PLS SIG Conference Wednesday 29th March 2006

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PLS SIG Conference Wednesday 29th March 2006

• Reflections on clinical practice assessment

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Unseen Triads the light is on

• Elinor Clarke

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Welcome

• In the dark?
• Lights On
• Triads Illuminated.
• 40, 60 or 100w?
• Conclusion

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In the dark?

• What is an triad?
• A triad is
• a method of assessment of student midwives in
  clinical practice. A summative assessment of
  theory in practice.
• Levels 1,2 and Level 3 (Competent)
• Based on Fit to practice at the point of
  registration.

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Unseen Triads the light is on!

• Triads Illuminated
• What are unseen triads?
• Roles Responsibilities.
• 40w, 60 w or 100w?
• Evaluation
• Partnership
• Liberated or empowered?

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Triads Illuminated

• Roles Responsibilities.
• Assessment criteria
• Conduct of the Triad
• Logistics
• Marking
• Domestic arrangements
• Equity.

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Triads Illuminated

• Triads were developed planned (1998), utilised
  in the curriculum since May 2001
• Triads are a summative assessment of clinical
  education modules.
• There are 3 triads. Only one is unseen (Level
  3)
• The Unseen triad is used to assess ALL student
  midwives (long 3yr shortened course78 weeks)
• Triads are an assessment tool which mark or grade
  clinical practice.
• Triads are weighted to value midwifery care in
  practice.
• The first unseen triads were conducted on 12th
  January 2004

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Unseen Triad

• An Unseen triad is a level 3 triad
• The assessment provides the opportunity for the
  student to demonstrate autonomy the ability to
  undertake the role and responsibilities of a
  midwife at the point of registration.
• The student is required to assess, plan implement
  and evaluate an episode of care for a woman/ or
  baby previously unknown to them, who has been
  selected by the clinical assessor.

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Unseen triad

• The unseen part of the triad relates to
• The clinical assessor is NOT the students mentor,
  she does not work with the student on a regular
  basis.
• The woman/baby to whom the student provides care
  has not met the student before.
• The care required may be antenatal or postnatal.

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Clinical assessor/Experienced mentor

• Definition an experienced midwife who is an
  established mentor with record of participation
  in Triad assessments.
• Criteria for selection
• willingness to participate in an unseen Triad
• Understands process of Triads
• Confident competent in assessment of students
• Participated in specific updating/workshop for
  preparation to assess unseen Triads.
• Has not regularly worked with the student
  (unbiased)

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Role responsibilities of Clinical Assessor

• The Clinical assessor (experienced mentor) is
  supernumerary on the day of the triad
  (unrostered/ but on duty)
• To identify and choose a suitable woman / or
  baby to receive care the day before the
  assessment takes place.
• To prepare the woman and her family for the
  students assessment and establish willingness to
  participate and gain consent.
• To inform the student and Link tutor of time and
  venue for the assessment.
• To participate in the awarding of marks.

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Role responsibilities of Link Tutor

• To provide copies of the assessment criteria
• To confirm assessment may be conducted.
• To provide written evidence of student
  assessment.
• To confirm attendance at Triad when informed by
  clinical assessor.
• To thank the student for the reflection and thank
  the assessor for her contribution time.
• To update and inform clinical assessors of
  developments to student assessments.

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Role Responsibilities of Student Midwife

• To attend the Triad on the date and time
  specified by the Clinical assessor.
• To confirm his/her intention to present for
  assessment
• To have prepared for the assessment
• To bring with them the documentation for the
  assessment
• To attend the assessment be responsible for
  keeping to time participate in the agreement of
  marks.

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Assessment Criteria

• All assessment criteria remain the same as
  introduced (NMC 2004 Competencies)
• All students have a copy of the criteria in their
  handbooks at the start of the course.
• Students requested (CCC) clarification of the
  numerical award system in an attempt to improve
  inter assessor reliability.
• An additional grid has been produced and passed
  subject quality group (SQG) process

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Conduct Unseen Triad (Level 3)

• The assessments will take place on the
  antenatal/postnatal wards
• Students will not (should not) have the
  opportunity to meet with the woman or view the
  notes prior to the triad
• The assessment is expected to last 40-60 minutes.
• 20-30 minutes for the student to provide care and
  20 minutes for the presentation.
• The presentation must not exceed 20 minutes and
  will be a reflection.
• Each member of the triad will have a copy of the
  marking sheet with the criteria listed.
• Each member should identify their mark and
  agreement will be made on the final mark

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Logistics

• Proposed Unseen Triads are clearly identified.
• Annual leave, sufficient experience
• University staff have been organised into Triad
  Teams.
• Level 3 TRIAD Team members meet regularly to
  facilitate the process.

