Keywords
performance-based assessment, education/training programmes, clinical educators
Performance-based assessment (PBA) is a complex process undertaken in the workplace by healthcare practitioners known as clinical educators, who assist universities in determining health professional students’ readiness for independent practice. Preparing healthcare professionals for PBA is considered essential to ensuring the quality of the assessment process in the clinical learning environment. A preliminary search of the literature indicated a paucity of research guiding the development of education programmes that support practice educators to understand and implement PBA.
The aim of this scoping review is to investigate and describe education programmes delivered to allied health and nursing clinical educators, to develop PBA knowledge and skills.
This review will follow the Joanna Briggs Institute (JBI) methodology for conducting scoping reviews. Electronic databases relevant to this research topic will be searched including, EMBASE, ERIC, MEDLINE (Ovid), Web of Science and CINAHL and other targeted databases for grey literature. Studies that include PBA as the main focus or a component of the education programmes, of any format, delivered to clinical educators in allied health and nursing will be included. Studies may report the design and/or implementation and/or evaluation of PBA education programmes. Relevant English language publications will be sought from January 2000 to October 2022. Two reviewers will screen all titles and abstracts against the inclusion/exclusion criteria, and publications deemed relevant will be eligible for full text screening, confirming appropriateness for inclusion in the scoping review. Data will be charted to create a table of the results, supported a by narrative summary of the findings in line with the review objectives.
performance-based assessment, education/training programmes, clinical educators
This revised version provides a restructured ‘Introduction’ section to enhance the transparency of the background. Supplementary sentences have been added to the rationale section, which summarise the reasons for scoping review and provide a clearer connection to the research question. GreyLit has been removed from the protocol as it was not available when the Grey literature search was carried out.
See the authors' detailed response to the review by Lindy L. McAllister
See the authors' detailed response to the review by Yvonne Finn
See the authors' detailed response to the review by Susanne Friis Søndergaard
Assessment of health professional students during work-based placements, also known as performance-based assessment (PBA), refers to the appraisal process conducted during clinical placements, and establishes students’ readiness for independent professional practice1. PBA determines health professional competence2, providing evidence of students’ abilities to care for patients in a real, uncontrolled clinical learning environment3. This assessment process aligns with effective outcome-based education, where students are required to achieve standardised professional competencies in order to graduate as competent clinicians2. Preliminary searches of relevant literature highlighted a paucity of evidence-based education programmes for clinical educators. Clinical educators are healthcare practitioners primarily involved in service delivery, who undertake student supervision and PBA in the workplace4. Titles used to describe health professionals who undertake this education role include practice educator, preceptor, mentor, fieldwork educator, clinical teacher and clinical educator5–8. For consistency, the term ‘clinical educator’ will be used throughout this protocol.
Assessment in the clinical environment is a complex process open to many challenges and influenced by several factors including the assessor, the clinical learning environment and the assessment task9–11. Considerable responsibility is placed on these clinicians, as PBA often determines progression through the programme and may contribute significantly to the overall grade awarded to the student12,13. Dynamics impacting PBA relating to the assessors may include, variation in interpretation of the task and how it is judged14, differences in understanding of the assessment criteria15, and navigating the complex student-clinician relationship, where assessors act as both mentor and examiner9,14. Other relevant influences may include potential lack of commitment to the assessment process by clinical educators due to it been seen as a non-service related activity16, and cognitive or cultural biases10,14. In the clinical learning environment, issues such as time pressures17, the multiple demanding roles of the clinician1 and the uncertain nature of the clinical setting, often presenting complex learning opportunities10, also present challenges. Assessment tasks may be viewed as problematic, requiring assessors to convert an observed performance into a numerical score1,18, with the added challenge of precise recall of a performance, due to the time lapse between observation and actual grading18. Furthermore, these difficulties may be heightened when a clinical educator is supervising and grading an underperforming student19.
