WORKING TOGETHER AND SHARING BEST PRACTICE IN VETERINARY NURSING EDUCATION


The first subject centre meeting for Veterinary Nursing occurred at the Royal Veterinary College on

Saturday 13th February 2010. The aim of this event was to bring together veterinary nurse higher education course providers to discuss and share best practice and the group discussions were facilitated by Hilary Orpet and Sophie Pullen both lecturers in Veterinary Nursing at the Royal Veterinary College. There were attendees from most of the higher education Veterinary Nursing (VN) course providers.

The intended outcomes of the meeting were to:


The meeting explored various aspects of teaching and assessing veterinary nurses at undergraduate level through a number of focused discussion groups. Three main areas were discussed; student selection and retention, work based assessment and assessment challenges.


Student selection and retention

The academic requirements for entry were similar across all courses. There appeared to be universal issues with the basic literacy and numeracy competency of quite a high number of the students. It does not appear that the GCSE grades in English language and mathematics truly represent the abilities of the students. Basic skills assessment is often necessary to ascertain the true ability of the students in these areas with additional support sessions being provided.

The vocational nature of the degree and the current requirement of 70 weeks of practical placement meant that veterinary work experience is a prerequisite to starting a course. Most providers insisted on work experience in a veterinary practice together with additional animal experience in establishments such as kennel and catteries. It was generally felt that work experience was essential to ensure that the students were aware of the important role the veterinary nurse plays in a practice and the references subsequently obtained were useful to help decide on a person’s suitability for a course.

Most course providers carried out either group or individual interviews. One of the main advantages for conducting group interviews was that they reduced anxiety and allowed the interviewer the opportunity to observe the candidate in a group. It was noted that it was more difficult to judge a candidates ability if they were very quiet. Many Universities noted that time constraints often dictated the interview style adopted. The structure of the interview process usually involved a presentation by the course provider and a tour of the facilities. Further information about a candidates experience and level of written English could be obtained by asking them to answer a few written questions. Some universities required students to demonstrate practical tasks such as making up a Buster collar and demonstrating restraint techniques on a toy cat or dog, as this helped to identify issues associated with manual dexterity and a candidate’s ability to problem solve. It was also noted that using ‘props’ such as blood tubes and vaccine bottles helped to guide discussion and identify a candidate’s level of knowledge. Group discussion, provided a useful insight into a candidates ability to interact with others.

Dropout rates for human nursing degree students have been stated at around 25% (Pryjmachuk et al. 2008). It was discussed amongst the attendees that one of the main reasons students leave the course is to take up the offer of paid employment in a veterinary practice with the offer of paid vocational training. It was stated that this particular issue may continue to be a problem especially with increasing tuition fees.


Practical assessment in the workplace

Undergraduate veterinary nurses currently complete a portfolio of evidence of their practical skills and further summative assessment takes place at the university.

The Nursing Progress Log (NPL) is the new electronic skills recording device introduced by the RCVS which will replace the current National Vocational Qualification portfolio system. The students will be supported in practice by ‘clinical coaches’ who will demonstrate particular tasks to the students, allow them to practice and then for the clinical coach to confirm competence. The suggested framework for attaining practical skills will be based on Benner’s (1984) novice to expert model. Universities will be able to build in the reflective component which would help to bridge the perceived theory- practice divide of the academic -vocational veterinary nurse.

Reflective journals/diaries provide a very useful tool from which to explore beliefs and values in terms of your own experience and can provide a valuable teaching tool when used during individual tutorials or group discussions (Hinchliff, 2004). The use of a reflective diary provided a ‘framework for analysis and discussion’ and formed a link between theory and practice. Initial work at the RVC has shown that the daily reflective diary has been very useful in the students being able to identify areas they need to improve on and to clarify what they have learnt from the experience. There are a number of models of refection which are useful in guiding the process of reflection. Students at the RVC are currently writing journals using Rolfe’s Reflective model (2001, based on Borton’s model, 1970) and many students are producing some good entries however many also require a lot of support highlighting the need for good communication between student and tutor whilst the student is on placement. Gibbs Reflective Cycle (1988) is another model that has been used by students at the RVC however it appears that some students find this model harder to use. In a study conducted with students studying human nursing, Timmins et al, (2008), concluded that ‘students in the more senior years were more likely to use a cycle and move beyond the first phase of reflection, whereas the junior students, particularly the first years were more likely to confine reflection to the first phase of Gibb’s’. Anecdotal evidence suggests that this situation is also occurring within the field of veterinary nursing.


