Assessment of Initial Clinical Assessment of Initial Clinical Competence for NP Regulation: The Competence for NP Regulation: The
Development of an Objective Development of an Objective
Structured Clinical ExaminationStructured Clinical Examination
Marie Napolitano RN, PhD, FNPMarie Napolitano RN, PhD, FNPOregon Health & Sciences UniversityOregon Health & Sciences University
Chief Examiner, NP OSCEChief Examiner, NP OSCECollege of Registered Nurses of BCCollege of Registered Nurses of BC
Alison Roots RN, MHSMAlison Roots RN, MHSMProject Manager, NP OSCEProject Manager, NP OSCE
College of Registered Nurses in British ColombiaCollege of Registered Nurses in British Colombia
InnovationInnovation
First OSCE for NP regulation (licensure) in First OSCE for NP regulation (licensure) in the international communitythe international community
OSCEOSCE
Objective Structured Clinical ExamObjective Structured Clinical Exam Used in Canada by the disciplines of Used in Canada by the disciplines of
medicine, physiotherapy, midwifery and medicine, physiotherapy, midwifery and pharmacy to assess clinical competencypharmacy to assess clinical competency
Structured examination that “biopsy’s” or Structured examination that “biopsy’s” or samples a variety of clinical skillssamples a variety of clinical skills
College of Registered Nurses of College of Registered Nurses of British ColombiaBritish Colombia
Responsible for the licensure or Responsible for the licensure or registration of nurse practitioners in the registration of nurse practitioners in the province of British Colombia (BC), Canadaprovince of British Colombia (BC), Canada
Received approval of requirements for NP Received approval of requirements for NP licensure in 2005 – same time as new NP licensure in 2005 – same time as new NP programs were graduating first NPs in BCprograms were graduating first NPs in BC
Licensure for NPs in BCLicensure for NPs in BC
RequirementsRequirements Graduation from a CRNBC recognized NP Graduation from a CRNBC recognized NP
program or equivalent program or equivalent Pass score on an approved written examPass score on an approved written exam Pass on the OSCEPass on the OSCE
Objectives of the OSCEObjectives of the OSCE
Assess the capacity of NP Candidates to Assess the capacity of NP Candidates to provide health care services to a client provide health care services to a client from a holistic nursing perspectivefrom a holistic nursing perspective
To determine whether the minimum To determine whether the minimum standard to practice has been standard to practice has been demonstrateddemonstrated
To assess the candidate’s readiness for To assess the candidate’s readiness for independent safe practiceindependent safe practice
Development of the OSCEDevelopment of the OSCE
Official parties identifiedOfficial parties identified Project managerProject manager Nurse Practitioner Nurse Practitioner Examination Advisory Examination Advisory
GroupGroup Chief Nurse ExaminerChief Nurse Examiner Case (scenario) authors Case (scenario) authors ExaminersExaminers
Development of the OSCEDevelopment of the OSCE Writing case scenariosWriting case scenarios Creating checklists - observable behaviours Creating checklists - observable behaviours
specific to case scenariosspecific to case scenarios Determining checklists weighted scores and Determining checklists weighted scores and
minimum passing scores minimum passing scores Identifying critical incidentsIdentifying critical incidents Developing the global assessmentDeveloping the global assessment Training standardized patients (SPs)Training standardized patients (SPs) Orienting examiners Orienting examiners Orienting candidatesOrienting candidates
OSCE componentsOSCE components
Five minute scenarios – client interactive Five minute scenarios – client interactive PEPs (post exam probes) – written PEPs (post exam probes) – written
stations to accompany five minute stations to accompany five minute scenariosscenarios
Ten minute scenarios – client interactiveTen minute scenarios – client interactive
Focus of testingFocus of testing
Integration of holistic nursing approach with the Integration of holistic nursing approach with the clinical skills of diagnosing, managing and clinical skills of diagnosing, managing and prescribingprescribing
Client EncountersClient Encounters complete history complete history or or perform physical examperform physical exam oror Counsel / manageCounsel / manage
PEPS PEPS differential diagnosing, diagnostic tests, management differential diagnosing, diagnostic tests, management
plans, writing prescriptions or referral letters.plans, writing prescriptions or referral letters.
Examination CompetenciesExamination Competencies
Assess and diagnose client’s health and Assess and diagnose client’s health and illness statusillness status
Manage client health careManage client health care Promote health and prevent illness/injuryPromote health and prevent illness/injury Maintain professional responsibility and Maintain professional responsibility and
accountabilityaccountability
Case scenarios for FNPCase scenarios for FNP
Cover the lifespan Cover the lifespan Include common client problems and Include common client problems and
needs including prenatal & post natalneeds including prenatal & post natal Developed by experienced NPsDeveloped by experienced NPs
Global assessment rating scaleGlobal assessment rating scale
Relationship developmentRelationship development Clinical knowledge and competenceClinical knowledge and competence
CandidatesCandidates
Graduates of recognized NP programs in Graduates of recognized NP programs in BCBC
Graduates from programs that are Graduates from programs that are educationally equivalent to BC programseducationally equivalent to BC programs
Candidates determined to be educationally Candidates determined to be educationally equivalent by Prior Learning Assessment equivalent by Prior Learning Assessment and Recognitionand Recognition
ExaminersExaminers
RoleRole Criteria to be examinerCriteria to be examiner
Faculty in Master’s level NP program orFaculty in Master’s level NP program or Experienced NP preceptorExperienced NP preceptor
Need to use experienced NPs from Need to use experienced NPs from Washington and Oregon to beginWashington and Oregon to begin
Examination Scoring ProcessExamination Scoring Process
Passing score on a minimum number of Passing score on a minimum number of client interactive stations (scenarios)client interactive stations (scenarios)
Minimum overall competency scoreMinimum overall competency score Demonstrate no critical incidentsDemonstrate no critical incidents
Examination Advisory GroupExamination Advisory Group
Comprised of:Comprised of: Chief and Deputy Nurse Examiners, FNP from Chief and Deputy Nurse Examiners, FNP from
BC (passed OSCE on first run), Registered BC (passed OSCE on first run), Registered Nurses with education and evaluation Nurses with education and evaluation specialtiesspecialties
Role of the Examination Advisory GroupRole of the Examination Advisory Group Determine OSCE scoring and pass criteriaDetermine OSCE scoring and pass criteria Review overall performance of scenariosReview overall performance of scenarios Review performance of candidatesReview performance of candidates
Scoring Development ProcessScoring Development Process
Pre- exam minimum passing standard set Pre- exam minimum passing standard set for checklist and PEPfor checklist and PEP
Scenario field tested ( trialed)Scenario field tested ( trialed) Post field test – performance of scenario Post field test – performance of scenario
analyzed, minimum passing score analyzed, minimum passing score reviewedreviewed
Checklist, PEP questions & passing Checklist, PEP questions & passing scores revised as neededscores revised as needed
Changes since first trial runChanges since first trial run
Scenarios fine tunedScenarios fine tuned Reliability and validity improvedReliability and validity improved
Results of OSCE Results of OSCE
At this time, minimal number of candidates At this time, minimal number of candidates does not allow for release of resultsdoes not allow for release of results
Factors that play important role in Factors that play important role in successsuccess
Orientation to examination processOrientation to examination process Candidate preparednessCandidate preparedness
Future directionsFuture directions
Addition of adult and pediatric NP Addition of adult and pediatric NP examinations in 2006examinations in 2006
Use of Canadian NP examiners, case Use of Canadian NP examiners, case writers writers
Thank youThank you