| AimsThe aim of this study was to develop an assessment method for clinical practice competence of Master of Nursing Specialist(MNS)studentsbased on the origin framework of Mini Clinical Evaluation Exercise(Mini-CEX).And to improve the rating accuracy and the score consistency of MNS students’ clinical teachers,Frame-of-Reference Training(FOR Training)was used.Finally,to explore the effect on MNS students’ clinical practice examination scores,self-assessment of MNS students’ clinical practice competence,satisfaction of MNS students with the assessment method,clinical teachers’ satisfaction with MNS students’ work,and patients’ satisfaction with MNS students’ work through empirical application of this assessment method.Methods1.Development of assessment method for clinical practice competence of MNS students based on Mini-CEXBased on the original framework of Mini-CEX,the former research and literature method,the framework of MNS studentsclinical practice competence assessment method waspreliminarily established,and the expert consultation questionnaire was initially formed.Two rounds Delphi expert consultation were conducted on 39 experts who met the inclusion criteria.The scientificity and reliability of the results of the consultation were analyzed by the positive coefficient of experts,the experts’ authority coefficient and the concordance coefficient of experts’ opinion.The first-level and second-level items were added,deleted or revised according to the written opinions of experts and relevant indicators such as the average value of item assignment,coefficient of variation,full score ratio.The weights of the first-level and second-level itemswere calculated through the proportional distribution method.2.The application of FORtraining in MSN students’ clinical teachers22 clinical teachers who are responsible for the MNS students in the the intervention group were selected as raters by purposive sampling method.The raters were trained by FOR training.Raters scored the clinical assessment of MNS students with the assessment method for clinical practice competence of MNS students based on Mini-CEX.The rating accuracy,score consistency and measures of dispersion of the two assessments were compared.3.Application of the assessment method for clinical practice competence of MNS students based on Mini-CEXThe grade 2017 and 2018 MNS students of Southeast University and Nanjing University of Chinese Medicine who participated in clinical practice from July to December 2019 were selected.MNS students of Southeast University were included in the intervention group while MNS students of Nanjing University of Chinese Medicine were included in the control group.Traditional method was used in the control group while the assessment method based on Mini-CEX was applied besides the traditional method in the intervention group.Both groups were assessedonce a monthirregularly.Data before and after the intervention were collected to compare the differences between the two groups in 5 aspects,MNS students’ clinical practice examination scores,self-assessment of MNS students’ clinical practice competence,satisfaction of MNS students with the assessment method,clinicalteachers’ satisfaction with MNS students’ work,and patients’ satisfaction with MNS students’ workResults1.Development of assessment method of clinical practice competence for MNS students based on Mini-CEX(1)The scientificity and reliability of the results of the consultationThe effective recovery rate of questionnaire in the 2 rounds were 95.24% and97.5% respectively,which explained the experts were highly motivated to participate in this study.The coefficient Cr of expert authority degree were 0.86 and 0.89,both greater than 0.7,indicating that the authority degree of the experts was high.In the second round,the concordance coefficient of experts’ opinion on the first and second level item was 0.157 and 0.127 respectively,both higher than the first round and P <0.001,which indicated that the experts’ opinions tended to be consistent.(2)The establishment of assessment method itemsAfter two rounds of expert consultation,a assessment method for clinical practice competence of MNS studentswas established based on Mini-CEX,including7 first-level items and 55 second-level items.The order of the first level items was nursing assessment,nursing measures,nurse-patient communication,nursing diagnosis/problems,overall evaluation,health education and humanistic care.2.The application of FORtraining in MSN students’ clinical teachersThere were significant differences between the raters’ score and the standard score of assessment I on some items(P<0.05),while there were no significant differences between theraters’ score and the standard score of assessment II on all 7items(P>0.05).Theraters’ scores on two assessments are consistent,Kendall’s W of assessment I was 0.245,and Kendall’s W of assessment II was 0.404,which was higher than that of assessment I,and themeasures of dispersion tended to decrease,but the level of score consistency is still general.3.Application of the assessment method for clinical practice competence of MNS students based on Mini-CEXA total of 20 subjects were collected from the two groups,including 10 subjects from the intervention group and 10 subjects from the control group.There was no significant difference in baseline data between the two groups(P>0.05).(1)MNS students’ clinical practice examination scoresAfter intervention,MNS students’ clinical practice examination scores in the intervention group and the control group were(87.98 ± 5.71)and(82.45 ± 3.85)respectively,with a statistically significant difference(P< 0.05).(2)Self-assessment of MNS students’ clinical practice competenceAfter intervention,there were statistically significant differences in the total scores of the self-assessment of MNS students’ clinical practice competence and the scores of three dimensions of “critical thinking”,“clinical nursing” and “professional development” between the intervention group and the control group(P< 0.05).(3)Satisfaction of MNS students with the assessment methodAfter intervention,the satisfaction of MNS students with the assessment method in the intervention group and the control group was 100% and 40% respectively,the difference was statistically significant(P< 0.05).(4)Clinical teachers’ satisfaction with MNS students’ workAfter intervention,clinical teachers’ satisfaction with MNS students’ work in the intervention group and the control group were(91.90 ± 3.45)and(81.00 ± 2.31)respectively,the difference was statistically significant(P< 0.05).(5)Patients’ satisfaction with MNS students’ workAfter intervention,patients’ satisfaction with MNS students’ work in theintervention group and the control group were 41.90±2.13 and 40.30±3.13 respectively,there were no significant differences(P> 0.05).Conclusions1.The assessment method for clinical practice competence of MNS studentsbased on Mini-CEX developed in this study was scientific and reliable.It can provide a basis for promoting the evaluation and development of clinical practice competence of MNS students.2.The FOR training improved the rating accuracy and the score consistency of the raters.However,the level of score consistency was still general,suggesting that repeated and rigorous training was extremely important and necessary.3.The empirical study showed that,the assessment method for clinical practice competence of MNSstudents based on Mini-CEX developed in this study,had obvious advantages in the aspects of MNS students’ clinical practice examination scores,self-assessment of MNS students’ clinical practice competence,satisfaction of MNS students with the assessment method,clinical teachers’ satisfaction with MNS students’ work.However,there was no significant improvement in patients’ satisfaction with MNS students’ work.It might be related to the small sample size and short research period.Therefore,in the future,we can choose multiple centers,expand the sample size,extend the intervention time to further explore the effect of this assessment method. |
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