Current literature in this area highlights challenges with PBA, citing inter and intra-rater reliability and knowledge of assessment processes as the greatest difficulties9,10,20,21. Clinical educators who are deficient in knowledge, skills and confidence for this role, may potentially compromise the PBA decision-making process, thereby casting doubt on a graduate’s credentials as a safe competent practitioner. Professional development to support clinical educators to carry out their role as assessors is critical to ensure the quality of work-based education and assessment6,9,12. Thus, exploring the current opportunities available for health professionals to address their educational needs in this area is most important6,22,23.
The majority of research related to PBA education for health-care professional is situated in medical education17,24,25, with preliminary searches suggesting limited studies for allied health professions and nursing26–29. In medicine, the literature on PBA spans both pre-qualification and post qualification programmes, where the implementation of PBA often differs from that applied in allied heath/nursing education. During medical rotations, students are generally under the supervision of clinical educators for short periods of time30,31, and commonly use assessment tools such as the Mini-Clinical Examination Exercise (Mini-CEX) and Direct Observation of Procedural Skills (DOPS), applying only a discrete number of assessment criteria3,4,32,33. Clinical performance is evaluated at distinct pre-arranged timepoints, often planned or identified by the student, and verbal and/or written feedback is not always included34,35. These assessment approaches and tools may not provide an integrated view of overall patient management by the student or reflect care provided over time31,32.
In nursing and allied health education, PBA is generally applied as a continuous assessment process over a prolonged period of time, for example 6 to 12 weeks36,37. Students are often supervised by one/two educators for the duration of the placement and work closely together under their supervision36. PBA generally consists of multiple daily observations of the student, which can include reviewing student’s assessments and clinical reasoning documentation, together with observation of their professional and communication skills38,39. PBA tools are frequently used for both formative and summative feedback, with written feedback informing the dialogue regarding the students’ performance40. Differences in supervision and assessment practices may suggest educational needs for clinical educators are also different, depending on how the PBA assessment is applied and their clinical learning environment.
There is some evidence to suggest that universities provide education programmes to induct new practice educators into their role, and more advanced programmes for experienced educators, to grow their teaching and assessment skills7,11,23,26,41. Programmes are delivered mainly through formal instructional approaches such as university-based workshops or online units, which may include education on implementing PBA11,26,41,42. However, certification requirements for these programmes are inconsistent and no specific guidance in relation to the format, content or frequency of PBA education is available20,43,44. A preliminary review of the research suggests similar education approaches are used across healthcare education programmes. In medicine, studies frequently use interactive workshops and video vignette of students’ clinical performances based on teaching approaches such as ‘Performance Dimension Training’ or ‘Frame of Reference’ training17,24,25. These studies have shown a positive impact on participants assessment confidence, skills and knowledge, with more variable success for grading accuracy and reliability. A small number of recent allied health studies using similar approaches, highlighted the benefits of interactive dialogue between assessors as part of the decision-making process, resulting in more transparent assessment processes, and also improved rating accuracy of assessors11,45. A preliminary search identified one systematic review specifically associated with professional development of clinical educators. Milne et al. (2011) reviewed evidence-based training for clinical educators in mental health professions, identifying 20 different topics provided in education programmes, however assessment was not explicitly reported as a component of training in any of these studies26. A further systematic review addressing the issues and concerns related to learning and assessment in the clinical learning environment23, and a more recent scoping review exploring the factors needed to support clinical educators in the workplace46, do not specifically addresses PBA education, however both highlight the requirement for professional development in assessment practices. A search for existing scoping and systematic review protocols related to education programmes on performance-based assessment for allied health or nursing professionals was conducted in MEDLINE (Ovid), Best Evidence Medical Education, Joanna Briggs Institute (JBI) Evidence Synthesis and Cochrane Database of Systematic Reviews in July 2022, producing no protocols on this topic.
Performance-Based Assessment undertaken by healthcare professionals in the workplace environment is complex and challenging. There is mounting pressure on universities from accreditation and regulatory bodies to ensure clinical educators are fit for their role, including the provision of credible and defensible PBA evaluations to safeguard the public. Preparing clinical educators to implement PBA and develop expertise as an assessor requires on-going education and experience46,47. In addition, considerable time resources are invested by healthcare managers releasing clinical educators to undertake PBA education, placing a responsibility on the universities to provide appropriate education and training. Therefore, it is a timely and essential task to investigate the breath and scope of existing literature regarding the education provided to clinical educators to deliver PBA. The aim of this scoping review is to investigate and describe education programmes delivered to allied health and nursing clinical educators, to develop PBA knowledge and skills.
