct that informs their practice, is crucial.
Assessment from within the educative paradigm, on the other hand, does do these
things, whilst also acknowledging that assessment itself is an essential
element of the educative process. Educative assessment takes full account of
institutional and occupational norms, and of the fact that there are actual
individuals involved who are not automatons but people who interpret and make
sense in terms of their experience; its structures are generated in response to
those features rather than in contradiction of them. It offers structures,
mechanisms, roles, and relationships that reflect interior processes and take
into account the essential ÔmessinessÕ of the workplace. It does not attempt to
impose a spurious logical order on what in practice is complex. In so doing it
performs a formative function as it performs the summative one. The one does
not follow the other, but happens in parallel. Assessment from the educative paradigm is integral to the
learning process that generates individual development. Competency-based
education stands provocatively on the bridge between the quantitative paradigm
and the educative paradigm, still making up its mind about the direction in
which it should move.
THE ASSESSMENT OF
COMPETENCE: A CONCEPTUAL ANALYSIS
Introduction
The study of the
assessment of competence would seem straightforward if it were not that
considerable controversy and confusion over what is to count as 'competence'
takes place at every level in the system.
One way of beginning the analysis of the 'assessment of competence' is
to ask such questions as:
¥ what function it serves
within a symbolic system or social process
¥ how it is related to other
elements or features
¥ how it is accomplished as a
practical activity
What characterises human
activity is its symbolic dimension.
That is to say, it is not enough just to observe a behaviour or an
action, one has to ask what it means within a complex system of thought and
action. Key concepts are
regulative agents in a system. In
other words, they generate order, they give a pattern to behaviour such that
each element is related to each other element. Every element can be analysed for its function in the
system. Meaning, however, is
not open to inspection like a physical object. What is said is not always what is meant. What one intends to mean is not always
what is interpreted by others to mean the same thing. The intended outcome of an action may have unforeseen
consequences because it has been variously interpreted, or because the system
is so complex it defies accurate prediction.
The intended outcomes of
assessment, for example, are to
ensure that certain levels of competence are achieved so that employers and
clients can be assured of the quality, knowledge and proficiency of those who
have passed. The unintended or
hidden purposes may be quite different.
For example, educationalists have long referred to the 'hidden
curriculum' and its ideological functions in terms of socialising pupils to
accept passive roles, gender and racial identities, their position within a
social hierarchy as well as social conformity and obedience to those in power. [3] Occupational studies in a range of
professions reveal that a similar social process occurs through which students
undergoing courses of education into a particular profession become socialised
into that profession's occupational culture. In studies of police training, for example (NSW 1990) police trainees talk about the gap between the
real world of practice that they experience when on placement in the field and
the lack of 'reality' of their academic studies. Similar, experiences are recorded in studies of nursing and
midwifery (Melia 1987; Davies and Atkinson,
1991). It could be said then that
there are hidden processes of assessment where students are assessed according
to their ability to 'fit in' to the occupational culture. This hidden process may parallel that
of the official or overt forms of assessment. How the two kinds of process interact in the production of
the final assessment judgement is a matter of empirical study. The following chapter will set the
scene for such empirical analyses by exploring alternative approaches to
conceptualising the issues involved in the study of a) assessment, b)
competency/ competence/competencies, and c) assessment of
competency/competence/competencies.
It would be artificial to separate completely these strands in the
following sections. Nevertheless,
it facilitates the organisation of the argument to emphasise each in turn under
the following headings:
¥ The Purposes of Assessment
¥ The Professional Mandate
¥ Approaches to Defining
Competence
¥ From Technicist to Educative
Processes in the Assessment of Professional Competence
¥ Finding a Different Approach
1.1. THE PURPOSES OF
ASSESSMENT
1.1.1. From
Technicist Purposes to Professional Development
Traditionally, the
purpose of assessment is to gauge in some way the extent to which a student has
achieved the aims and objectives of a given course of study or has mastered the
skills and processes of some craft or area of professional and technical activity. The act of assessment makes a
discrimination as between those who have or have not passed and further ranks
those who have passed in terms of the value of their pass. The grade or mark awarded not only says
something about the work achieved but something about the individual as a
person in relation to others and the kinds of other social rewards that should
follow. Eisner (1993) in tracing the relationships between testing,
assessment and evaluation from their origins in the scientific purpose 'to come
to understand how nature works and through such knowledge to control its
operations.' Through the influence
of Burt in Britain and Thorndike in America psychological testing was founded
upon principles modelled upon the mathematical sciences. During the 1960s, however, new
purposes arose : 'For the first
time, we wanted students to learn how to think like scientists, not just to
ingest the products of scientific inquiry'. This required approaches different to the educational
measurement movements:
Educational evaluation
had a mission broader than testing.
It was concerned not simply with the measurement of student achievement,
but with the quality of curriculum content, with the character of the activities
in which students were engaged, with the ease with which teachers could gain
access to curriculum materials, with the attractiveness of the curriculum's
format, and with multiple outcomes, not only with single ones. In short, the curriculum reform
movement gave rise to a richer, more complex conception of evaluation than the
one tacit in the practices of educational measurement. Evaluation was conceptualised as part
of a complex picture of the practice of education.
Scriven (1967) introduced the terms formative and summative
evaluation placing attention not simply upon specified outcomes that could be
'measured' but also on the quality and purposes of the processes through which
attitudes, skills, knowledge and practices are formed. The focus upon the formative
possibilities of evaluation drew attention to the processes of learning,
teaching, personal and professional development and the intended and unintended
functions of assessment procedures.
To address these kinds of processes, methodology shifted from
quantitative to qualitative and interpretative approaches which focused upon
the lived experiences of classrooms.
What was found there was a complexity and an unpredictability that
earlier measurement methods had overlooked.
During the mid-1970s and
to the mid 1980s in America, and broadly the 1980s to the present day in the UK
concern was expressed regarding the outcomes of schooling. There was a general call from
politicians and employers to go 'back to basics'. This call was articulated through increasing political
demands for testing and for accountability. However, as Eisner points out many realised that
'educational standards are not raised by mandating assessment practices or
using tougher tests, but by increasing the quality of what is offered in
schools and by refining the quality of teaching that mediated it.' In short, 'Good teaching and
substantive curricula cannot be mandated; they have to be grown.' Professional development together with appropriate
structures and mechanisms for the development of courses and appropriate
methods of teaching and learning are thus essential.
With the return to
demands for 'basics' and 'accountability' the term assessment has come to
supplant that of evaluation in much of the American literature. However, this term is new in that it
does not simply connote the older forms of testing course outcomes and
individual performance, but includes much of what has been the province of
evaluation. As Eisner concludes
'we have recognised that mandates do not work, partly because we have come to
realise that the measurement of outcomes on instruments that have little
predictive or concurrent validity is not an effective way to improve schools,
and partly because we have become aware that unless we can create assessment
procedures that have more educational validity than those we have been using,
change is unlikely.'
Brown (1990) has described the emergence in British education
of a multi-purpose concept of assessment 'closely linked to the totality of the
curriculum'. The purposes included
are: fostering learning, the
improvement of teaching, the provision of valid evidence bases about what has
been achieved, enabling decision making about courses, careers and so on. The TGAT report on assessment in the
National Curriculum for schools saw information from assessments serving four
distinct purposes:
1 formative, so that the positive achievements
of a pupil may be recognised and discussed and the appropriate next steps may
be planned;
2 diagnostic, through which learning
difficulties may be scrutinised and classified so that appropriate remedial
help and guidance can be provided;
3 summative, for the recording of the overall
achievement of a pupil in a systematic way;
4 evaluative, by means of which some aspects of
the work of a school, an LEA or other discrete part of the educational service
can be assessed and/or reported upon.
In addressing these
concerns, there are four kinds of purposes that need to be considered when
thinking about assessment:
¥ technical,
¥ substantive,
¥ social, and
¥ individual developmental
purposes.
1.1.1.a. Technical
Purposes
The essential technical
purposes of an assessment procedure are reliability, validity, fairness and
feasibility in what it assesses, providing in addition, feedback to student,
teacher, the institution and national and professional bodies ensuring the
quality of the course. To these
may be added the six possible purposes of assessment provided by Macintosh and
Hale (1976): diagnosis, evaluation, guidance, grading, selection, and
prediction.
1.1.1.b.
Substantive Purposes
The substantive purpose
of a nursing or midwifery course includes a grasp of the appropriate knowledge
bases as well as the accomplishment of appropriate degrees of practical
competence in occupational settings.
The question of who should decide what counts as an appropriate
knowledge base and an appropriate level of performance are made more complex
with the advent of local decision making.
At a local level, market forces may lead to the tailoring of courses to
meet local needs. The question
arises then, concerning how national standards, or levels of comparability can
be maintained. A professional
trained to meet the needs of one area may be inadequately trained to meet the
needs in another part of the country.
Substantive issues are thus vital to maintaining a national perspective
not only on professional education but also on professional competence.
1.1.1.c. Social
Purposes
At a social and
political level the public needs to be assured of the quality of professional
education. Assessment in this case
serves the function of quality assurance and can contribute to public
accountability. However, there are
other hidden (even unintended) social functions. To gain a professional qualification means also gaining a
certain kind of social status. It
means taking on not merely the occupational role, but the social identity of
being a nurse, a midwife. With the
role goes an aura of expertise, a particular kind of authority that can extend
well beyond the field of professional activity into other spheres of social
life. On the one hand, it can be
argued that through their authority the professions act as agents of social
control; equally, it can be argued that they act as change agents, raising
awareness of say the impact of unemployment or poverty on health.
1.1.1.d.
Individual Developmental Purposes
Work is still the
dominate social means through which people form a sense of self value, explore
their own potential, contribute to the well being of others and feel a sense of
belonging. Therefore, becoming qualified
to enter a profession marks a stage not only in the social career of the
individual but also in the personal development of the individual. Assessment
is thus, in its widest sense, about human development, purposes and action.
To become a professional
means that the individual has internalised a complex cognitive conceptual
schema to respond appropriately to dynamic practical situations. Knowledge, skills and attitudes blend
in the person to the extent that the individual's identity is bound up with
professional activity. This
is what makes both defining competence and its assessment so difficult to
achieve. It is not just that the
individual is perceived as a professional. The individual is perceived to have a mandate to act.
1.2. THE PROFESSIONAL
MANDATE
A mandate to act can be
defined at one level as having the legal power to enforce an action. A professional mandate, however, is not
limited to this. The mandate arises
because the professional has an authority, a social standing, a body of
knowledge through which change can be effected. Both nursing and midwifery have during this century
undergone changes in status and currently lay claim to a professional
identity.
As recently as 1969
Etzioni regarded nursing as a
semi-professional occupation because training was too short and nurses were not
autonomous nor fully responsible for their decision making. Not only is nursing perceived by many
as subordinate to the medical professions, midwifery is in the process of
distinguishing its own professional identity from that of nursing. Whittington and Boore (1988: 112) following their review of the literature
identified the characteristics of professionalism as:
1. Possession
of a distinctive domain of knowledge and theorising relevant to practice.
2. Reference
to a code of ethics and professional values emerging from the professional
group and, in cases of conflict, taken to supersede the values of employers or
indeed governments.
3. Control
of admission to the group via the establishment, monitoring and validation of
procedures for education and training.
4. Power
to discipline and potentially debar members of the group who infringe against
the ethical code, or whose standards of practice are unacceptable.
5. Participation
in a professional sub-culture sustained by formal professional associations.
Hepworth (1989) refers to the fact that nursing has been
considered variously as an 'emerging profession, as a semi-profession and as a
skilled vocation'. Nevertheless,
at first glance at least, nursing and midwifery could be said to be
increasingly able to meet the above criteria. Hepworth, however, points back to the underlying uncertainty
concerning the status of nursing as a profession and the impact this has upon
attempting to assess students when assessors:
are required to assess a
student's competence to practice as a professional, when the role of that
professional is ambiguous, changing, inexplicit, and subject to a variety of
differing perspectives. The effect
of this complexity is evident in the anxiety and defensiveness which the
subject of professional judgement often raises in both the students and their
assessors/teachers, particularly if that judgement is challenged or it is
suggested that the process should be examined.
Added to this, the
British political context for all the health professions has been, is, and is
likely to be for the foreseeable future, one of considerable change where old
practices and definitions are replaced by new ones, where professionals often feel
under threat and de-skilled by innovations and their demands. In the face of such external pressure,
there has never been a greater need for both nursing and midwifery to reflect
upon their status as possessors of domains of knowledge and theorizing in order
to assert their independence and identities. However, like any complex occupation there is no
homogeneous, all embracing view of 'nursing' or 'midwifery' as the basis upon
which to construct domains of knowledge.
There is rather an agglomeration of spheres each with their own views
and associated practices which broadly assembled come under the name of
'nursing' or 'midwifery' (c.f. Melia 1987).
