E.P EN PACIENTES INFANTILES

Dictionary definitions of assessment tend to focus on value or quality; the act of assessing, appraising or evaluating (Walsh, 2010). However, there are many variables depending on who and what is being assessed; which have been considered above. Rowntree (1987 p. 4) sees assessment ‘occurring when one person, in some kind of interaction, direct or indirect, with another, is conscious of obtaining and interpreting information about the knowledge and understanding, or abilities and attitudes of that other person. In his words, it is to ‘know’ that person. Examining the effect of the relationship between the student and mentor in practice is essential to understanding the assessment. While each pedagogic relationship is unique, they will share common characteristics. The assessment outcome says

something about the student’s work but also about their relationships with others (Schostak, et al., 1994). The student who knows not to ‘rock the boat’ is likely to make the ‘right’ impression with their mentor (Clouder, 2003). These students, who understand their interactions, are more likely to be successful. The problem then with pedagogic relationships and assessment is to enable all students to understand their interactions and the significance of these on the relationship with others and assessment practices.

Many studies noted the special and supportive relationship between students and assessors in clinical practice. Some mentors were aware of the relationship they developed with the student, recognising if the student mirrored their way of working this positively affected the grade. Similarly, the relationship hindered delivering candid feedback and leniency in grading seemed to occur (Briscoe, et al., 2006; Seldomridge and Walsh, 2006; Fazio, et al., 2013). Assigning lower grades was more difficult when the boundary between student and faculty was blurred and an emotional bond had developed (Scanlan and Care, 2004). One study suggested investigating the relationship between the student and placement educator, which was hypothesised to impact upon the assessment of practice (Roden, 2016). One way to increase the reliability and validity of the practice assessment was to ‘separate out the relationship’ that developed over several weeks in clinical practice (Clouder and Toms, 2008). One student in this study perceived that the grade awarded for practice was dependent upon the quality of interactions with the

practice educator and that the oral exam assessed by two people was more objective than the mentor only assessment (Clouder and Toms, 2008).

A lack of relationship with an assessor was interpreted to have an impact on a student’s confidence and was attributed to a low practice grade (Lefroy, et al., 2015). This was also hypothesised to explain why assessors could not differentiate between acceptable and unacceptable performances in videoed practice assessments in two studies (Reubenson, et al., 2012; Eggleton, et al., 2016). One might also suggest that the lack of relationship made it easier for the assessors to fail the student. Assessors did not have to offer face-to-face feedback as the student was not actually present (Reubenson, et al., 2012; Eggleton, et al., 2016).

To bring together the different types of practice assessments, Wolff, (2007) offers a discourse on grading. He refers to grading compulsory education in the USA but many of the principles apply equally to healthcare education programmes. In his ‘ideal university’, Wolff defines three types of grading: criticism, evaluation and ranking. Criticism, when used to assess complex matters, such as healthcare, is bound up in arguments over style. A mentor who has one style may prefer the student to adopt a similar style; commensurate with the mentor’s normative values. Smith’s (2007) midwifery study acknowledged this halo effect. Some sort of

evaluative standard may be implicit in the criticism grade, but not always. If a student’s style is not commensurate with the mentors’ values and beliefs, there will be tension within this form of grading.

Evaluation, the second type of grading, is the measuring of a performance against a standard of excellence (Wolff, 2007). There is an association between competence and standards (Norris, 1991). The standard is a desirable or necessary level of attainment. It should be possible to determine whether a student’s practice is acceptable or unacceptable. However, some of the studies were not able to

discriminate between performances (Reubenson, et al., 2012; Eggleton, et al., 2016). According to Wolff, it is possible to determine excellent, acceptable or unacceptable performances but not to provide a linear scale of grades from 0-100 as this is too fine a measurement for accurate discrimination. While several studies had three or four descriptors (Seldomridge and Walsh, 2006; Pulito, et al., 2007; Murphy, et al., 2014; Lefroy, et al., 2015) many of the practice grades stated were expressed as a percentage (for example Plakht, et al., 2013; Murphy, et al., 2014; Hiller, et al., 2016). Therefore, one can question the accuracy of these grades, especially when most grades were in the 70% + bracket (Table 1.2). The grades seem to signify something but not necessarily a measure of performance against the criteria because according to Wolff (2007) it is not possible to be this accurate.

Ranking is the third grading activity, where a mentor considers the performance of this student on the merits of the predecessor; which is whether this student is better or worse than the last student (Wolff, 2007). This form of grading does not allow the mentor to demonstrate how much better this student is and should not be used in healthcare education, since each student should be assessed on their merits against an acceptable standard that protects the public. Wolff supports this premise, stating

that evaluation is at the heart of professional practice (Wolff, 2007). A pass means the healthcare student can enter the professional register, fail means they cannot. Wolff suggests that since most professions are now degree educated we should dispense with grading of practice and award the degree and eligibility to enter the profession upon meeting the standards alone. However, this is clearly not what is happening from the research (Table 1.2).

From the reviewed literature two diagrams can be drawn (Figure 1.1 and 1.2). The figures show the difference between quantitative and qualitative research; with the qualitative research encompassing more of the context of practice than the

Figure 1.1 Visual representation of quantitative survey findings

Practice