The Evaluation Process

Clinical courses are the most effective and potent experiential learning opportunities that nurse practitioners receive during their academic careers. The evaluations provided by preceptors help students conceptualize what they are doing right and wrong, supplying both motivation and instruction for improvement.

Duke University School of Nursing Preceptor Evaluation of Student Clinical Performance Form

Clinical Reasoning and Decision Making

Clinical reasoning is the process by which healthcare professionals collect cues, process information, come to an understanding of a patient problem or situation, plan and implement interventions, evaluate outcomes and reflect on and learn from experiences treating patients.

Critical reasoning enables nurse practitioners to meet the needs of the patients as they consider the patient’s preferences, consider alternatives, and think reflectively. This results in better patient-centered care.

Decision making can range from fast, intuitive, or heuristic decisions through to well reasoned, analytical, evidence-based decisions.

Core Skills of Clinical Decision Making

When teaching clinical decision making, you will want to make use of the following strategies:

Pattern recognition: Teach the student to recognize patterns, apply lessons learned to other cases that share similarities as they learn from experience.

Critical thinking: Exemplify removing emotions from reasoning as you consider all factors and deduct rational diagnoses and treatment plans.

Communication skills: Model effective questioning and active listening to the patient.

You will also want to teach the following evidence-based approaches:

Teamwork: Emphasize the importance of getting support from colleagues and other members of the team, and providing support in return, when appropriate.

Sharing: Model the effectiveness of getting feedback from colleagues.

Reflection: Show the student how you use feedback from your colleagues and others.

Nurse practitioners with effective clinical reasoning skills have a positive impact on patient outcomes. Conversely, those with poor clinical reasoning skills often fail to detect impending patient deterioration. The development of keen clinical reasoning skills is dependent upon critical thinking and is enhanced by observing and discussing cases with seasoned medical professionals.

The student will absorb a sense of clinical reasoning as they shadow you, but the bulk of this understanding is fostered through practical experience, reflective discussion and evaluations provided. This is why our preceptors must recognize the value of effective evaluation techniques.

Types of Evaluation: Formative and Summative

We ask our preceptors to provide two types of evaluation: formative and summative.

Formative evaluation is an assessment of student performance during the clinical rotation. Formative evaluation provides the students with feedback and an opportunity for improvement while they continue to learn. The preceptor should discuss areas of strength, as well as areas that have been identified as needing improvement. Strategies to improve should be included and documented in the evaluation. Formative evaluations should take place at midterm.

Summative evaluation is the assessment that describes the student’s performance, development, and areas for improvement after the clinical rotation. The summative evaluation of performance is based on the criteria indicated in the evaluation tool provided by the Duke University School of Nursing course faculty. Written comments are important and valuable if the student requires remediation in a competency area. The student’s self-evaluation should be considered during evaluation discussions. Summative evaluations take place at the end of each clinical semester.

Duke University School of Nursing Preceptor Evaluation of Student Clinical Performance Form

How Evaluations Factor into Clinical Course Grades

Students who receive a rank of 2 or lower out of 4 on midterm evaluations will be subject to an on-site clinical visit by clinical instructors or course faculty. Also, students are required to complete remediation measures. For most clinical courses, students must achieve a minimum of a rank of 3 out of 4 on each evaluation to successfully pass the clinical course. We encourage preceptors to be as honest as possible with the student, even if this requires giving the student a low or failing grade. This appropriate feedback is critical to ensuring that students are receiving the feedback they require to improve.

While the desire to pass clinical courses is inherently a motivating factor for students, your evaluations will provide much more value than simply acting as a stick or carrot. Your evaluations carry weight. A recent study conducted on students at an eastern US university concluded that detailed comments are the most effective motivators to performance improvements. That is why we ask our preceptors to provide detailed, actionable strategies for improvement that students can use on a practical level.