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Marking

• The triad mark forms 60 of the total module
  mark.
• The student must get a minimum of 40 of the
  possible triad mark in order to pass this
  assessment
• All items must reach at least a score of 2

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Domestic arrangements

• The Clinical assessor should inform the student
  and the Link tutor the time and venue for the
  assessment.
• All students have 10 minutes to view the woman's
  records prior to the assessment should also
  receive a verbal report from the midwife
  responsible for the womans care.
• The Link tutor will provide copies of the
  assessment criteria for those who forget to bring
  theirs.
• The student will declare him/herself fit well
  to undertake the assessment.
• The student is responsible for time management of
  her care and the presentation

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Guidelines to promote equity

• Students will not receive any prompts /questions
  by either Link tutor or clinical assessor during
  the presentation.
• Each member of the tripartite assessment should
  identify their mark on the assessment sheet. Each
  should identify their mark and agreement made on
  the final mark. Where no agreement can be reached
  then the mark awarded will be that of the two
  closest agreed marks e.g. 4,5 and 4 the mark of 4
  will be awarded.

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Recap/Summary

• Triads are a method of assessment for student
  midwives.
• Unseen triads are assessed at level 3
• The student, the clinical assessor and the link
  tutor all participate in marking
• The student must pass this assessment to qualify
  as a midwife!

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Evaluation 40w 60w or 100w!

• What do we perceive from reflecting on this
  method of assessment?
• Hearsay time consuming, stressful
• Evidence co-operation, results
• Are Triads a good method of clinical assessment?

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Analysis

• Is there any evidence that Unseen triads liberate
  student midwives?
• Is it possible to empower students when they have
  to demonstrate skills?
• Can student assessment empower participants?
• What does partnership mean in the provision of
  health care and education?
• Do triads liberate clinical assessment?
• How does partnership working impact upon clinical
  assessment?
• Creativity ?

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Liberation in clinical assessment

• Engaging students in critical thinking in
  midwifery is complex
• Problem solving potentially re-enforces medical
  model of care.
• Partnership with women alienates husbands,
  partners and obstetricians
• Professionals have historically taken the lead.
• Reflection on incidents exposes staff to
  challenges to their delivery of care.
• Potential to generate creative power

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Partnership

• Not new to midwives work in partnership with
  pregnant women and their families.
• Based on DoH (1993) Changing Childbirth
  (choice,continuity and control) for childbearing
  women
• Bsc (Hons) Midwifery programme is based on
  partnership with local NHS Trusts.
• Learning contracts partnership with mentors.
• Adult learners

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Action Plan ??

• Continue to use Unseen Triads for the assessment
  of clinical practice
• Promote the benefits to the NHS TRUST
• Share and disseminate our experiences.
• Place Unseen Triads in Learning Repository
• Publish our experiences.

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Thank You

• For
• attending the workshop
• being willing to discuss Unseen Triads
• Considering some of the issues surrounding
  clinical assessments in midwifery

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References

• Coventry University (2002) Curriculum
• Coventry University (2002) Criteria for Marking
  Triad Assessment Level 3 Competent. School of
  health Social Sciences. Competence Log Book
• Freire P (1996) Pedagogy of the oppressed.
  Penguin.
• UKCC (2000) Requirements for pre-registration
  Midwifery programmes. London. UKCC
• Nursing Midwifery Council (2004) Standards of
  proficiency for per-registration midwifery
  education. NMC.London.

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Workshop Evaluation

• Please complete the evaluation in order that I am
  able to monitor, develop and improve this
  workshop.

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Aims and Objectives

• Aim to reflect upon the unseen triad.
• Objectives are that by the end of the workshop
  participants will
• Understand the process of unseen triad
  assessments
• Recognise the roles contributions of all
  participants
• Identify how the Unseen Triad may empower the
  student and clinical assessor.
• Consider the practicalities of this assessment.
• Share examples of good practice which emerged
  from Unseen triads.

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Plan of workshop

• 11.05 Welcome and introduction
• 11.04 PP Presentation in the dark?
• 11.10 Handout re Triads
• 11.15
• 11.25 Questions
• 11.30 Finish

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Historical Landmarks

• 1988 Introduction of Triads into the Midwifery
  curriculum
• 2001 Unseen triads validated for Level three
• 2003 Clarification of numerical award system (to
  improve inter assessor reliability)
• 2003 Introduction of Triad assessment grids
• 2004 Unseen triads used for the first time