Project 2000 and direct
entry midwifery diplomas each speak to a change in what may be called their
appropriate 'occupational mandates'. This mandate includes not only the official
requirements as laid down by the ENB, UKCC and EC but also the knowledges,
skills, competencies, values, conducts, attitudes, and images of the nurse and
the midwife in relation to other health professionals that have developed
historically. These
interrelated images, ideas and experiences constitute the concept of the
competent professional.
Change cannot simply be mandated by legislation. The historically developed beliefs and
practices of a profession cannot be altered overnight. Of course legislation can force
changes. Nevertheless, these may
not be in the directions desired.
Official changes can be subverted, resisted, or glossed over to hide the
extent to which practice has not changed.
If real change is desired then it needs to be 'grown' rather than
imposed. Project 2000 and the
direct entry midwifery diploma may be seen as an attempt to grow change in the
professions. In the process,
competing definitions as to competence emerge some of which draw upon
traditional legacies, others upon official pronouncements and legal texts and
yet others upon the personal and collective experiences of practice. Accordingly, professional competence as
a concept is open to variations in definition, many of which are vague.[4]
1.3. APPROACHES TO
DEFINING COMPETENCE
1.3.1. Some
Approaches to Finding a Definition
For Miller et al (1988) competence can be seen either in terms of performance,
or as a quality or state of being.
The first is accessible to observation, the second, being a
psychological construct, is not.
However, it could be argued that the psychological construct should lead
to and therefore can be inferred from competent performance. Hence, the two
definitions of competence are compatible.
The question remains, however, how easily and unambiguously can
performance signify competence?
The breadth of definitions of competence ought to lead researchers to
some caution as to the answer to this question. Runciman (1990) draws on
two broad definitions of competence:
Occupational competence
is the ability to perform activities in the jobs within an occupation, to the
standards expected in employment.
The concept also embodies the ability to transfer skills and knowledge
to new situations within the occupational area .... Competence also includes
many aspects of personal effectiveness in that it requires the application of
skills and knowledge in organisational contexts, with workmates, supervisors,
customers while coping with real life pressures.
(MSC Quality and
Standards Branch in relation to the Youth Training Scheme)
(Competence is) The
possession and development of sufficient skills, knowledge, appropriate
attitudes and experience for successful performance in life roles. Such a definition includes employment
and other forms of work - it implies maturity and responsibility in a variety
of roles; and it includes experience as an essential element of competence.
(Evans
1987: 5)
Although these
definitions offer an orientation towards competence, neither offers sufficient
precision to be clear about how such competence can be manifested unambiguously
in performance. In order to
overcome this, one approach has been to take a strategy of behaviourally
specifying individual competencies in the form of learning outcomes and
associated criteria or standards of performance, the sum of which is the more
encompassing concept of competence.
Thus competence is seen as a repertoire of competencies which allows the
practitioner to practice safely (Medley 1984). This approach is broadly
quantitative. How these
competencies may be identified for quantitative purposes is then the next
problem.
According to Whittington
and Boore (1988) there has been little
research in actual nursing practice thus competencies have generally either
been produced in an intuitive, a priori fashion, or have been based upon
experts' perceptions of what counts as competence (as in the Delphi[5] or Dacum[6] approaches). However, this criticism is being
addressed in the work of Benner (1982, 1983),
qualitative studies such as Melia (1987),
Abbott and Sapsford (1992) and the
increasing interest these kinds of work are stimulating through which an
alternative approach can be developed.
In the final section of this chapter, this alternative approach will be
discussed in relation to its implications for the development of an educative
paradigm through which competent action may be educed and evaluated.
Although it is not the
central purpose of this project to explore methods of identifying competence,
such methods have direct implications for the forms that assessment processes
and procedures take. A predominantly
quantitative approach has quite different implications than a largely
qualitative approach. Norris and
MacLure (1991) provided a summary of
approaches following a review of the literature in their study of the
relationship between knowledge and competence across the professions. For the purposes of this study their
summary has been reframed into two groups together with a minor addition as
follows:
Summary of
methodologies for identifying competence
Group A
¥ brain-storming/round table and
consensus building by groups of experts (eg ETS occupational literature; Delphi
and Dacum);
¥ theorising/model building (based
on knowledge of field/
literature - eg Eraut, 1985; 1990);
¥ occupational questionnaires;
¥ knowledge (conceptual framework)
elicitation for expert systems through
interviewing (eg Welbank, 1983)
¥ knowledge elicitation through
observation in experimental settings;
(Kuipers & Kassirer,
1984) or modelling of expert judgement
via simulated events (Saunders, 1988)
Group B
¥ post hoc commentaries on
practice by expert practitioners (based on recordings/notes/recollections - eg Benner, 1984)
¥ on-going commentaries on
practice (eg Jessup forthcoming);
¥ practical knowledge/tacit theory
approaches (self-reflective study): (Elbaz, 1983; Clandinin, 1985; Schon,
1985).
¥ critical incident survey and
behavioural event interviews (eg McLelland, 1973);
¥ observation of and inference
from practice (based on practitioner-research e.g., Elliott 1991)
[Based on MacLure &
Norris, 1991: p39]
There are those, group
A, which are essentially a priori
and quantitative, seeking measurable agreements and those, group B, which focus
primarily upon the analysis of observation and interview accounts. Group A tends towards the quantitative
paradigm, whereas group B tends towards the qualitative paradigm. In group A, it could be argued that
expert panels include a high degree of qualitative material and in group B the
McLelland approach results in quantitative criteria. Qualitative approaches do not necessarily exclude the use of
quantitative techniques and quantitative approaches frequently depend upon
'soft' or subjective approaches to develop theory for testing. The difference, in each case, is a
difference of value and purpose, the essential difference being that
quantitative approaches more highly value measurement and explanation; where as
qualitative approaches tend to value more highly, meaning and
understanding. The former tends to
reinforce technical (and in the extreme, technicist) approaches to training and
assessment, whereas the latter tends to reinforce the development of personal
and professional judgement. In
this latter approach, both training and assessment demands the provision of
evidence of critical reflection on practice in which appropriate judgement has
been the key issue. Since
judgement is context and situation specific it cannot be reduced to behavioural
units but can be open to public accountability through the discussion of
evidence.
The issue for assessment
concerns the nature of the
domain(s) of knowledge and theorizing relevant to the sub-spheres of practice
that is possessed by competent nurses and midwives and which is essential to
marking them out as professions. It may be an argument for their status as
emergent professions rather than as fully fledged professions, that much of
their knowledge is held implicitly or tacitly. Or, it may be that such tacit knowledge is characteristic of
any profession. In either case,
what approaches to the identification of competence and its assessment are
appropriate to such complex fields of action?
1.4. FROM TECHNICIST
TO EDUCATIVE PROCESSES IN THE ASSESSMENT OF PROFESSIONAL COMPETENCE
1.4.1.
Differentiating Quantitative and Qualitative Discourses
A formal assessment
process requires both a social apparatus of roles, procedures, regulations, and
also a conceptual structure adequate to generate evidence upon which to base
judgements on student achievements.
A structure to make this happen can be logically, even scientifically,
formulated. However, the actual
events that take place as a result may not always be those expected. Events are contingent whereas structures
may be rationally determined or legally imposed. Where a role may be rationally defined and related to other
roles in a clear structural pattern, the individual who occupies that role is
contingent in the sense that it is the role that is necessary to the structure
not the individual. Each
individual who could occupy a given role
brings different individual needs, interests and aspirations as well as
abilities, values and experiences which frame how in practice the role is
interpreted and realised. Broadly,
the assessment process can be analysed according to such structural and
contingent aspects. In the
development of an assessment structure, the issue is whether the structural
aspects are to be imposed upon, or to be derived from actual practice.
In one sense, the
process of assessment can be read as an attempt to impose a logical order on
the 'messy' reality of actual practice.
Its purpose would be to control or regulate processes through well
defined mechanisms and procedures to produce outcomes which ensure some
comparability and to assure certain standards of quality or attainment. In the second sense, assessment structures,
mechanisms and procedures are seen as outcomes generated by reflective feedback
on practice. Through
reflection structural or common features of practical competence are identified
but not to the detriment of specificity, difference and variety. The second is thus sensitive to the
dynamics of situations in a way that the first is not.
Generally speaking, quantitative
methods are typically employed in
approaches which seek to control and hence compel the adoption of a certain
kind of structure. The
alternative approach which seeks to generate (or grow) structure based upon
reflection upon practice, places at the centre of its arguments concepts of
'value', 'meaning' (as distinct from observable and measurable units),
attitudes, judgement and other personal qualities - a qualitative
approach. The latter approach thus
places human action, reflection
and decision making at the centre of its discourses whereas the former
replaces the human decision maker by instruments which are constructed to measure
or calculate and thus reduce 'human judgement' which is seen as a source of
potential error.
Each has quite different
implications. Firstly, there are
implications both for the way education to enter the professions is organised,
and also for the legitimation of and status of a profession in relation to its
client groups and its employers.
Secondly, there are implications for the principles, procedures and
techniques of assessment. For the
sake of convenience, the first group of discourses about competence will be
referred to as the quantitative, and the second as the educational. The term educational or educative is
chosen so as not to reinforce the easy opposition between mathematical
approaches and qualitative approaches in the social sciences. Where a quantitative approach in the
interests of 'objectivity', may seek to exclude discourses of value, judgement
and human subjectivity, an educational approach values all the power of
precision that mathematics and logical forms of analysis can contribute to the
full range of human discourse, judgement and action. In this sense, the educative approach is inclusive and
action centred, whereas the quantitative approach is exclusive.
1.4.2. The
Quantitative Discourses
(With Particular Reference To
The Behavioural and Technicist Variants)
Assessment should not
determine competence, but rather competence should determine its appropriate
form of assessment. How competence
is defined depends upon the methods, beliefs and experiences of the professional. Such definitions can be revealed
through the kinds of texts they produce and the ways in which they talk about,
support and contest meanings of competence. The definitions that emerge or can be drawn out (educed)
from the range of texts and discourses provide accounts of how practical
competence is seen. Within these
discourses, it is frequently the case that quite distinct, even mutually
exclusive views can be described.
To mark such distinctions the term paradigm is often used.
The term 'quantitative
paradigm' as to be employed here, refers to those discourses of science which
involve throwing a mathematical grid upon the world of experience. Logical deductive reasoning,
measurement and reduction to formulaic expressions are its features. The technicist paradigm as employed in
this report is a particular kind of version of the more general quantitative
paradigm which seeks measurement, observable units of analysis and logical
arrangements. The technicist
paradigm is reduced in scope in that it takes for granted its frameworks of
analysis and its procedures and employs them routinely rather than subjecting
them to the judgement of the practitioner. Although this characterisation is an 'ideal
type' it has a basis in the data.
Later discussions will report the sense of frustration some assessors
and students feel in filling out assessment forms, in trying to interpret the
items in relation to practical experience and in accordance with their best
judgement. The typical complaint
may be summed up as being that the key dimensions of professionality cannot be
reduced to observable performance criteria[7].
The aims of the
technicist paradigm can be seen most clearly in the 'scientific management' of
Taylor (1947[8]) and the developments
in stop watch measurement of performance, the behaviourism of Watson (1931) and later Skinner (1953, 1968), the mental measurement of Burt (1947),
Thorndike (1910) and Yerkes (1929) and
programmed learning and instructional design (GagnŽ 1975;). Here the emphasis
was upon control and predictability through measurement and the reinforcement
of appropriate behaviours to produce desired outcomes.
In making such a
reduction, the technicist paradigm reinforces a split between theory (or
knowledge) and practice by separating out the expert who develops theory
(knowledge) from the practitioner who merely applies theory that can be
assessed in terms of performance criteria. Also implied in this is a hierarchical relation between the expert and the non-expert
whether seen as practitioner or trainee.
In addition, within a quantitative/technicist paradigm, skills
assessment models, and competency based education each assume the student
initially lacks the required skill or competence. Through training a student then acquires the particular
skill or competence required. A
particular combination or menu of such skills or competencies then defines the
general competency of the individual.
This is most clearly expressed by Dunn et al in a medical context
(1985:17):
... competence must be
placed in a context, precise and exact, in order for it to be clear what is
meant. To say a person is
competent is not enough. He is
competent to do a, or a and b, or a and b and c: a and b and c being aspects of a doctors work.
The essential
'messiness' of everyday action, the complexity of situations, the flow of
events, and the dynamics of human interactions make the demand for a context
which is 'precise and exact' unrealistic.
The operationalisation of such an approach is exemplified in the
programmed learning of GagnŽ (see GagnŽ and Briggs 1974) or in the exhaustive and seemingly endless lists
of Bloom (1954, 1956). The issue raised at this point is not
about the value of analysing complex activities and skills, but the use to
which such analyses are put in everyday practice.
