Audit on Clinical Competency of Fresh Medical Graduates in a Malaysian Private University Using Kirkpatrick Level-1 Evaluation Model

Clinical competency is the core of the medical curriculum. Careful ongoing evaluation of clinical competency is required to ensure continuous reviewing for curriculum development. The objective of this study was to investigate self-perceptions of clinical competency of fresh medical graduates using the Kirkpatrick framework – the most convenient and widely used model for measuring clinical competency. A cross-sectional study was conducted among 50 fresh medical graduates of Widad University College, Malaysia in 2019 using a standardised questionnaire containing 43-items of competency. Respondents were asked to rate self-perceptions of his/her competency in these attributes using a five-point Likert scale against each attribute, where 5 = always competent and 1 = never competent. The response rate was 92%. Out of 43 items, graduates were always competent in taking clinical history and examining a patient thoroughly; frequently competent in eight attributes; sometimes competent in 29; and occasionally competent in four. The graduates have not yet started their houseman-training; and thus, got fewer chances to practice all the procedures. It is expected that graduates’ competency will improve during their houseman training. There is scope for improvement, as faculty need to pay more attention to improving student competency by arranging additional training. The teaching of clinical competency also needs integration with the pre-clinical phase for early exposure. The findings have direct implications for faculty development towards competency-based education that would bridge the gap between education and practice. This study offers other medical schools a window towards comprehensive use of competency tools to assess the competency of their graduates.

Clinical nursing competency assessment: a scoping review

Objective To ensure that only competent graduates are licensed to practice nursing, councils conduct licensing examinations, which may include among others clinical competency assessment. This review explored current practices in clinical competency assessment of nursing students as part of a larger study aimed at developing an evidence-based, context-specific framework for clinical competency assessment in a sub-Saharan African (SSA) country. Methods A scoping guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) was conducted. Results Findings from 28 out of 1151 studies identified from Scopus, PubMed, CINAHL, Wiley Online Library, and ProQuest were included and synthesized. Results show that a good assessment system must be valid, reliable, transparent, feasible, fair, objective, and must provide feedback and continually improve to have an educational impact. Clinical competency assessment systems must be developed on sound empirical evidence, pilot tested, and involve thorough training and evaluation of the examiners. Continuous evaluation of the assessment system is also essential to ensure the quality and relevance of the assessment system. Only one of the included studies was conducted in Africa. Conclusions The paucity of clinical competency assessment research in sub-Saharan Africa may lead to benchmarking assessment systems on research conducted outside the context. Sub-Saharan Africa has a set of circumstances that demand a context-specific clinical competency assessment framework to guide clinical competency assessment.

Nursing students’ confidence in clinical competency and job readiness during the COVID-19 pandemic era

Purpose: This study explored nursing students’ experiences of attending clinical practicum courses in 2020 during the COVID-19 pandemic era, focusing on their confidence in clinical competency and job readiness.Methods: The data for this study were collected using online questionnaires that were uploaded to a free online survey website and distributed via a link to the survey to 334 nursing students attending four-year nursing colleges at four national universities. Data analysis was done with descriptive statistics, independent t-tests, and ANOVA.Results: The participants were mostly female (83.2%) college seniors (78.1%). About 60% of the participants practiced between 40% to 100% of their clinical practicum hours in alternative ways. Almost a third of the participants reported that they were not ready for a job (30.2%). However, participants’ confidence in clinical competency and job readiness was not related to the rate of alternative practice, but rather to both achievement of educational outcomes and satisfaction in the nursing practicum.Conclusion: Due to COVID-19, it is evident that effective and efficient materials and ways of delivering clinical courses are constantly to be sought and developed. In particular, recently graduated nurses who experienced abrupt and considerable alterations in their clinical practicum courses due to COVID-19 are in need of attention while they strive to make clinical adaptations.

The Effects of Self-leadership, Self-directed Learning Competency, and Clinical Competency on Career Adaptability of Nursing Students: Focusing on Mediating Effects of Self-directed Learning Competency and Clinical Competency

Objectives: The purpose of this study was to determine the impacts of self-leadership, self-directed learning competency, and clinical competency on the career adaptability of nursing college students. This study also was conducted to explore the mediating effects of self-directed learning competency and clinical competency on the relationship between self-leadership and career adaptability among nursing college students.Methods: Participants were 150 nursing college students. Data were collected from November 1 to November 30, 2020 using self-report questionnaires and were analyzed using frequency, t-test, one-way ANOVA, Pearson’s correlation, multiple regression analysis, and Baron and Kenny’s method for mediation with IBM SPSS 22.0.Results: The regression model explained 64.0% variance of nursing college students’ career adaptability (F = 63.94, p< 0.001). Significant factors were clinical competency (β= 0.40, p< 0.001), self-directed learning competency (β= 0.36, p< 0.001), self-leadership (β= 0.18, p= 0.011), and application motivation (β= 0.11, p= 0.035). Moreover, self-directed learning competency showed partial mediating effects on self-leadership and career adaptability. Clinical competency also showed partial mediating effects on self-leadership and career adaptability.Conclusions: The results suggest that nursing college students’ career adaptability can be increased through strategies aimed at increasing self-leadership, self-directed learning competency, and clinical competency.

Impact of A Simulation-Based Training on Self Assessed Nursing Performance in Anaphylactic Shock Management: A Pre-Post Educational Intervention Study

Background The New Nurses who lack the ability to recognize and manage anaphylactic shock can endanger the patients. In this study, we explored the effect of a simulated scenario designed to improve nurses’ understanding of their roles and responsibilities during the rescue of a patient with anaphylactic shock. Methods The program of a simulation-based training was designed to teach learners to recognize the signs and symptoms of anaphylactic shock, place the patient in the correct position, stop ongoing intravenous infusion of the antibiotic which trigger the anaphylactic shock, restart an intravenous infusion on a new infusion apparatus, give 100% oxygen via a nasal cannula or mask, preserve airway patency, call the rapid response team (RRT), and correctly administer the medications prescribed by the clinician. Instructors evaluated each learner’s skills and behaviors by using a clinical competency questionnaire. All learners then completed the Chinese version of the Simulation Design Scale (SDS) and participated in semi-structured interviews with their instructors after the training. Results All learners showed significant improvements in the 6 competencies assessed by the clinical competency questionnaire after the simulation-based training (all P<0.001). Scores on the SDS revealed that the learners were highly satisfied with all aspects of the simulation-based training (the 20 satisfaction rates were all above 90.00%). During the semi-structured interviews, new graduated nurses reported that simulation-based training in the management of anaphylactic shock was extremely important and would guide them in clinical practice. Conclusions The simulation-based training in anaphylactic shock is a potentially viable and effective method to teach new registered nurses to manage clinical incidents.