This proposed scoping review will be conducted in accordance with the Joanna Briggs Institute scoping review guidelines48, informed by the Arskey and O’Malley framework49, with consideration of the recommendations from Levac et al.,50, Duadt et al.,51 and Peters et al., 202252.
Scoping reviews are an effective method to establish the extent of the available research on a particular topic by exploring diverse international research sources, clarifying key concepts and identifying gaps in the knowledge on a specific research topic51,53. In addition, given the limited yield of literature from the initial search and investigative nature of this research, a scoping review is well positioned to identify any gaps in the research.
This study protocol will address the following question: what is known about education programmes used to develop PBA knowledge and skills for clinical educators in allied health and nursing?
The review objectives are as follows:
To explore the extent, range and nature of the literature on PBA education programmes provided to allied health and nursing professionals
To chart specific characteristics related to the context, target population, format, aim, instructional methods/teaching strategies, content, pedagogical approaches, evaluation and key findings or educational impact of these programmes
To collate, describe and summarise the available evidence on PBA education programmes, and identify any gaps in the existing research
The purpose of the review is to explore and describe education programmes delivered to allied health and nursing clinical educators, to develop PBA knowledge and skills.
The search strategy was constructed using the Population-Concept-Context framework to guide the eligibility criteria. An overview of the inclusion and exclusion criteria are outlined in Table 1.
The primary population of this review are clinical educators, described as clinicians who supervise pre-qualification students on clinical placements. Clinical educators may work in a part-time or full-time capacity and be employed across a wide range of workplaces providing healthcare to service users. This scoping review will consider studies that include clinical educators from the following health and social work professions: dietitians, occupational therapists, nursing, optometrists, orthoptists, physiotherapists, podiatrists, psychologists, radiographers, radiation therapists, social workers and speech and language therapists. Professions identified include those awarded a recognised professional entry-level qualification from universities and have work-based placements as an integral part of their programmes.
This scoping review is designed to explore PBA education programmes provided to allied health and nursing clinical educators who supervise pre-qualification students. Medical education programmes were not included as their assessment practice in clinical education differ considerably from allied health and nursing. These programmes may be designed, developed and delivered by academics with a practice education remit or dedicated discipline specific practice education staff. Education programmes must include PBA as the main focus or as a component of a programme, giving a clear description of the design and/or implementation and/or evaluation of the assessment aspect. All instructional methods or teaching strategies for programme delivery will be considered and may include but are not limited to, interactive workshops, didactic lectures, structured reflection opportunities, role-play or other simulation approaches, workplace observational coaching or other methods. Evaluation outcomes for the programmes will be pursued.
PBA education programmes may be based in the university as a face-to-face event, or as a university e-learning virtual programme or facilitated in a clinical setting. Programmes may also vary in duration from single interventions completed over a number of hours or a single day, to more longitudinal programmes delivered over a defined period of time. Literature will be searched from the year 2000 recognising the growth in research and development in the area of work-based assessment in recent decades. There will be no limits on geographical location.
A professional librarian will be consulted to assist with developing comprehensive search strategies to identify relevant literature from a broad range of sources including electronic databases, reference lists and grey literature. Initial searches of EMBASE and PUBMED databases were undertaken in July 2022 to identify studies relevant to the research area. Keywords and index terms of the relevant studies were then used to create search strategies. The final EMBASE search strategy is outlined in Table 2.
A comprehensive search will be undertaken to identify relevant publications in the following databases: EMBASE, ERIC, MEDLINE (Ovid), Web of Science and CINAHL. Bibliographies of relevant publications and review articles will be examined for further citations and checked for suitability using the eligibility criteria. A grey literature search will be undertaken using databases identified in the inclusion criteria and the Grey literature search strategy (see Extended data54). Websites of individual professional bodies, universities, professional regulator or government education departments will not be searched as this is beyond the resources of this research project, considering the breath of professions included in the review. The search will be iterative and any relevant additional terms, concepts or literature sources, emerging during the search, screening or selection processes, may be added to the search strategy as the review progresses52. Only publications in the English language will be included.