Schematically the
relationship between the quantitative view, the behavioural and the technicist
can be set out as follows:
(Figure 1)
The diagram represents
the decreasing scope from quantitative to technicist which moves from a
systematic method of investigating and comprehending the whole world of
experience open to thought, to the reduction of scope to observable behaviours
(as opposed, say, to felt inner states) and finally the reduction of methods and
knowledge for limited purposes of social control or the engineering of
performance. Thus, in general
terms, as Norris (1991) comments, discourse
about competence:
has become associated
with a drive towards more practicality in education and training placing a
greater emphasis on the assessment of performance rather than knowledge. A focus on competence is assumed to
provide for occupational relevance and a hardheaded focus on outcomes and
products. The clarity of
specification, judgement and measurement in competency based training indicates
an aura of technical precision.
The requirement that competencies should be easy to understand, permit
direct observation, be expressed as outcomes and be transferable from setting
to setting, suggests that they are straightforward, flexible and meet national
as opposed to local standards.
This requirement can be
seen in the three dominant approaches in the quantitative paradigm to assessing
practical competence:
¥ Minimum Competency Testing
(MCT)
¥ Competency Based Education
(CBE)
¥ National Vocational
Qualifications (NVQs)
Each will be discussed
in turn in the section which follows the summary immediately below.
1.4.3. Minimum
Competency Testing (MCT)
When some notion of a
golden age when life was simpler is held by policy makers, forms of assessment
can be seen as tools to engineer this state. A particularly reductive form of the behavioural
approach is to be seen in Minimum Competency Testing which exemplifies a
minimalist version of the technicist paradigm.
According to Lazarus
(1981:2):
Minimum competency testing is an effort
to solve certain problems in education without first understanding what the
problems are. In medical terms,
minimum competency testing amounts to treating the symptom without paying much
attention to the underlying ailment.
Here the major symptom is a number of high school graduates who cannot
read, write, and figure well enough to function adequately in society. No one knows how many there are, though
they certainly constitute a small fraction of all high school graduates. The treatment for this symptom? Test all students in the basic skills
of reading, writing and arithmetic.
Some states go further; they make receipt of a high school diploma
conditional on the student's passing the test.
Whether such a diploma
sanction applies or not, minimum competency testing is precisely what the name
implies: a programme to test
students in terms of, and only in terms of, whatever competencies state or local
authorities have decided are minimally acceptable result of an education.
As Lazarus goes on to
point out, MCTs feed the test construction industry which in turn 'impede
nearly all attempts at educational reform' (p.9). This is because a considerable investment is placed into
the construction of tests and thus the investment has to be recovered through
sales. Once a test is in place, it
defines the curriculum. The
curriculum cannot be radically changed without changing the test and the test
is concerned only with outcomes, not processes.
By emphasising outcomes
rather than processes, schools and colleges become learning delivery systems,
where instruction, as Lazarus points out, is an analogue to manufacture (p.
13), aimed at a well defined market.
In 1977 Glass criticised the use of psychological and
statistical tools as lending a spurious rationality and precision to the
arbitrary criterion levels or standards chosen. Similarly,
Norris (1991) comments:
If the assessment of
competence presents difficulties of standards setting this is in part because
the relationship between standards and good practice or best practice is not at
all straight-forward. Like theories
standards are always going to be empirically under-determined. What is worrying is the extent to which
they are not empirically determined at all, but are rather the product of
conventional thought. Even if this
were not the case the pace of economic and social change suggest that standards
once set might quickly become obsolete.
Competency based
education (CBE) seemed to offer an alternative to MCTs.
1.4.5. Competency
Based Education (CBE)
Competence should not be
equated with behavioural definitions (f.
Grussing 1984)[9]. In practice, the relationship between a
test outcome and the real competencies involved in the cultural application of
a particular complex skill may be tenuous. Competence in everyday life can be defined in terms of a
vast range of changing contexts, needs and interests that defy any attempt to
formulate a minimum set.
Competency Based Education seeks to address the legitimate concern to
ensure that professionals are actually safe and competent to practice not by
focusing upon minimum standards but by seeking to ensure agreed objectives are
met. These agreed objectives may
be lent weight through drawing upon panels of expert opinion. However, such approaches do not
overcome central objections. On
the one hand, the drive towards consensus that the Delphi and Dacum approaches
are subject to, filters out the full range of alternative views. Secondly, there is no guarantee that
such approaches do not merely reinforce folklore and prejudice. Thirdly, as Benner (1982) points out it is to be doubted that the
appropriate testing technology can actually service the expanded requirement.
According to Fullerton
et al (1992) in America, norm-referencing
has been the basis for pass-fail examinations in midwifery but there has been
an increasing interest in criterion-referencing. They describe their own approach of constructing criterion-referenced
essay exams. Still, its main focus
is upon producing standardisation across markers rather than upon the nature of
competency itself and the relation between competency, the form of assessment,
and the process through which formative evaluations can be made in areas of
clinical practice. As such, it is
a sophisticated form of the technicist approach and one which does not meet
Benner's doubts.
Thus the inherent danger
of student assessment which follows CBE approaches is that it glosses over
central methodological questions to do with the definition of standards. It also glosses over issues concerning
what the student knows as distinct from how the student performs. Ticking off an objective achieved is
not equivalent to probing the extent to which the student knows and
understands. Such issues are
often glossed over because they are either considered too hard, or too
philosophical and thus impractical.
For example, Hepworth (1989)
indicates the existence of such problems but then sides steps them explicitly
in a parenthesis writing that 'it is difficult to see how' such a philosophical
discussion of the nature of knowledge 'could provide nurse educationalists with
the practical support which is needed now'. However, such a discussion engages directly the alternative
paradigms concerning what counts as knowledge of competence through which assessment can take
place. Choice of paradigm has
vital practical implications concerning what is or is not taken into account in
the assessment procedure.
The temptation is to slip towards a technicist view which seems to speak
directly to the control, surveillance and measurement of performance without
having to consider how performance relates to knowledge, understanding and the
development of professional judgement.
In short, the choice affects not only the way in which data is collected
about a student and upon which pass/fail assessments are made but also what
counts as data.
By not engaging in such
a discussion Hepworth and others while being aware of alternative methods and
their associated problems do not possess a sufficient framework for
development. The assessment of
students in many ways is an unsatisfactory game of how to fit the assessors
professional judgement of the student into the appropriate boxes. In this sense, the assessment
categories are interpreted in the light of background knowledge concerning
'competence' and concerning the student.
This background knowledge may be neither very deep nor made explicit.
The weaknesses of the
CBE approach were explored in a three-year project led by Benner (1982) which sought 'to develop follow-through
evaluation instruments for schools of nursing and hospitals' and to this end
'develop competency-based examinations that reflected the performance, demands,
resources, and constraints of actual nursing practice for new graduates.' It was found that:
These test-development
efforts, however, were hindered by the lack of adequate methods for identifying
competencies and the lack of adequate pre-existing definitions of competency in
nursing. Most efforts to identify
competencies in nursing, to date, have been based on expert opinion rather than
on observation, description, and analysis of actual nursing performance. Thus, identification of competencies
and evaluation of competency-based testing for nursing was undertaken.
In order to pursue the
project they undertook their own identification of competencies and consequent
construction of a method of assessment.
Competency based education, if it is to be of more than ritualistic use,
must attempt to predict successful performance in work roles post
graduation. However, competency must be distinguished from
other work-related qualities an individual may have. Is an attitude a competency? What is the relation between a skill and a competency? Is insight a competency? Rather than attempt to make a wide ranging
set of distinctions at this point, it is useful, at least, to refer to
Benners distinctions between a
basic skill, attainment and competence:
A basic skill is the
ability to follow and perform the steps necessary to accomplish a well-defined
task or goal under controlled or isolated circumstances. In attainment, the desired effects or
outcomes are also judged under controlled circumstances. Competency, however, is the ability to
perform the task with desirable outcomes under the varied circumstances of the
real world.
She provides the
following summary of frequently cited elements of competency-based curriculum
and testing:
(1) identification of competencies in
specified roles, based upon observation and analysis of actual performance in
real situations; (2) relating the identified competencies to specific outcomes;
(3) establishment of a criterion level for the competence; and (4) derivation
of an assessment strategy from the competency statement that is objective and
predictive of competent performance in actual performance situations.
This clear summary
statement is essentially programmatic.
To accomplish the programme is complex and difficult. Benner details six major
reasons for the difficulty. The
following is an interpretation of these:
1. There
is an absence of well defined behaviour domains in nursing. Nursing possesses
few identifiable outcomes since these are largely dependent upon situationally
specific interactions, and the limited nature of research and development
efforts.
2. There is the
confusion between competence as denoting actual success in a real setting with
objectives that seek to enable a student to improve a particular skill without
being placed into a real situation possessing a particular goal and context.[10]
3. All tests have
problems with predictive validity.
This is particularly so where the behavioural domain is not well defined
as in the case of problem solving and clinical judgement.
4. Skills relating
to the building of working relationships are not only the most important but
also the most difficult to test - e.g., empathy, ability to relate to others.[11] Assessment is only possible in
realistic situations.
5. The creation of
lists of behaviours listed in incremental steps associated with a task excludes
the inherent meanings of the whole performance comprised of a related set of
tasks. There is an absence of
guidelines concerning priorities or the relative importance of tasks.
6. The creation of
formal lists and sub-lists in task analysis at best may well be an infinite
process, at worst an impossible mission.[12] Indeed, it overlooks the way in which
specific situations demand a meaningful organisation of responses, not simply
the reiteration of procedures.
1.4.6. National
Vocational Qualifications (NVQs)
Burke and Jessup
(1990:194) provide a detailed account of
NVQs which take a broadly competency based approach. They diagrammatically represent the approach as follows:
NVQs, on this
model, seek to combine a wide
range of methods to construct an evidence base. At first sight it may seem to offer a step beyond the
quantitative paradigm in that it appears to employ forms of assessment not
easily reducible to measurable entities (essays, assignments, simulations,
reports) along side those that are (multiple choice questions, skills tests and
so on). While the evidence base so
constructed is richer than the other methods, it shares with them the basic
orientation of imposing a pre-determined, standardised structure upon
occupational practice. For
example, although performance evidence is constructed from 'natural observation
in the work place' it is already framed within pre-determined categories of
'Elements of competence with Performance criteria'. It is not a structure that is 'grown' from reflection upon
practice. It thus is subject to
similar criticisms as Benner lays against competency based education in
general.
1.4.7. SUMMARY
Technicist and
behaviourist approaches to the assessment of competence are predicated on the
notion that predictability of outcome is possible in human activity. They
assume situations sufficiently controllable to enable learning to be measured
in terms of pre-specified outcomes. It is, however, unrealistic to expect
contexts to remain stable (ie. unchanging) and equally unrealistic to believe
that the only outcomes of a specified action will be the intended ones. The
contexts of human interaction are, in any case, essentially ÔmessyÕ, requiring
judgement as much as knowledge and technical skill; judgement is not obviously
amenable to assessments which look only for what is directly observable, and
can be either measured or ÔtickedÕ as having been observed. Behind assessment
operated according to the quantitative paradigm, there is a desire for
accountability, but also for an easy way of identifying strengths and
weaknesses so that reinforcement can be given to maximise the chance of
achieving a desired outcome. There are three major problems with this paradigm
as a means of assessing competence in nursing and midwifery. Firstly it splits
the ÔexpertÕ theorist from the practitioner who becomes the person who applies theory that can be
assessed. Secondly, it places greater emphasis on the assessment of performance
criteria than it does on the assessment of knowledge. Thirdly, it fails to take
any account of the complexity and dynamism of human interaction and organisational
processes.
1.5. FINDING A
DIFFERENT APPROACH
1.5.1.Towards
Alternative Paradigms
The alternative paradigm
begins with actors as agents in their own definitions of and approaches to
competence and its assessment.
Appropriate structures with their mechanisms and procedures to produce
desired outcomes are developed by reflection upon work place practice. Such structures are continually
negotiated and redefined because work is both dynamic and situationally
specific.
Light is increasingly
being thrown upon these structures and processes by qualitative research which
has focussed in particular upon the unintended or hidden processes involved in
occupational socialisation and learning.
For example, Woods' (1979) studies of
pupils negotiating workloads with teachers, albeit in schools, is relevant in
alerting researchers to how students negotiate what they consider to be
appropriate workloads in classrooms and clinical settings and appropriate tasks
for assessment. Davies and
Atkinson (1991) have identified a number of
student midwife coping strategies.
The particular students were already qualified nurses who had the added
problem of coping with a return to student status. Such coping included 'doing the obs' (that is, observations)
which organised their time and allowed them to 'fit in'. It included avoiding certain staff, or
'keeping quiet'. In short,
students learnt to manage the kinds of impressions that they were giving to
their assessors and other key staff. These may be referred to as student competencies. Having spent many years in student
roles (whether in school or in college, or clinical situations) most are
experts or at least highly proficient in such roles. Some students are very sensitive to and readily pick
up on the cues that staff provide concerning what is or is not acceptable to
them. Others are cue-deaf.