Assessment challenges and standard setting

It is important to consider the end product – a Registered Veterinary Nurse when designing the assessments. Ensuring the learning outcomes are aligned with the teaching and learning methods and also the assessment are necessary when formulating the curriculum. The consequential assessments should also be reliable and valid and various methods of standard setting were the main topics of discussion.

Getting the students to engage with the intended learning outcomes so that they understand what they are and they can help with their studies. Well-written learning outcomes also make assessment design much easier.

With regards to teaching & learning methods, it is important to give the student a chance to practice what they are going to be assessed on. Problem based scenarios will help them put the information into action. It will then enable feedback to be given (would should actually be called ‘feed forward’ -) on how can they improve next time.

Assessment methods should be valid, reliable and defensible. Standard setting can help with ensuring this process. Standards are based on judgements about examinees’ performances against a social or educational construct. It is also important to consider the level of the assessment and the associated level of competency -student nurse about to graduate versus competent and experienced RVN.

There are various standard setting methods depending on the type of assessment. Relative methods (norm referenced) are based on judgements about groups of test takers. It compares performances of examinees, i.e. the top 80% of the group pass. Absolute (criterion referenced) methods [Ebel, Angoff] are based on judgements about the test questions and on judgements about individual performance (how much do they know?). For practical assessment, the following methods may be used;

The examiners clinical expertise is used to judge the candidates performance. The global judgement is based on candidates’ performance. Again it is important to remember the level of the exam when making the judgement.


HE BENCHMARKS


Subject benchmark statements set out expectations about standards of degrees in a range of subject areas. They describe what gives a discipline its coherence and identity, and define what can be expected of a graduate in terms of the abilities and skills needed to develop understanding or competence in the subject. It is important to consider whether they are at the right level and whether they will they help us teach and assess at the level to produce graduate nurses? Group work and further discussion focussed on finalising the draft copy so that it may be submitted to the Quality Assurance Agency.


My thanks go to the attendees who contributed to all the discussions making it a very enjoyable day and also to Gillian Brown at MEDEV who kindly organised the sponsorship of the meeting.


References and bibliography

Biggs,J. and Tang,C. (2003). Teaching for Quality learning at University. 3rd ed. Open University Press.

Burns, S and Bulman, C., 2000. Reflective Practice in Nursing: the growth of the professional practitioner 2nd edn. Oxford: Blackwell Science.

Downing et al (2006) Procedures for establishing defensible absolute passing scores on performance examinations in health professions education. Teaching and Learning in Medicine 18(1) 50-57

Duffy, A., 2008. Guiding students through reflective practice – the preceptors experiences. A qualitative descriptive study. Nurse Education in Practice. 9,iss. 3 166-175

Ehrenfield & Tabak (2000) Value of admission interviews in selecting undergraduate nursing students. Journal of Nursing Management. 8, 101-106

Hinchliff, S., 2004. The Practitioner as Teacher 3rd edn London: Elsevier.

Hutton M (1998a) Do school qualifications predict competence in nursing calculations? in Nurse Education Today 18: 25-31.

McCready, T., 2005. Portfolios and the assessment of competence in nursing: A literature review. International Journal of nursing studies 44, 143-151.

McMullan, M., 2008. Using portfolios for clinical practice learning and assessment: The pre-registration nursing student’s perspective. Nurse Education Today 28, 873 – 879.

Pryjmachuk, S. Easton, K. & Littlewood, A. (2008) Nurse education: factors associated with attrition. Journal of Advanced Nursing 65(1), 149-160

Quinn, F. M., 2000. The Principles and Practice of Nurse Education, U.K.: Stanley Thornes (Publishers) Ltd.

Stern et al (2005) The prediction of professional behaviour. Medical Education; 39;75-82

Storey, L. and Haigh, C., 2002. Portfolios in professional practice. Nurse Education in Practice 2, 44-48.

Taylor, B. J., 2000. Reflective Practice: a guide for Nurses and Midwives, Milton Keynes: Open University Press.

Teekman, B., 2000. Exploring reflective thinking in nursing practice. Journal of Advanced Nursing 31(5), 1125 – 1135.

Timmins, F. and Dunne, P. J., 2009. An exploration of the current use and benefit of nursing student portfolios. Nurse Education Today 29, 330-341.

Tiwari, A. and Tang, C., 2003. From process to outcome: the effect of portfolio assessment on student learning. Nurse Education Today. 23, 269 – 277.


RVC School of Veterinary Nursing 7 | Page