The Clinical Assessment Tools (CAT)are used throughout the midwifery student’seducation to assess clinicalskills and the ANMAC competency standards. The Learning toolsare assessed by the midwife working with the student.Successful completion of thelearning toolsat each year level aids in building midwiferycompetence. In addition, a separate competency assessment utilising the ANMC competencies, is also completed by both the student and Clinical Facilitator for each placement.
Learning tools
The skill should be assessed in a ‘real life’ situation however if a section ofthe learning toolappears irrelevant or is not applicabletothesituation, thestudent shouldbe asked tocomplete thosecomponentsviasimulation orin theory.Forexample in learningtool number9 ‘Management ofpainrelief inlabour’, ifthestudent does nothavethe opportunity toassist the woman tousea TENSmachine,the assessorwouldask thestudent to explainthe use ofthe TENS machine andmay ask the student toshow her wherethe pads areapplied and howthemachine works toassessknowledgeand competence.
It is the student’s responsibility to ensure all required learning tools are completed for each clinical placement.
How to complete the learning tool assessment
When the student feels ready they will approach the midwife they are working with or a clinical facilitator, to complete a learning tool assessment. If the assessor does notfeelcomfortable toassessthe studentthey should communicate this tothe student prior toattempting to complete the learning tool.
It is best thatonce theskillhas beenperformedthatthe studentandassessorsit together to complete the learning tool assessment.The student isresponsible to completethe columnentitled ‘student’ andthemidwife is responsible forcompletingthecolumnentitled ‘assessor’. The assessor should initial each box as discussed and determinethe overallassessment grade by referringtotheBondyscale (see below).
Please clearly circle the final grade for the learning tool assessment.
An opportunity isavailablefor both parties tomake written comments,thismay include if parts ofthe assessmentwerevia simulation or intheory.
Following this the student and assessor both sign and date the learning tool.
Inthe situationthe studentreceivesan unacceptable grading, the student can repeat the tool at a later opportunity. If the student indicates that they would like further supported practice or the assessor is concerned, they shouldcontact the Clinical Facilitator. Contact detailsforuniversity staff areavailable inthestudent’s practicingportfolios, and feedbackis welcomed.
Criteria for assessment
Themethod of assessmentchosen for boththe learningtools and competencyassessmentsis a modified Bondy scale.The criterion for clinical evaluation developed by Bondy consists of 3major areas:
Professional standardsforthe procedure:theseare interpretedin termsofsafety, accuracy, effect (achievingpurposeof behaviour)andaffect (manner anddemeanour).
Qualityofperformance: refers todegreesofskilldevelopment such as useof time, equipment, spaceandexpenditureofenergyi.e.whether the student anticipates andusestime efficiently. Astudentmay attimesexpend excess energy in attemptingto anticipatethe next step, for example recheckingequipmentor repeatingabehaviour.
Typeandamountofassistance requiredtoperformthe behaviouror skill: Cuestoassistthe student canbe supportive ordirective. Supportivecuesencourage thestudent, such as‘that’s right’ or ‘keep going’.Directivecuescanbeverbalor physicalandare requiredtopromptthestudent in what todonext,or correctthe student.
It is thesecriteriawhichformthe cruxofthe assessment andreducethe amountof subjectivityand variabilityamongstassessors. It is importantthat before completingeachlearningtool, the student and the assessor revisitthese criteria.
The 5 levels, Independent;Proficient;Assisted;Supported; Dependentaredesigned for students at a beginninglevelofmidwifery practice.
It is quiteacceptablethatstudents wouldregularlybe assessedat levels Independent and Proficient during their 2nd and final year, as this wouldinformothersthat they practicesafely, effectively,with appropriatebehaviour, are coordinatedand completetasks in areasonabletime frame.The scale isnot designed sothat “Independent”is somethingthat canonlybe attainedwhen thestudent is ready tobeendorsed as a midwife.Alternately,thereis scopeto assessthe student atlevels,Assisted;SupportedorDependent.
We anticipate that all students would be assessed at a minimum level of Assisted in their 1st year to pass the learning tool assessment and that Supported and Dependent would signal that the student requires further practice or assistance.
The Modified Bondy Scale
Scalelabel / Professionalstandardsandprocedures / Qualityof performance / AssistancerequiredIndependent (I) / Safe andaccurate
Effectiveeachtime
Appropriate behaviour anddemeanoureach time / Proficient,coordinated, confident, occasionalexpenditure of excess energy withinan expedient timeframe / Withoutsupporting
cues
Proficient(P) / Safe and accurate
Effectiveeachtime
Appropriate behaviour anddemeanoureach time / Efficient,coordinated,
confident,
Some expenditureof
excess energy withina reasonable timeframe / Occasional supportive
cues
Assisted (A) / Safe and accurate
Effective mostofthe time
Appropriate behaviour anddemeanour mostof the time / Skilful inpartsofbehaviour
Inefficiencyandlacking coordination
Expends excessenergy Withina delayed timeframe / Frequent verbal and
occasional physical directive cues in additiontosupportive cues
Supported (S) / Safe but not alone
Performs atrisk
Accuratenot always
Effectiveoccasionally
Appropriate behaviour anddemeanour occasionally / Unskilled, inefficient,
considerable expenditureofexcess energy
Prolonged time period / Continuousverbaland
frequent physical cues
Dependent(D) / Unsafe
Unable todemonstrate behaviour / Unable todemonstrate
procedure/behaviour
Lacksconfidence, coordination,efficiency / Continuousverbaland
physicalcues
Bondy,K,N.(1983).Criterion-referenceddefinitions for ratingscales in clinicalevaluation.Journal of nursingeducation22(9)376-382.
Thank you for participating in educating the next generation of Australian Registered Midwives