Clinical practice for
students who have no prior clinical experiences is itself a phase of
socialisation into work practices.
Workplace cultures have their own idiosyncratic practices as well as
drawing upon wider, more general professional belief systems, formal and
informal codes of conduct (f. Melia 1987).
Students thus have to juggle not only their developing understandings of
workplace cultures but also the academic or educational definitions.
Such studies indicate
the complexity of the learning process within which assessment takes
place. There are quite distinct
kinds of competency, which include:
¥ competency as defined by
course and/or official statements
¥ competency as defined by
assessment documentation
¥ competency as defined by
occupational cultures
¥ student competency to
negotiate and manage impressions, workloads and expectations
¥ tutor/mentor/assessor
competency to impose/negotiate practice
These are not meant to
be exhaustive but rather illustrative of what may be involved in what seems at
first sight a simple act of assessment.
Alternative paradigms
attempt to engage with work practices and social and educational interactions
rather than impose upon them. The
focus is not on the aggregation of elements, but upon processes, relations, and
meanings, that is, upon selves in action.
Norris (1991) in addition to the
behavioural approaches described above identifies two further views or
constructs of competence: the generic and the cognitive. Generic competence 'favours the
elicitation through behavioural event or critical incident interviewing of
those general abilities associated with expert performers' Cognitive constructs have
reference to underlying mental structures through which activity is
organised. However, these
alternatives do not exhaust the possibilities. One could refer to theories where intuitive relationships
are formed through a combination of experience, intelligence and
imagination. One may ask to what
extent competence is some product of personality, linguistic habits of thought
and discourse repertoires.
Such alternatives attempt to grapple with the complexity of those
processes through which expertise is accomplished. They mark the difference between painting by numbers and
painting from life.
Benner (1982, 1983)
drawing on Dreyfus and Dreyfus (c.f. 1981)
provides one of the most sophisticated attempts in health education to
understand competence. It
falls within a cognitive approach.
She postulates five stages towards expertise: novice, advanced beginner,
competent, proficient, expert.
What is appropriate of the student nurse, and particularly of the
undergraduate as opposed to the Project 2000 diploma nurse or non-Project 2000
nurses?
The Benner model assumes
not simply a progression but a qualitative transformation in the way an
advanced beginner operates and a competent nurse operates, and then a further
qualitative transformation in the move towards proficiency. Benner (1983:3;) focusses her analyses of nursing upon actual practice
situations The differences:
can be attributed to the
know-how that is acquired through experience. The expert nurse perceives the situation as a
whole, uses past concrete situations as paradigms, and moves to the accurate
region of the problem without wasteful consideration of a large number of
irrelevant options (...). in
contrast, the competent or proficient nurse in a novel situation must rely on
conscious, deliberate, analytic problem solving of an elemental nature.
Such expert knowledge
while not amenable to exhaustive analysis can be 'captured by interpretive
descriptions of actual practice' (p.4).
The task is to make the 'know-how' public. There are six areas of such practical knowledge identified
by Benner:
(1) graded qualitative
distinctions[13]; (2) common meanings;
(3) assumptions, expectations, and sets; (4) paradigm cases and personal
knowledge; (5) maxims; and (6) unplanned practices. Each area can be studied using ethnographic and
interpretative strategies initially to identify and extend practical knowledge.
(p.4)
These areas are common
to most professional action. Such
action is not bound by exact mechanical procedures, rather it is framed by
judgement, and appropriate actions are dictated by the specifics of the
situation. Thus the interpretative
strategies employed by experts rather than the procedures become the main focus
of analysis. A procedure may be
competently, even skilfully executed but if it is not appropriate, it will
fail. The vital element is
judgement.
Benner reports studies
by Herbert and Stuart Dreyfus (1977) which
'demonstrated that only by dropping the rules can one become really proficient'
(p. 37). The example given is of
undergraduate pilots who had been taught a fixed visual sequence to scan their
instruments. The instructors while
issuing the rules were found not to follow them. Because they did not follow their own rules they were able
to find errors much more quickly.
Actual practice and official procedures may diverge radically. Indeed, in some circumstances following
the rules may be dangerous. If the
practice of expert practitioners in nursing and midwifery is under researched
as many suggest, then upon what is competency based assessment founded?
Ashworth and Morrison
(1991) in discussing the assessment of
competence sees it as 'a technically oriented way of thinking, often
inappropriate to the facilitation of the training of human beings'. It is inappropriate because:
assessing involves the
perception of evidence about performance by an assessor, and the arrival at a
decision concerning the level of performance of the person being assessed. Here there is enormous, unavoidable
scope for subjectivity especially when the competencies being assessed are
relatively intangible ones.
Moreover, the specification of assessment criteria in competence is
unlikely to affect the problem of subjectivity.
Does the approach by
Benner offer an alternative method of assessment? Rather than trying to exclude subjectivity, the approach
actively involves the subjective experiences of experts in trying to access and
build up a body of 'know-how' which can then form the basis for inducting
novices into expert practice. The
alternative paradigm offered here rests upon being able to access the expertise
of the expert. Ethnographic or
qualitative forms of research methodology are argued to be the appropriate
methods. While these methodologies
can provide a detailed data base of professional practice, they do not in
themselves provide either a method of teaching nor a curriculum, nor a method
of assessment.
Benner (1982) provided
illustrative examples of what would be the basis of such a curriculum and later
(1983) provided more detailed analyses of appropriate nursing
competencies. These point the way
towards an educative paradigm.
Benner (1983) employs a concept of
experience narrower than the commonsense use of the term but appropriate for
the development of expert knowledge.
For her, experience 'results when preconceived notions and expectations
are challenged, refined, or disconfirmed by the actual situation.' It is therefore, as she says, 'a
requisite for expertise'. This
formulation contains within it the basis for an educative approach in the development
of nursing knowledge. It is
important for a nurse to be able to read a situation and make this explicit:
The competent nurse in
most situations and the proficient nurse in novel a situation must rely on
conscious, deliberate, analytical problem solving, which is elemental, whereas
the expert reads the situation as a whole, and moves to the accurate region of
the problem without wasteful consideration of a large number of irrelevant
options. (p. 37)
Unfortunately, as
Meerabeau (1992) comments, the knowledge of
the expert is typically tacit and as such is a 'methodological headache'
because it is very difficult to make explicit. There are two implications. The first is for the development of nursing theory, where
knowledge is derived from practice;
the second is for nursing education. Although, these implications do not yet adequately take into
account sociological dimensions to the construction of competence as a social
phenomenon there are nevertheless important implications for assessment which
rest upon the nature of the evidence that must be collected and recorded in
order to ground judgements. If
increasing professionality depends upon the richness and variety of experience,
then assessment should be directed towards not only the student's performance
at safe levels of practice, but also the student's knowledge of situations as
evidenced through an ability to record, analyse and critique an appropriate
range of their own clinical experience and set this into relationship with the
clinical experience and practice of others. The task for the student is to make explicit personal and shared understandings
through which action takes place in given situations in ways that are open to
critique and are knowledgeably argued.
This method does not abstract procedures from situations but sets them
meaningfully into relationship with personal and shared experience. It is the role of knowledge and
evidence relating to performance and technical accomplishment that becomes
critical in an educative paradigm.
1.5.2. Towards the
Educative Paradigm
The educative
paradigm depends upon a structure
of dialogue through which competent action , knowledgeability and their
evaluation are educed (or drawn out) by students and staff reflecting together
upon evidence.
Evaluation/assessment under this paradigm seeks to inform the decision
making of all parties (student, assessor, teacher, ward staff, clients).[14] The approach does not exclude
quantitative and analytical approaches but employs them within a relationship
that focuses analytical and critical reflection upon performance in clinical
areas.
As discussed in the
previous section, the background interpretative strategies of the practitioner
are what distinguishes the novice from the competent and from the expert. Since the tacit knowledge of the
expert is not freely available to the student, a process is required which sets
students and staff into educational relationships. The educative paradigm bases teaching and assessment upon
identifying the repertoires of interpretational strategies available to the
practitioner. In practice this
means that the student and the staff adopt a standpoint of mutual education
which involve taking research and inquiry based strategies to make explicit the
assumptions, the values, the rationales for judgement, the case-lore built of
memories possessed by the expert.
The educative approach sets theory and practice into a different kind of
relationship to the traditional separation of the two. Theory building and practice become the
two sides of the same action.
Rather than a division
between academic and professional competence as implied by crude distinctions
between theory and practice, it could be argued that to be a professional
requires students to have the special competence to inform practice through academic
reflection. This is the
perspective of the reflective practitioner (Stenhouse 1975, Dreyfus 1981, Schon
1983, 1987, Elliott 1991, Benner 1982,1984)
where theoretical knowledge, far from being developed independently of
practice, is grounded in the experiences of practitioners who test theory
through practice and broaden their practical frame of reference through
principled application of that theory.
Such an approach is founded upon a notion of the mutuality of theory
and practice which entails the
modification of theory through practice and the modification of practice
through theory. It is an approach which demands an appreciation of professional
identity which places research at the heart of professional judgement and
action. To come to any worthwhile conclusions about the achievability of
excellence in both academic standards and professional competence, an
evaluation must be able to examine the nature and quality of judgements, and
gain access to students' reflections in both the clinical and the classroom
environment.
Eisner (1993) in his reconceptualisation of assessment in
schools and colleges proposed, in summary form, the following criteria for
practice:
¥ The tasks used to assess what
students know and can do need to reflect the tasks they will encounter in the
world outside schools, not merely those limited to the schools themselves
¥ The tasks used to assess
students should reveal how students go about solving a problem, not the
solutions they formulate
¥ Assessment tasks should
reflect the values of the intellectual community from which the tasks are
derived
¥ Assessment tasks need not be
limited to solo performance
¥ New assessment tasks should
make possible more than one acceptable solution to a problem and more than one
acceptable answer to a question
¥ Assessment tasks should have
curricular relevance, but not be limited to the curriculum as taught
¥ Assessment tasks should
require students to display a sensitivity to configurations or wholes, not
simply to discrete elements
¥ Assessment tasks should
permit the student to select a form of representation he or she chooses to use
to display what has been learned
These criteria may
provide a point of departure to construct principles of educative assessment
for the professions. Although it
is not the object of this report to complete such a task, in the succeeding
chapters further insights will be explored that may contribute to such an
endeavour (see in particular chapters 8, 9, 10).
1.6. THE EDUCATIVE
PARADIGM: A SUMMARY
There is a commonly held
but spurious distinction between theoretical and practical knowledge. It is a distinction reinforced - albeit
unintentionally - by assessment methodologies employing quantitative discourses
which adopt behaviourist and/or technicist strategies. Theory and knowledge become two
sides of the same coin in approaches which see knowledge and theory production
as being generated through action, and reflection upon the effects of action.
It has been argued that
the latter approach more closely fits the needs of contemporary demands being
made upon assessment. Assessment
is increasingly being seen as having multiple purposes that are integral to the
educational process and not additional to it.
Brown (1990) in connection with assessment in schools, sees
five emergent themes:
¥ a broader
conception of assessment which fulfils multiple purposes
¥ an increase in
the range of qualities assessed and the contexts in which assessment takes place
¥ a rise in
descriptive assessment
¥ the devolution
of responsibilities for assessment
¥ the
availability of certification to a much greater proportion of young people
The first four of these
are clearly relevant to nursing and midwifery assessment, and to them may be
added:
¥ the assessment
of professional judgement
¥ the assessment
of professional action and problem solving
¥ the assessment
of team participation
¥ issues of
professional and cross professional dialogue and communication
¥ issues in the
generation of learning environments
There are here issues
both of cross disciplinarity and of what counts as knowledge. In particular, assessment must address
itself to the question of what constitutes the domain of professional
knowledge. Assessment thus becomes
integral to the whole question of the development of a professional mandate.
