Implementation and evaluation of the post-practicum oral clinical reasoning exam

Abstract

Nurses with effective clinical reasoning skills have a positive impact on patient outcomes. For this reason it is imperative that students understand and are able to demonstrate application of the clinical reasoning process. While clinical reasoning is often taught and assessed in preparation for clinical placements, a post-practicum assessment can help to identify if and to what extent students’ clinical experiences influence their learning. The aim of this chapter is to provide a detailed overview of the development of a post-practicum clinical reasoning exam, guidelines for educators interested in adopting this novel approach, and results from the initial evaluation of the exam. The post-practicum clinical reasoning exam for nursing students was conducted in the following manner: Students were provided with a verbal clinical handover and the healthcare records of four patients. In the individual face-to-face oral exam that followed, students were required to describe how they would prioritise, plan and manage the care of the four patients using the clinical reasoning cycle as their organising framework. The exam was marked by a trained staff member, and immediate summative feedback was provided. On completion of the oral exam students were invited to complete a short evaluation survey with closed and open-ended questions. Quantitative data was statistically analysed and qualitative data was thematically analysed. There were 471 students enrolled in the clinical course; of these, 181 participated giving a response rate of 38%. The mean satisfaction score was 3.03 out of a maximum of 5 indicating a moderate level of satisfaction with the oral exam. Three themes emerged from qualitative analysis: ‘Better than written assessment items’, ‘Authenticity of the approach’ and ‘The need for better preparation’.