Following the searches, appropriate publications will be imported into Covidence, and any duplicates not already detected will be removed. To ensure reliability in selection, two reviewers will independently screen the title and abstract of a random sample of 20 retrieved articles, to ensure consistency between the reviewers regarding the eligibility criteria52. All records will then be screened by two reviewers, with titles and abstracts appraised against the inclusion/exclusion criteria51. Uncertainties or disputes related to the study selection will be discussed at scheduled meetings at the beginning, midpoint and final stages of the abstract review process50. Where an inclusion or exclusion decision cannot be agreed from the title or abstract, the full article will be screened. Publications deemed appropriate will be eligible for full text screening, by the two independent reviewers, confirming appropriateness for inclusion in the scoping review. Any disagreements will be resolved through discussion and consensus with a third reviewer.
Covidence will be used to manage citations and perform data extraction based on pre-determined data characteristics listed below. Initially, five to ten identified papers will be piloted by two reviewers to ensure agreement on data extraction characteristics and that the data fields are consistent with the research question50. During the review process, data fields may be further refined with any changes reported in the final review49,55. Any questions will be resolved by discussion to reach consensus. Where ambiguity or omissions exist, study authors will be contacted for further details. Data will be extracted by a single review author and verified by a second reviewer. As the purpose of this scoping review is focused on describing sources of evidence on a specific research topic, a risk of bias for source of evidence will not be included49,52.
The following fields will be extracted from the included studies:
1. Author
2. Year of publication
3. Country of study
4. Healthcare profession
5. Size of study population
6. Format/type of programme
7. Location and duration of progamme
8. Overall aim or focus of the programme
9. Instructional methods/teaching strategies
10. Content of programme
11. Theoretical/conceptual framework/pedagogies under-pinning teaching methods
12. Evaluation methods
13. Key findings/educational impact
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review (PRIMSA-ScR) checklist will be followed for organisation of information and reporting56. A PRISMA flow diagram will be used to report the results of the literature search. This will include numbers of articles imported, duplicates identified, titles and abstracts screened, irrelevant studies removed, rationale for exclusion of articles and final full-text studies included for review57. To maintain transparency, any changes from the protocol will be reported in the scoping review report52. All data extracted will be mapped into tabular format, based on descriptive headings in the data extraction form, and accompanied by a narrative summary of the results in line with the review objectives. A comparison of allied health/nursing and medicine PBA education programmes will be included in the discussion.
Open Science Framework: Education programmes on performance-based assessment for allied health and nursing clinical educators: A scoping review protocol, https://doi.org/10.31219/osf.io/sjxhf54
This project contains the following extended data:
An earlier version (preprint) of this article can be found on Open Science Framework: ‘Education programmes on performance-based assessment for allied health and nursing clinical educators: A scoping review protocol’ (https://osf.io/sjxhf/).
Is the rationale for, and objectives of, the study clearly described?
Yes
Is the study design appropriate for the research question?
Yes
Are sufficient details of the methods provided to allow replication by others?
Yes
Are the datasets clearly presented in a useable and accessible format?
Not applicable
Competing Interests: No competing interests were disclosed.
Reviewer Expertise: Nursing, Education, Hospital design, Advanced nursing practice, Perioperative nursing
Competing Interests: No competing interests were disclosed.
Is the rationale for, and objectives of, the study clearly described?
Partly
Is the study design appropriate for the research question?
Yes
Are sufficient details of the methods provided to allow replication by others?
Yes
Are the datasets clearly presented in a useable and accessible format?
Not applicable
Competing Interests: No competing interests were disclosed.
Is the rationale for, and objectives of, the study clearly described?
Yes
Is the study design appropriate for the research question?
Yes
Are sufficient details of the methods provided to allow replication by others?
Yes
Are the datasets clearly presented in a useable and accessible format?
Yes
Competing Interests: No competing interests were disclosed.
Alongside their report, reviewers assign a status to the article:
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Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. Consider the following examples, but note that this is not an exhaustive list:
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