CHAPTER TWO
ABSTRACT
Texts (i.e. written statutory
guidelines, approved institution documentation, etc: and spoken advice) about
competence and its assessment are interpreted in relation to
situationally-specific, Ôreal-lifeÕ nursing and midwifery events. As they work
in their particular clinical location, individuals strive to understand
official regulations in relation to their career-long personal experience. Institutions
are made up of such individuals and consequently organisations themselves are
dynamically evolving Ôlearning institutionsÕ. They are places where the meaning
of competence is continually being developed and better understood, and where
strategies for implementing devolved continuous assessment are changing in
response to that new understanding. Institutions which have (at best) a
well-established culture of reflective practice or (at least) an embryonic one
are in a strong position to support the introduction of the new
responsibilities and roles necessary for this implementation; responsibilities
and roles which incorporate
reflective practice at their very heart. Where the culture is less
established, the guidelines and regulations are experienced as impositions and
resistance occurs. Individuals are less able to adjust their concepts of
competence, construing knowledge, for instance, as a sort of tool kit of
information containing separate items which are useful in themselves but are
rarely used as a set because the job for which they are to be used is not yet
clearly identified. It is only through the experience of working with concepts
of competence and addressing the issue of what counts for assessment purposes,
that coherence is achieved. In the course of work people ÔtestÕ the concepts
that frame the statutory texts, through their practice itself and the accounts
they share. Concepts of competence are, then, defined from a multi-dimensional
perspective and developed through individual reflective practice within a
reflexive institutional culture. While competence is assessed by strategies
that are adapted in operation to accord with the historically embedded
perceptions of the purpose of assessment that are peculiar to the particular
institution. The national strategy for devolved continuous assessment must,
therefore, take account of the variety and range of perceptions and
institutional cultures. It must encourage the development of structures for
principled movement towards a form of assessment that takes account of the
global needs of the profession and the local needs of individual institutions.
THE ASSESSMENT OF
COMPETENCE: THE ISSUES DEFINED IN PRACTICE
2.1. COMPETENCE
Introduction
This chapter explores
the issues identified by staff and students in their reflections upon and
experiences of the assessment of competence. It is divided into two broad sections. The first section
draws upon the ways in which practitioners and students define competence in
practice. The second draws upon
staff and student experiences of assessment practices as they relate to the
traditional forms of assessment and the new demands on them made by devolved
continuous assessment.
For some of the
students, practitioners and educators involved in the study, it was obvious
that they had previously given much thought to the concept of competence and
how it should be assessed, but even then had only reached provisional
understandings. For many, articulating their thoughts on competence and its
assessment was a difficult activity.
Their discussions during interview appeared to be first attempts at
exploring tacit and unarticulated beliefs. What is described in this chapter,
therefore, is the range of developing understandings of competence that people
work with on a daily basis. They are separated for convenience in creating a
description, but because they are in a state of becoming, they flow
into each other in practice.
2.2. HOW PEOPLE
DEFINE COMPETENCE IN PRACTICE
2.2.1 Developing
Conceptual Maps in Practice
It is important to
distinguish between definitions of competence and assessment within academic
debates and official texts, and understandings and beliefs concerning
competence that arise during the course of practice. The discussions in chapter one provided conceptual maps
which arise within different academic or scientific paradigms. In practical
day-to-day affairs, understandings concerning competence and its assessment may
arise in many different ways. They
may be held tacitly, they may be adopted uncritically, they may be part of a
strong value or belief system regarding traditional or radical images of how
professionals ought to behave. In short, each individual has their own
conceptual map of what counts as competence, the competent practitioner, and
assessment. These idiosyncratic maps may be informed by academic and official
discourses, or unreflectingly adopted through a process of occupational
socialisation. The focus in this chapter is on the range of 'maps' that people
actually draw upon in their judgements about, and interpretations of, competent
practice and student performance.
It is not just a matter
of there being different definitions of competence. Each definition is the result of a different kind of
discourse, that is, a different way of talking about experience and of
providing rationales for action.
Paraphrasing Kuhn (1970) adopting one conceptual map as distinct from
another involves perceiving the world differently. Different maps define the boundaries between one entity and
another differently. Rather like the gestalt figure which can be seen either as
a duck or a rabbit, the same material entity (the lines on the page) can be
perceptually organised in quite different ways and result in mutually exclusive
judgements: to one person it is a duck, to another person it is a rabbit, to a
third it is a perceptual illusion or trick! Similarly, one person's conceptual map of professional
practice may yield quite different judgements about what procedures should
apply in a given situation to the judgements of an individual whose perceptual
map is organised in a quite different way. In changing the conceptual structures that define competence
or professionality, the mechanisms and procedures which guide actions also
change. Thus for example, the
perceptions, mechanisms and structures underpinning a ward based practical test
used to assess the Rule 18 nursing competencies are not appropriate for the continuous assessment of the
broader Rule 18a nursing competencies for Project 2000. In general, the events that are
considered significant and valuable under one conceptual map may not be so
under another; indeed, an event recognised as having existence under one
conceptual scheme may not be considered 'real' under another. It thus matters very much how people
come to define competence. This in
turn has consequences for the development of professional practice and a body
of knowledge.
2.3. UNIDIMENSIONAL
APPROACHES TO DEFINING COMPETENCE
2.3.1 Statutory
Definitions of Competence
Statutory competencies
for nursing and midwifery (Rules 18 and 33 respectively) have been in place
since 1983 with the introduction of the Nurses, Midwives and Health Visitors
Act.[15] These statutory
requirements guide individuals as they attempt to come to an understanding of
the concept of competence:
Well, we have a
criteria as a midwife, we've got a set of rules, a code of conduct...rules that
we have to follow and your practice has to be safe otherwise you wouldn't be
following those rules so that's how I judge my competency....this is what
you...have to be able to do to be
a midwife.
(midwife)
As this midwife makes
clear, statutory guidelines constrain the way in which a conceptual map can be
drawn up; they can also broaden them, however. If we take nursing as an
example, we can see how Rule 18a has constructed competence as a broader set of
things to be achieved than Rule 18. [16] For instance, under
Rule 18 students must:
b) recognise situations
that may be detrimental to the health and well being of theindividual
However for students to
fulfil this particular focus of competence under Rule 18a, their understanding
of factors detrimental to health requires greater scope and detail. They must
demonstrate the following:
a) the identification of
the social and health implications of pregnancy and child bearing, physical and
mental handicap, disease, disability or ageing for the individual, her or his
friends, family and community
b) the recognition of
common factors which contribute to, and those which adversely affect physical,
mental and social well being of patients and clients, and take appropriate
action
d) the appreciation of
the influence of social, political and cultural factors in relation to health
care
These revised statutory
competencies for Project 2000 courses incorporate new educational aims, placing
greater emphasis on professionality. Nurses and midwives are expected to
demonstrate competence through:
c) the use of relevant
literature and research to inform the practice of nursing
e) an understanding of
the requirements of legislation relevant to the practice of nursing
Statutory definitions of
competence provide a way of criterion-referencing assessment and thus ensuring
that standards are met. At the same time they offer the individual a set of
criteria for formulating their own version of the essential conceptual map.
2.3.2 The Tautology
of Statutory Definitions of Competence
Where assessment
criteria are constructed narrowly in terms of statutory definitions of competence
this can lead to a tautology. Used in this way they can shape the concept of
competence in terms of the minimum standard necessary to meet the assessment
requirements. Fulfilling the assessment criteria for the course defines
competence; anything not defined in the assessment criteria is Ôworth-lessÕ as
far as this particular aim is concerned.
Just as IQ has been defined as what IQ tests measure, so competence can
be defined as what assessment procedures measure:
We're competent as a
qualified nurse because we've satisfied the system that requires us to
demonstrate it. We've passed the assessments etc so therefore we are competent.
That's one definition. (education manager)
This points to two very
real assessment issues. How much of assessment is about bureaucracy rather than
judgement or education? How do personal understandings about competence 'fit'
with those defined through assessment documentation? The issue of competence as
a minimum standard is a live one for curriculum planners and practitioners
alike.
2.3.3 Statutory
Competencies- a Minimum Standard?
Whilst some interviewees
identified the statutory competencies within their own 'maps' of competence,
others expressed worries about statutory definitions being perceived by others
as 'minimum' standards, where no reflection and development occurred once the
'basics' had been achieved:
...they're a good springboard for further development, but I would
challenge anyone who sees them as the be all and end all. Or who always points to the
competencies and says as long as a nurse can do that she is therefore a nurse. (educator)
...if it's a
statutory requirement then it can not be ignored (...) a course has got to be
approved. I think there is a danger that they become the bench mark, and I've
got no evidence to support that, this is a personal opinion, I just speculate
that it could be a danger, that curriculum development group would say that's
what we've got to achieve. (...)I would see it as a minimum gateway that you
get through some time during the course, but there's far more to be achieved
than that, bearing in mind levels and that we're only looking for a diploma
level etc, etc. I'm not advocating that we build in the course any more than
that, but I still think there's a great difference between the statutory
minimum requirements and what can be achieved even within the diploma level
course. And I guess if you went around the country and looked at all the
different courses that they all probably fall at different points within that.
I'm sure there are...I know there are some on the statutory minimum in a sense
and that they just achieve the minimum requirement and that's it, but I know
there are others that I'm sure are much more innovative than that.
If statutory definitions
can be regarded as a 'minimum' to be attained or as a 'springboard' for
development, there is a danger that teaching and learning may be addressed to
the minimum rather than to developmental opportunities.
2.3.4 Competence as a
Cluster of Components
Interviewees talked
about competence in terms of it being broken down into 'components' which are
considered to contribute towards the whole. These components clustered into
categories, examples of which are outlined below:
¥
possessing a wide range of skills:
×practical/technical
skills
×communication
skills
×interpersonal
skills
×organisational
skills
¥
safe practice
¥
knowledge base which is up to date
¥
critical thinking
¥
functions as a member of a team
¥
professional attitude
¥
motivation and enthusiasm
¥
confidence
This list is not
exhaustive, but illustrates the range and kinds of components interviewees
described. Each of these components may be further broken down into
sub-components in what may well become an indefinitely extendible series of
'bits', as in a broadly behavioural approach (c.f. Medley 1984, Evans 1987 and
the MSC) [17]. However, upon closer inspection many of
the 'components' referred to by interviewees seem to resist exact
definition. This is demonstrated
in the examples of the
'components' in the following figure.
..professionals first
and
foremost...
...you've got to keep
yourself
aware
of changes in
current
thinking... ...tremendous self
awareness...
...good practical skills... ...safe...who
admits when they
don't know something...and goes to the right place and finds out who to
ask...
...enthusiastic
and eager to learn,
wanting to develop new skills...
...an adequate knowledge base...
personality
counts for a lot...
...someone who's
organised and can think
things through
logically...doesn't rush things, ..the
ability to provide a high
just stands and thinks for a
while standard
of care...not only meeting the
or
can organise themselves... mother's physical need but also her psychological
needs as well...
...communication
skills...
...it's being a
patients advocate...
...motivation...and to be able to take
...thinking; if
you want just an interest in ward
activities.
want
one word it's about That's very important....
thinking...
Figure: Components of
Competence (Part i)
..able
to show empathy with relatives
or carers...
...you can be competent at knowing
what to do, competent at
knowing how to do it...but
it's really knowing
why you're doing it...
...using
your resources suitably...
...good
with staff and able to help, see that
somebody's drowning under a lot
of work (...)
to
go in and help and guide them through, support
...a
supporter...
Figure: Components of
Competence (Part ii)
It is possible to
itemise what constitutes 'good practical skills' for an individual. It is even
possible to regard keeping up to date with changes in 'current thinking' or
having 'an adequate knowledge base' as observable and measurable elements. It
is more difficult to define 'tremendous self awareness' , or Ôregarding oneself
as a professional 'first and foremost', or 'thinking for a while' in the same
way. These latter point towards a more holistic conception that implies
processes of interpretation and judgement. All the so-called components could be reinterpreted as
features of a multi-dimensional holistic map, not reducible to bits but integral to the work process as it
reveals itself in concrete practice.
Nevertheless, a focus upon particular skills and qualities as
discernible 'bits' or 'elements' required for good practice, is a common way of
talking about practice whether or not that practice can actually be itemised
and quantified.
2.4. MULTIDIMENSIONAL
APPROACHES TO DEFINING COMPETENCE
2.4.1 The Factors
which Contribute to Multi-dimensionality
There are, then, several
factors which lead to development and reconceptualisation of competence. One is
the changing professional mandate.
In nursing, the amended competencies for Project 2000 were described by
one educator as:
...a new form of
competence. That it's not the skills based competence that we had before, it's
much more open, learning, flexible, outcomes type of thing.
There are concomitant
changes in the educational process too:
I think I'm taught
about what a competent nurse is, is somebody who can maintain the safety of the patients on the ward. But I think there's more to the
competencies, I don't think a lot's put down on communication skills which is
really what nursing, a lot of it's really about, it's being a patient's
advocate, and you can't be a patient's advocate unless you've got really good
communication skills. (student)
In addition, there is
change motivated by a changing world Ôout thereÕ to be taken into account:
...there are clinical
skills which I think a nurse needs to learn in order to survive in an ever
changing world. If you look at technology
and things like that, so the whole issue about the nurses role needs constant refining, i.e. can
nurses give IV drugs? (educator)
Multi-dimensionality is
also encouraged by working practices which continue to change roles. As one
midwife, in making a comparison with the 'extended role of the nurse', says:
...they're going on
about the extended role of the nurse, I just fall about because our midwives,
it's not an extended role, it is their role; for instance they perform episiotomies...they also suture their
cuts...they can also give life saving drugs without having to wait for medical
staff to get there.
