A Handbook for Teaching and Learning in Higher Education Enhancing academic and Practice

Nursing and midwifery
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Supervised experience in healthcare placements typically lasts from four weeks to just
over three months. The focus of learning is different for each placement and should relate
to the student’s level and identified learning needs. Each student is allocated a mentor
from within the practice team to provide support and facilitate learning. Students should
both observe care and participate in giving care. Their placements should be in a range
of settings, including hospital wards, health centres and patients’ homes, thus providing
opportunities for developing a broad spectrum of skills and giving exposure to a variety
of professional specialisations (ENB and DoH, 2001).
Providing sufficient suitable clinical placements is difficult. In many areas nursing and
midwifery students compete with students from other disciplines for practice experience.
Continual effort is required to identify new placements; to prepare these for students; to
support the clinical staff in their roles of supervising, mentoring, educating and assessing
students; and to regularly audit all practice learning environments. The large numbers
of students now in placements, the pressures upon clinical staff and the fast pace of health
practice make it desirable that students acquire some basic skills before entering practice
areas. This protects both students and patients. Teaching these skills is best conducted in
the simulated ward settings of traditional practical rooms or more sophisticated clinical
skills centres.
The assessment of practical skills, clinical reasoning and professional judgement in the
practice area are usually conducted by the mentor who identifies the student’s level of
achievement by reference to a framework. There are three common formats: practicebased
assessments, skills schedules and portfolios. Practice-based assessments focus on
specific outcomes for different stages of programmes and mentors identify if the student
has achieved these at the required level. Similarly for skills schedules, the curriculum
lays down threshold requirements for the number, range and level of skills acquired at
milestones within the programme. Finally, portfolio formats vary but usually include
learning outcomes and required skills with some element of reflection. They are a vehicle
for identifying future learning needs (Gannon et al., 2001).
Practice-based assessments are widely used by the health professions, practitioners
generally taking a positive view of their face validity, authenticity and practicality.
However, there is some disquiet in relation to reliability, objectivity and the equality of
opportunity. The concerns arise due to the large number of students and the consequent
number and range of placements (usually several hundred), offering variable learning
opportunities. Involving several hundred mentors in assessing students presents
challenges for education and updating to promote consistency and accuracy. In addition,
there is often no overview for a mentor of a student’s previous placement performance
nor a real sense of development for students from one placement to another. Schools
strive to overcome some of these concerns by moderating at least a sample of mentors’
assessments; by using a single portfolio over an extended period (see Case study 1);
or by augmenting mentors’ assessments with more easily standardised tutor-led assessments
in simulated practice settings. In addition, reflective writing, while difficult at first,
provides a means through which students may develop critical analytical skills for their
practice (Jasper, 1999).