Neither the behavioural
nor the legislative conceptualisations of competence address these kinds of
issues:
I mean generally
people I think in nurse education aren't happy with competency based
training. We think it concentrates
on performance, skills, the technician... and doesn't take sufficient account
of the development of the individual. The cognitive, the intellectual, the
reflective practitioner. And certainly this is a worry since one of the major
things about Project 2000 (...) at Diploma level, is that it strives to develop
cognitive and intellectual skills which enable the person to be reflective, a
critical change agent at the point of
practice, but also someone who can resource their own learning, their
own continuing education and direct that and influence all of
those things as an equal partner with all sorts of other professions. And I'm
not sure that the competencies necessarily reflect that side of the
professional role...either of them (pause) 18a
is certainly better but I think the very fact that they are still cold
competencies, which has a very clear manual task related definition.
2.4.2 Working
Relationships and the Dynamics of Work
In the multidimensional
approach, competence is defined by describing the features of the totality of
the concept as it is expressed within the context of work. It is not an easy task to convey the
variety of highly individual understandings in a way which makes sense of the
diversity without over-simplification.[18] IntervieweesÕ
reflections on competence appeared frequently to be exploratory in character,
often revealing inconclusivity and difficulty in articulating the indefinables
without resort to concrete instances or events. The following interview gives a sense of this:
It's very hard isn't
it? Because each individual's probably, you know, different. I think (pause) a
competent nurse...(pause) someone who can work in a team, work with other
disciplines, I think someone who is aware of current research, doesn't sort of
stay stagnant, is always trying to update her knowledge...a person who's
approachable, a person who has genuine regard for her patients...maybe has
experience of life as well. Erm, can identify maybe mood changes and take into
consideration why this happens. A
patient maybe has just been given bad news...so can adapt her approach (pause)
you don't want a nurse coming in bouncing if her patient has just been told
they've got inoperable carcinoma. So you've got to have counselling skills,
listening skills. Erm and to have a good rapport with patients, you know for
the patient to feel that they are able to come to the nurse, even just to sit
in silence and for the nurse to be there and just offer support, to sort of
show empathy with her patients. (staff
nurse)
At its broadest,
competence includes 'life experience'. Most importantly, there is the sense of
competence being based in work, and in particular, being based in a working
relationship. The features of working relationships are that they are
situationally specific and skills required in the situation are shaped or
tailored according to specific needs and circumstances.[19] In the conveyor belt
technology of car production it is possible to standardise patterns of work and
procedures so exactly that a robot can be programmed to perform them. What characterises nursing and midwifery
is the opposite. Work situations
are dynamic, conditions change, no two situations are identical. Programmed responses of the robotic
kind are not merely impossible but undesirable. These concerns are again echoed in the following extract
from a student:
It's a hard
question. One aspect of it is
actually having a good grasp of the kind of nuts and bolts of the job, like
when it comes to psychiatric nursing...you should as a competent nurse know the
relevance of the sections of the Mental Health Act thoroughly so you're not
fumbling around when the situation comes up....and similarly when it comes to
carrying out procedures like intramuscular injections dressings and so on....I
think when you're at least familiar you're far more competent in things like
that and I feel more confident and
then I think that sort of flows over you into sort of the other areas. (pause)
I find it difficult to put into words, but part of it is a sort of sensitivity
to other people because it's very much about personal relationships and
building relationships and a rapport with people who you know are in various
kinds of mental distress...So to me that's quite an important part of being
competent. I mean there's so much involved in that, it's not always what you do
it's what you don't do...knowing when to actually say something to somebody,
when to get into deep conversation, when to play it cool and when to stop a
conversation. (student)
It could be argued that
this interviewee while pointing to contextual matters also points to particular
'elements' that are necessary to professional competence. For example, having a
grasp of the 'nuts and bolts' seems to imply a kind of tool kit knowledge of
the job. Knowing relevant sections of the Mental Health Act is a case in
point. This kind of knowledge is
not just Ôa bit of knowledge to be added to other bits of knowledgeÕ, however. The Act is itself a complex text that
has to be interpreted in relation to situationally specific events. There are two kinds of reading here: a
reading of the text, and a reading of the real life situation. This double reading then leads to a
decision that certain procedures are required. In attempting to explain how this is done the interviewees
give the sense of trying to hold onto the image of a very large picture, while
trying to bring into focus each of its details.
In each case, however,
there is a structural coherence to this picture. It is a coherence that is provided by the experience of
work. Experiences of work provide
the materials for accounts and reflections which can be shared with
others. Asking what the
relationship is between one account of work and a developing body of
professional knowledge is rather like asking what the relationship is between
the particular and the general.
Competence involves acts of generalisation which at one level draw upon
the common features of a wide range of experiences and on another level relates
those generalisations to other bodies of knowledge or conceptual maps [20]. These acts of generalisation allow the
professional to make decisions with respect to the immediate case at hand. Without such acts of generalisation
there would be no guidelines for decision making.
In the previous two
extracts, both staff nurse and student try to make some generalisations but are
well aware of the situational specificity of competence. The student suggests that a procedure
that is appropriate to one context, or with one patient is not necessarily
appropriate to another apparently similar situation. Her remarks seem to indicate that competence involves the
ability to build up a repertoire of experiences and situations that bear some
similarity to each other but at the same time reveal significant differences. [21] To be able to work in a
given situation requires an extraordinary sensitivity to its specifics, such as
responsiveness to intangibles like mood changes. It is a background knowledge of the effect of context on
application that makes the vital difference. The subtlety required in being able to discern which
approaches and decision making are required for actions in individual contexts
is considerable. This in itself
has major implications for
learning and professional development, in particular it means that a sharing of
personal experience and group reflection on cases is vital to building up an
internalised body of case histories relevant to decision making.
2.5. COMPETENCE AS
REFLEXIVE KNOWLEDGE EXPRESSED IN WORK
2.5.1 Competence and
Professional Practice
The attitude of working
to satisfy minimum criteria, from an ethical point of view, cannot be regarded
as professional. Mechanisms can be
set in place to enable development beyond the acceptable minima. Professional action is effective action. Effectiveness does not work toward, nor
is it satisfied with, minimal criteria.
Rather it works according to criteria of continual improvement in
professional action. In this view, competence is always developmental in
orientation, never looking back to the minimal criteria but always looking
forward to better performance, improved decision making and greater quality of
outcome. This view of competence
firmly centres it in 'work' and work relationships. At its broadest work can be defined as the process of
manipulating and transforming physical and social environments for human
purposes (Sayer 1993[22]). Work as the dominant
means for people to structure their lives, find self value, form a sense of
identity and engage in relationships with others is fundamental not only to
self development but also to cultural and professional development (Lane 1991[23]). Competence, then, and the forms of
knowledge and knowing and acting that underpin it, can be defined as
expressions of work.
2.5.2 Competence and
the Development of a Reflexive Body of Knowledge
Self and peer review are
procedures that contribute to the development of a reflexive body of
professional knowledge, grounded in shared experience. They are procedures that
facilitate the internalisation of processes of professional judgement and
evaluation. The importance of
individual understandings of competence is emphasised as these frequently form
the basis of self and peer review.
Some interviewees focused upon these activities as professional competencies
in their own right. They talked
about nurses and midwives developing their own standards, and being ready to
assess themselves. They saw the development of competence as an on-going
process which takes place in a relationship of mutual support and critique with
colleagues.
You have to be self
judging as well, as well as your peers judging you I suppose...so if you feel
you're achieving those competencies yourself, then you're in (a) position to
judge someone else I suppose. (midwife)
Such imprecision may
disappoint those who want to measure clearly defined signs of competence. Yet, what is being judged is
imprecisely defined because it is not a single entity but rather a complex of
concepts, perceptions, feelings, values that constitute an orientation, a focus
and a rationale for acting:
I feel a lot of the
time nurses loose sight of the prime reason that they are there, and that is
the patient. Because it's so easy
to do because there's so much else going on. And a professional person is able
to constantly pull themselves and say, "Now hang on, what am I doing? Where am I going? It's not good enough just to measure
myself against the competencies and say, "Oh well I come up to that
standard."
In this case then, a
defined set of competencies is inadequate to generate the sense of competence
that is being described here. A
rationale is not a set of competencies but is generative of the criteria and reasons
that distinguish between competent and incompetent action. Such a view requires a sense of
continuous assessment of action, indeed a sense of mutual assessment:
...I mean I think we
all assess ourselves and our work colleagues continuously, all the time anyway.
I mean I'm sure as a team leader, the team leader will look at her staff... if
she's got a very poorly patient and know who to shout for if there's an emergency. And that way she's assessing her staff
isn't she, as she goes on...you assess people by how they go about their work, how
organised they are, are they tidy?...Are their patients happy?...Are they
lifting patients that are in pain without analgesia and that sort of thing. (student nurse)
The view of assessment
as supportive critique is an important one which requires further exploration.
It is necessary to discover, for instance, the extent to which that kind of
critique is possible given the pragmatic (eg time) and cultural (eg busy-ness)
constraints in nursing and midwifery environments, and also the extent that
these constraints affect everyday competence. [24]
Some interviewees
suggested that the competence of the qualified practitioner becomes such that
individual competencies are no longer distinguishable, having become features
of performance in general. They pointed out that these features are so embedded
in the practitioner's daily activity that it was often difficult, if not
impossible, to articulate them as specific competencies, as in Benner's (1984)
work:
...some of the skills
come with experiences of life and I think intuitiveness. I could work with a
student and I could say, 'What do you see in this patient?' and the student
could say, 'Well she looks fine.' Now intuitively I might say, 'Well I don't
think she is' and I can't explain why I think that. It's come with
experience...so that I don't think can be taught. That is something that has to
be acquired throughout as they go on. (staff nurse)
The concept of
competence as an expression of work seems inextricably linked also with a
concept of continual development.
2.5.3 Competence and
Professional Development
As understandings of
competence and expectations of role develop, notions of appropriate outcomes of
courses need also to change. A
newly registered practitioner may be able to take on certain kinds of work expectations
but may not be considered fully competent in their new role until they have
begun to consolidate their course-based knowledge in relation to an extended
period of work. As one educator commented:
...I have got
feelings that we are expecting maybe too much to say that at the end of training
the student is a competent practitioner.
And you would say that perhaps a student becomes a competent
practitioner when they have had sufficient time, and that's got to be
individual, to consolidate their overall training in a specific area which they
choose to work.
Even given time for
development, however, there is not necessarily a linear progression in
competence from level to level. Development is often not orderly and its pace
is certainly not open to external regulation. Seen from a developmental
perspective competence can be conceived in terms of individual readiness for
transition to competent practitioner status. This means, as the nurse quoted below suggests,
that there is no externally pre-specifiable point at which it is possible to
say for each and every individual that competence has been fully accomplished
with respect to every aspect of nursing or midwifery.
And I don't think
that in three years of training a nurse has even approached perfecting those
sorts of skill, (interpersonal and communication skills)if she ever perfects them,
but she certainly hasn't even begun...So things like the skills you need to be
self aware and to have good interpersonal relationship skills takes years and
years, if I look at myself (...) to build up, to define and refine.
It also means that the
maintenance or development of competence is not guaranteed, and that competence
is on a continuum along which, in common with all other continuums, it is
possible to move backwards as well as forward.:
I think it's
transient. I think it (pause) you glide in and out of competence and I don't
think you have it for ever and a day erm and yet our notion of it really is
that when you're competent that's it and you always are forever more, so it
needs nurturing.
If this is the case for
registered nurses and midwives, then it is certainly true for students, whose
development is taking place within a time-limited Project 2000 programme, and
whose learning still remains to be consolidated by extensive experience. Work
situations are dynamic, and the situationally specific events of everyday
experience are not precisely controllable. The experience of being competent to handle such situations
is thus likely to fluctuate according to the sense of being in control, knowing
what to do next and handling the unexpected. Thus:
It's not an all or
nothing state is it? They (students) are partially competent and I think most
practitioners are only partly competent ...
In this view, then,
competence is not a steady state; it is a fragile achievement and never a total
accomplishment.
I mean to be
competent as a nurse do you have to be competent in everything? Because
I'm not competent then... Because
applying it to my own situation there are a range of skills that I have to
bring to my job. There are some I do well I think, there are some I can handle
reasonably well, and there are some I'm quite poor at. What I tend to do is
delegate the poor ones, avoid them myself. So am I competent or not? I'm
competent in the areas in which I practice, but because I avoid the areas where
I might not be, does that keep me competent?
But while the
professional development view defines competence as something which continues
to evolve over time in fits and starts rather than by linear progression, it
nevertheless recognises a sense of purposeful direction, a sense of striving to
improve action in professional work.
2.6. COMPETENCE: A
SUMMARY
The concept of
competence resists easy categorisation. There are many different aspects of
this wide-ranging and complex concept which have to be taken into account when
designing strategies for itÕs assessment. Professional perceptions indicate
clearly that there is more to competence than simply what can be easily
observed and measured. From the developmental perspective, statutory
competencies may be considered as merely an initial framework, or starting
point for professional development.
Competence continues to develop and grow as the individual begins to
construct a more detailed picture of the general requirements of nursing or
midwifery by building up a repertoire of situation-specific experiences.
Competence is, therefore, a concept which is worked out and continually
reformulated through work itself. Assessment needs to take account of all
these complexities.
2.7. ASSESSMENT
Introduction
Devolved continuous
assessment was introduced into nursing and midwifery education as a response to
the need to assess a wider range of educational purposes and a developing
concept of competence. Long-established cultural practices are not changed
overnight, however, and the move towards devolution has been marked by a degree
of culture clash. Where there is transition there is also variety, as new forms
of assessment are introduced to run, for the time being, alongside more
traditional forms. Consequently, the experience of non-continuous, four-ward
based assessment has continued to affect the perceptions of assessment for some
time after the introduction of the more educative approach. Twin-track
assessment (i.e. different forms of assessment running in parallel within the
same institution) offers both a cultural challenge to the institution, and a
potential psychological challenge to the individuals in it. The inevitable
pragmatic and conceptual confusions become part of the discourse about what
constitutes satisfactory assessment practice. Like competence, therefore,
assessment itself is worked out, or constructed, in the process of doing it.
The net result is that both the quality of nursing and midwifery being assessed
and the instrument for assessing it are defined from multiple perspectives. To
discover how far devolved continuous assessment is effective in assessing
competence, it is necessary to identify not only the range of views of
competence that make up that unstable concept, but also the range of
experiences of assessment that have created the culture in which assessment is
to take place.
2.8.
TRADITIONAL FORMS OF ASSESSMENT
2.8.1 Centralised
Periodic Assessment
In 1971, the assessment
of nursing practice through classroom based simulations was replaced by a series of four practical tests conducted in clinical
settings[25]; a maximum of three
attempts at each test was permitted.
During placement experiences, the practical tests were supplemented with
King's Fund type ward reports, completed by clinical staff. Assessment of theory took the
form of a final determining exam, for which students could make three
attempts. Assessment for midwifery
students consisted of a final qualifying examination, with written and oral components.
The overall assessment
systems were the subject of much criticism, which was recognised at all levels
in the profession (Gallagher 1985; Aggleton et al 1987; Bradley 1987; ENB 1984,
p1; ENB 1986, p 1; Lankshear 1990) and stimulated ongoing debate about more
preferable alternatives. As a
consequence of the criticism and debate, continuous assessment was debated on
the assessment agenda for a number of years. A small number of pilot schemes were operated by the ENB
from the 1970's onward; however such developments were not widespread (Spencer
1985) until the national implementation of
continuous assessment.
2.8.2 Practical
Assessment
Although many
practitioners still cling to some of the ideals of traditional assessment with
the consequence that the nursing and midwifery culture in specific locations
within particular institutions has been slow to change, most when interviewed
were clear about its shortcomings. The apparent contradiction in this serves
only to illustrate the power of habituated practice to continue to frame
corporate action in the face of contrary innovative practice constructed around
essentially unstable (in the sense of developing) concepts. The information
people offer about their dissatisfaction with piecemeal, periodic forms of
assessment is interesting, therefore, from two points of view. Firstly, it
confirms the general sense that nurses and midwives are, in principle,
committed to continuous assessment as a ÔfairerÕ means of gauging student
competence. Secondly, it provides evidence of the fact that people can be aware
of shortcomings and yet still continue to work for some time without complaint
within a culture in which flawed practices persist.
1. One-off
practical tests
Interviewees
acknowledged that this approach was inadequate for the assessment of practical
competence. They comment about
performance situations which:
¥lacked reality
Interviewees made it
clear that assessment focusing on the ability to perform satisfactorily on
one-off occasion within an essentially 'false' situation did not reflect the
realities of everyday practice. Staff and students spoke of how a great deal of
rehearsal occurred prior to the assessment. Typical of comments that suggested
this performance element were the following:
I don't always feel
it's fair to the student really, because it's not real and when they qualify
and they get out there it's so different... And I can remember thinking it,
"But on my management it wasn't like this!" Everything went so
smoothly.'
(staff nurse)
You tend to do
probably extra things that you wouldn't normally do. (student)
..making sure the
trolley's perfectly clean and that you've got everything on the bottom, where
probably on a normal drug round...day to day you'd just look quickly then rush
off with the trolley. (student)
¥were stressful
Unsurprisingly, many
students expressed anxiety prior to and during assessment events. As one student commented wryly:
I suppose it assesses
how to cope with stress...you're nerves are just shot to pieces. I'm not a
particularly nervous person or highly strung...I'd hate to find someone who
gets quite intimidated by it all..it really is horrible.
¥assessed limited
application of principles to different contexts
Many students were
concerned that the focus on one-off performances provided little opportunity to
show what they knew about the principles of nursing or midwifery in a variety
of settings:
...like aseptic
assessments, you can have an assessment on a dressing and can not have gone
near a suture line or clips or anything and suddenly you're competent enough to
go off with your trolley and take out clips and sutures and God knows what else
on the ward.
Others were concerned
that success in a one-off situation did not guarantee transfer of competence to
a variety of contexts:
...It doesn't
suddenly mean that you're labelled safe and it doesn't mean that you can start
pulling down the barriers of double checking...
¥poorly
discriminated levels of performance
The limited capacity of
the assessment to pass 'good' students and detect and where necessary fail
'poor' ones was noted by several interviewees.[26]
...You do get
referrals to people that shouldn't be referred, and you know are quite capable
that have done something amazingly silly. But you know if they'd actually done
it on a day to day basis you'd just say, "Well that's stupid, I've got to
start all this again"..and then you get those who, you know to be honest
don't really put in a great deal more than they have to on a day to day basis
that come out with a glowing performance on the day.(educator)
2. Ward Reports
The shortcomings of the
King's Fund or 'ward report' forms used on students' clinical placements as an
adjunct to practical tests were largely to do with the lack of real evidence
that they provided:
...the King's Fund
report form is very erm... open and there's not a lot of room on it for comment.. (staff nurse)
Well, the thing is
they're never used properly, I mean half the time they just tick and there's
never any comment made at all, to reflect what the ticks are actually saying. (educator)
3. Final
examinations
Many students had strong views about the
inappropriateness of the final summative written exams in nursing, and the
final examination papers and orals in midwifery. They were unhappy with its one
off nature and its associated pressures.
It was also felt that an exam did not assess their nursing or midwifery
competence, and was therefore seen as unnecessary as well as unwelcome. Typical worries of student were:
I mean that sort of
really worries me, the fact that it comes down to an exam paper at the end of
the day, you know the final decision. The fact that I've passed the ward-based,
the practical assessments and been deemed to be competent or whatever... erm
comes down to the fact that at the
end of the day, pass the finals.
Personally I'm very
bad at exams...I've always had very good or outstanding ward reports but on
exams my marks are normally borderline or just over borderline, sort of 50 to
60%...I get into an exam and I know what I want to put and I know it all, well I know quite a
lot of it! But putting it down on a piece of paper's just something completely different...everything hinges on that
day.
The general attitude
towards exams and one-off assessments is summed up by the student who, in
advocating a more continuous approach, indicates what is missing from the
traditional one:
...you see it as a
hurdle...some people thrive on hurdles and jump them. But a lot of people see
them as a barrier...you've got to get through that barrier. If it was like
continuous assessment erm, I think
you'd keep yourself more aware of what you were doing and would be more willing to change your
practice, not just as a student but you'd have that sort of framework, so that when you do qualify you're still
able to look about at what's happening and change your practice.
He, like the majority of
students, practitioners and teachers interviewed, saw examinations as being
about something other than competence. Indirectly, such a perception
re-iterates the view that theory and practice are separate entities.
2.9. DEVOLVED CONTINUOUS
ASSESSMENT
2.9.1. The Reality of
Continuity
National guidance for
devolved continuous assessment was produced by the ENB in its Regulations and
Guidelines for the Approval of Institutions and Courses 1990[27]. The strategy requires students to
demonstrate the Ôacquisition of knowledge, skills and attitudes of differing
complexity and applicationÕ, and to include clearly identified summative and
formative assessment activities (ENB, 1990, p 50). The guidelines place a strong emphasis
on formative assessment, reflecting principles which are intended to maximise
learning, build on students' strengths, respond to their weaknesses, provide
profiles of progress, link the identified 'parts' of the overall strategy and
encourage student participation in self assessment (ENB, 1990, p 50).
The increased sense of
reality that this continuous process can provide is identified by this
midwifery teacher:
...the new assessment
will be a much...not so much fairer but a more realistic assessment of a
students progress.
The in-depth approaches
to the assessment of theory which continuous assessment allows is also
welcomed:
...at the General
Hospital they do a project where they've got so many weeks to do it, and I
think that's a good idea because you can demonstrate your knowledge in a much
deeper way...you've got more time and you can spend more care and...it's not as
traumatic as doing a big, you know
a two, three hour exam.
Insofar as competence
was seen as an ability to perform consistently over time, there was a view that
continuous assessment facilitated this.
An approach which
represents changes in educational aspirations must also map into work contexts,
the only scenarios through which professional competence is expressed and
realised. The recognition of distribution of responsibilities is therefore
essential to the functioning of continuous assessment. The cascade of responsibilities to all
levels was recognised by interviewees.
Some commented on the
effects on students:
I think it makes you
more aware for three years, certainly you've got to know what you're doing all
the time. (student)
I'm sure that a lot
of people believe that continuous assessment is an easy option, and that
ultimately it will dilute the performance of the individuals... I believe that
it will actually concentrate their minds considerably...(educator)
Others noted that not
only did continuous assessment have the potential to concentrate students'
efforts but also to foster in them a developmental attitude and an expectation
of education as an on-going process.
2.10. INNOVATION IN
AN ESTABLISHED WORKPLACE CULTURE
2.10.1.
The Persistence of the ÔOldÕ
Interviews show that
perceptions of the weaknesses of single-event assessment and the strengths of
continuous assessment do not always lead to different approaches to the
activity of assessing. It seems
that for many a reconceptualisation is required if assessment is to be part of
an educative process. Some interviewees comment that some schedules are still
dominated by behavioural formats which do not adequately reflect the
complexities of continuous assessment. In them, competencies are broken down
into numerous parts or sub-skills in order to measure them on a pass/fail
basis. They focus on techniques rather than 'complex' competence. It appears that 'technicist' approaches
are still evident in some continuous assessment documentation and hence they do
not promote assessment of the 'complex' or 'higher order' competence that
typically characterises a professional. The implication seems to be that in
evaluating the effectiveness of various forms of assessment, there is a need to
consider not only the forms themselves but also the general methodologies
employed within them.
In the same way that
nursing and midwifery competencies have been statutorily defined but are
modified and extended in practice, so the strategies for assessing competence are set down
in official procedures but adapted 'on-the-ground' as they are put into
operation. There is, for instance, a clear distinction in the Board's
regulations between formative and summative assessments, whereas interviewees'
comments provide evidence that some assessors employ all assessment
diagnostically and formatively. And despite the Board's clear distinction
between 'single event' assessment and continuous assessment, people talk about
both in ways that suggest both forms of assessment are carried out in similar
ways. All the interviewees, however, have definite views about the nature
and quality of different forms of assessment, and those views inevitably affect
their assessment practices. [28]
The part played in
shaping continuous assessment by 'residual' perceptions, held by those still
operating the earlier approach, albeit alongside the new one, and the often
cynical attitudes these engender, cannot be ignored. The following comment
encapsulates that cynicism.
I'd argue that
there's a conspiracy of passing people at the moment because if they judged it
by their (clinical assessors)values they (students)shouldn't pass, they're not
competent within their values, but they know their values aren't what's being
asked for but they have to assess them...to say someone's not competent to do
that you've got to know what you're talking about and their training may not have given (them that) ...if
you don't know you might as well
put a tick because if you put 'no'
and they challenge you...
The dilemma is summed up
nicely in the following comment, as the speaker unfavourably compares
preparation for the major attitude and practice shift required to facilitate
the radically different form of assessment required by devolution and
continuity, with the preparation offered to people in industry who are about to
undergo an innovation of similar proportions .
...half of the people
(assessors)
or whatever number have been trained literally as they work to operate within
one system. We are then asking then to assess with a different philosophical
view...apart from a 998 course here or there, I mean not particular help to do
it. If any industry was remodernising it would put in massive resources to
change it to operate the new machinery, Nursing somehow hasn't put that (in),
and after all assessing that they (students) are
competent to practice in this new
way when you've never practiced in it (pause) it's like asking me to judge
something I know nothing about.
There is clearly an
issue of what constitutes an appropriate investment in resources for a major
innovation.
2.11. ASSESSMENT: A
SUMMARY
Assessment, like
competence, is an activity informed by an evolving concept. It is also an
activity which is carried out regularly and thus becomes habituated. Where
institutions have a culturally embedded reflexivity, their assessment
strategies and practices develop gradually and meet the educational needs of
the profession. Where the imperative for change is entirely an external one
which impinges upon a non-reflective institutional culture, the attempt to
accommodate to that change is often traumatic, and the strategies adopted lead
to piecemeal adaptation within an ÔunreadyÕ context. By contrast, in a nascent
reflective culture there is principled movement towards a form of assessment
that satisfies the professional requirement that competence should be founded
in the application to practice of appropriate skills, knowledge, and attitudes.
Institutional histories are therefore of considerable importance in determining
the extent and rate at which a particular assessment strategy will succeed. The
success of devolved continuous assessment relies upon the people who operate it
having a sense of ownership, without which they will lack the necessary
commitment and understanding to exercise effectively the increased
responsibility it brings.
CHAPTER THREE
ABSTRACT
A system of assessment which is
devolved, must be capable of handing responsibility for design and implementation
to individual approved institutions without losing the capacity to hold them
accountable for meeting national criteria. The institution itself must be able
to ensure that it provides a course of professional preparation that equips
students with the competence to practice at a professional level. In any
assessment system there are, then, internal and external points of reference,
and individuals, committees, and planning groups must all respond to both sets
of constraints. The devolvement of decision-making scatters the centres of
decision; this can lead either to the development of collaborative or of
competitive relationships between institutions. Where there are well-defined
roles and structures that promote partnership between all the interested
parties, the personnel involved in the design and subsequent implementation of
an assessment policy feel a sense of ownership. Internal partnership rather
than external legislative imposition ensures a comfortable fit between the
needs of practice, teaching and learning, and assessment. The most facilitative
structures enable rather than constrain the process of parallel curriculum and
assessment policy design from the earliest possible opportunity. The most
supportive roles are defined in a way that encourages dialogue, and brings
together different perspectives (e.g. nursing and midwifery) and specialist
interests (e.g. branches within a course) in a mutually enabling relationship.
Where the assessment histories of merging or merged Schools and Colleges are
very different or these institutions are at different stages in the development
of their assessment policies, individuals are obliged to invest large amounts
of their personal time and energy to achieve compatibility. They do this
willingly where there are stable structures for dialogue and partnership, but
experience frustration where the re-organisation process has resulted in
destabilised structures and uncertain role-definitions. This seems to point to
the need for a policy co-ordinator and assessment quality assurance role. It is
not simply at the local level that clearly-defined assessment roles and
structures are appreciated, however; they are also valued at a regional and
national level. There are many instances of a happy relationship between ENB
Education Officers and their local approved institutions, in which officer and
approved institution are able to critique national guidelines as a route
towards making sense of them and gaining the ownership mentioned earlier. This
relationship recognises the scope for local interpretation of national
guidelines, and looks positively for creativity in the approved institutionÕs
operation of them. Where the relationship between the parties is genuinely one
of partnership, guidelines are used as an enabling framework and the need for
dialogue about different interpretations fully recognised. Without such a
relationship, assessment documentation, schedules, and procedures are
introduced in which no-one at the approved institution level has any faith. Inevitably
these fail to provide reliable or valid assessment information.
DESIGNING DEVOLVED
CONTINUOUS ASSESSMENT STRATEGIES
Introduction
A planning structure must be able
to ensure appropriate conceptual frameworks, principles of conduct, role and
communications structures, and individual commitment to the enactment of the
process. This section will explore
the features and experiences of planning in relation to these:
¥ by giving an overview of the relevant features of
the operating context of institutions in terms of 'mapping the system'
¥ and by describing and analysing the experiences of
staff operating within that 'map'
3.1. MAPPING THE
SYSTEM
In general terms an
institution can be regarded as a system which must meet the demands made upon
it both internally and externally if it is to survive and develop to fulfil its
intended mandate. Assessment is of
course a key function in the mandate of an approved institution to engage in
the education of professional nurses and midwives. Assessment is not merely an internal matter. Reference is made to demands from a
variety of sources external to the approved institution (ENB, UKCC, EC
directives and other appropriate legislation). These reference points provide one set of guidelines common to all by which to construct a
map which can then act as a framework for analysis, comparison and contrast. These external points of reference in
turn make demands upon and place limits upon the ways in which institutions can
organise themselves to meet the demands.
There are thus external and internal factors to take into account.
The appropriate
structures will of course depend upon local circumstances. However, it is possible to begin the
process of analysis by setting out, in the first instance, a simplified schema
as follows:
Schema
1
Without appropriate
structures and associated role definitions, committees, working groups,
planning procedures and communications structures, little is likely to be
accomplished. Although
oversimplified as a representation, this initial schema does point to two
important structural dimensions for the
approved institution. There
are two directions that it must face, first 'vertically' towards the national
bodies (ENB, UKCC), European directives and local bodies (RHA, Trusts); and
secondly, 'horizontally' towards the clinical areas of the region (purchasers,
clinical placements). This
therefore divides external demands upon its organisational structure into two
kinds. Roles must be established
to respond to the two kinds of external demand. In addition, to be properly informed about regional
operating conditions, it needs access to information regarding the relationship
between national bodies and the clinical areas in its region. That the schema
is oversimplified is made clear when the complexities begin to be identified
for each broad category of institution.
Thus the national-local level can be further amplified:
Schema
2
Clearly, the approved
institution must respond not only to national demands but also to local
demands. The local context is not
a mediating layer between national and institutional levels but rather is
symptomatic of global developments throughout society. There is no unambiguous hierarchical
'line-management' relationship running from the national through to the local
and then to the approved institution.
Devolvement of decision making scatters the centres of decision making
them at least quasi-autonomous.
The movement then is into the formation of collaborative and/or
competitive relationships where negotiation rather than 'command' is the
central operating feature.
With the increasing 'marketization' of once nationalised public
services, decision making, while made more sensitive to local demands and
operating conditions at the same time, is subjected to national demands for
'quality assurance', 'standardisation of outcomes', efficiency, effectiveness
and so on. Tailoring services and
training to meet local conditions of demand may come into conflict with
national demands for consistency, for a common professional education. This particular tension between the
local and the national represent a modern feature of society which can be
termed the 'global-local' problem (c.f., Harvey 1989).
The implications for the
approved institution do not neatly separate into two classes but must rather
address the central problem posed by the new operating context with its
global-local poles of decision making.
This means, in general terms,
a need for structures for collaboration, dialogue and information
gathering.
The following diagram
begins to unpack the internal complexity of the approved institution
itself. The internal
organisational logic of a given institution has its own historic origins. This provides the internal operating
context within which planning takes place. While there may be surface similarities between some
institutions, in practice the operating conditions are unique to each
institution. In general terms,
there are typical operating differences as between the 'new' and the 'old'
universities. The new universities
come from a polytechnic culture with its CNAA[29] influenced principles
and procedures of course development, validation and assessment. The old universities draw upon a quite
different culture of autonomy and self-validation. Where the polytechnic culture has expressed itself in terms
of strong line management patterns of control (Heads of Department and Deans
being seen as professional managers), the old universities typically incline
towards individualism, a limited style of line management (Deanships rotating
amongst senior academic staff) or a democratic mode of
School/Department/Faculty management.
With amalgamations or affiliations of colleges of nursing and midwifery
different ways of working, different role definitions and different
occupational cultures and institutional histories are brought together. Mediating roles and structures not only
within the institutions but between the institutions become important.
Schema
3
It is not only the map
of the variety of institutions delivering education that is under change but
also the 'clinical areas' for student placements.
Schema
4
Each schema provides a
way of beginning the process of mapping the range and sources of information
necessary to plan the assessment structure.
In order to specify in
more detail the roles required for assessment design the structure for
implementation purposes must first be identified. For this purpose a further schema can be offered:
Schema
5
The roles that the above
schemas have identified in general terms are articulated in practice according
to the circumstances faced by each institution. However, if the system is to operate it must meet the functions
defined in terms of these roles.
3.2. THE EXPERIENCE
OF DESIGNING CONTINUOUS ASSESSMENT STRATEGIES
3.2.1. Operating in
the Local Context
Responsibility
for the detailed planning of assessment strategies belongs to individual
approved institutions. In theory that responsibility is determined by a set of
ENB guidelines, UKCC statutory requirements and EC directives. In practice,
because every institution has a unique assessment history there are marked
differences in the approach each adopts to the design of assessment strategies
to meet the Board's most recent requirements. Those who have already been
operating continuous assessment informally for several years simply continue
the institutionalised process of evolution and development; whereas those for
whom the experience is a new one face a considerable challenge of innovation.
The following extracts typify the range of experience:
...it's where you are
now, what experience, what you've come from, which is what we've tried to do
with that profile (...) we know where we are at now is the King's Fund
assessment forms. Let's see this as an interim, let's move slowly (...) because
it's not just the educationalists in the school, it's the people out there you
know, it's like moving where you are now, from where you've been in the past,
to moving to the future...it's about development.
The experience of
designing a new assessment strategy is most difficult where it represents a
major innovation. The experience is quite different for those professionals who
are are working in a context that has
member of a professional group like the one described below that has
engaged in a gradual evol.
...historically, we
have been running continuous assessment here for at least ten years, but
initially it was run in conjunction with the statutory mechanisms deemed by
what was previously the General Nursing Council and subsequently the ENB and as
a result of that obviously we feel we could work through that which in the
early days were quite primitive tools for determining the knowledge, skills and
values of a student (...) so evolutionary we've moved on and yet in some
respects of course we've still got tools that were relatively primitive.
This teacher and her
colleagues work in a culture which is familiar with regularly evaluating and
developing continuous assessment. For them, each new requirement is an
opportunity to upgrade what they have been doing previously.
3.2.2. Ensuring
Ownership Through Partnership Structures
Assessment is normally
planned in common with other aspects of a course, and the planning team that
does one is the same group of core educators, practitioners, and (less
frequently) students, responsible for the other. This partnership ensures that
in planning their assessment strategies a team considers both the educational
agenda and the agendas of nursing and midwifery practice. Partnership, as the teacher below
points out, avoids the pursuit of an ÔidealÕ strategy which is inoperable in
practice;
It will involve
teachers, managers, practitioners, student representatives and any other person
who has specialist knowledge about this particular issue that is going to be
written about or discussed. (...) To write a curriculum with purely
educationalists, I mean people tend to say that educationalists tend to live in
the ideal world, and sometimes don't tend to realise the reality of the
situation. It is fine to sit down and write the ideal curriculum, but in
practice it can't be implemented. (...) But here we have always taken the view
that education is a partnership between the college of nursing and the service
area.
Partnership is not
always easy, however, and sometimes it can be a little imbalanced with either
the practitioners having slightly more say:
...both the midwife
teachers and the clinical midwives, they both need each other to function
properly and so it would have been in my opinion very wrong for it to have been
as assessment strategy designed by midwife teachers. It's got to be both sides,
(...) in fact we had just one midwife teacher heading up a small sub group and
there were three preceptors plus her, so in fact...the emphasis within that
small team if you like, was more on the practising midwives rather than the
midwife teacher.
or the teachers:
...I mean we say we
say that the student owns the document, but they can't own it if they've not
designed it really to their own use...as long as educationalists are designing
the form then there's going to be problems. As soon as the clinicians design
the form then there's going to be problems with the educationalists. I think
until we can all sort of get together and speak the same language there will be
problems won't there?
The issue here is one of
ownership. In a satisfactory partnership, because all the partners make a
significant contribution to the design of the assessment strategies and
documents they eventually use, all partners feel a sense of ÔownershipÕ. Not
all planning groups achieve that sense however. The comment of the educator quoted above reflects a view
which was often expressed, and highlights the need for greater dialogue between
educators, practitioners and students to promote shared ownership.
In the true partnership
between practitioners, teachers, and students, the relationship between
planning and assessment is perceived as integral. Far from being something
designed separately by educators
and imposed on practitioners, or given an undue practical bias by virtue of an over-heavy
practitioner input, assessment is seen as fulfilling both a curricular and a
practical function. Where all the people involved in the design of the
assessment strategy become ÔownersÕ, as in the instance below, the match
between the needs of practice, teaching and learning, and assessment is high.
...our experience has
taught us you canÕt divorce assessment from the main curriculum planning, and
you canÕt have curriculum planning taking place and assessment coming later.
Our experience has shown us this is not on. So from 1990 you could say that we
have had to work very very closely together.
The implicit statement
is about the importance of ownership, and the potentiality for alienation where
one partner feels they have had something imposed on them which they do not
own.
3.2.3. Strategies for Achieving Coherence