Using the new Midwifery Practice Assessment Document: a guide for midwives

Introducing the Midwifery Practice Assessment Documents and Ongoing Achievement

Records The new practice assessment documents (PAD) and ongoing

achievement records (OAR) have been designed following consultation with academics from all of the universities involved in the project, staff from practice in all of the partner NHS Trusts, subject experts locally and nationally, students, Supervisors of Midwives and women who use maternity services.

The documents were validated by the NMC in February 2015 to be used in all undergraduate midwifery programmes by all of the universities involved in the project, beginning in September 2015.

How to use the practice assessment document (PAD)

At the front of the PAD there are generic guidelines, followed by guidance that is specific to the student’s programme and the university they are studying at.

The PAD is based on four practice assessments each year/part of your programme that will be undertaken whilst the student is on placement.

Assessments will be made of their knowledge, skill and attitude in four areas of care: antenatal care, labour care, postnatal and neonatal care and infant feeding.

Guidance for completion

There is a planning page at the front of each document to help the student to plan when to undertake each assessment.

The student will need to work with the Link Lecturer and the midwife responsible for planning the clinical allocations (this may be a Clinical Placement Facilitator, Practice Development Midwife or student co-ordinator) in order to use this assessment planner and the PAD effectively.

Students should be advised to check their course plans and clinical allocations to ensure that they plan appropriately. They are advised not to leave all of the assessments until the end of the year.

Students will also record the cases to count towards the EU requirements within each of the skills clusters. This also helps to demonstrate the amount of clinical experience they have had and to help the sign-off mentor decide on the best timing for the assessments.

Assessment planner and guidance

FAQs: Assessment planner and guidance

Q: What if students have to plan formative review and summative assessments in different areas?

A: This may need to happen if allocations to an area are shorter than four weeks. If possible, the appropriate areas and dates should be allocated by looking at the allocation plans with the CPF and Link Lecturer.

 

Q: What if students haven’t recorded the suggested numbers in the EU records by the assessment date?

A: The suggested numbers are provided for guidance only. Sign-off mentors can use their judgment to consider whether students have had the required amount of experience before undertaking an assessment. If significantly less (or more) cases are recorded than suggested, discuss this with the Link Lecturer and CPF.

Who is able to undertake student assessments?

The NMC standards for pre-registration midwifery education (2009) state that all summative judgments regarding student competence must be made by a sign-off mentor.

A sign-off mentor is a qualified midwife who has successfully undertaken a mentorship course that includes additional sign-off competencies.

A sign-off mentor must verify the achievement of all non-shaded competencies and undertake all formative reviews, summative assessments and medicines management assessments.

Who else can write in the PAD document?

Midwives who are not qualified sign-off mentors are able to complete the orientation to a clinical area, verify the achievement of any shaded competencies, complete the additional comments boxes and the additional skills log.

Every professional who writes in the document must complete the record of signatories page. There is a page for sign-off mentors and a page for others, please ensure the correct page is completed.

Students are expected to get some feedback from the women or families that they participate in providing care for.

This should be facilitated by midwives/sign-off mentors. The students should not approach women or their families directly.

Document signatories pages

FAQs: Document signatories

Q: I am working with a student but I am not a sign-off mentor, can I write in the PAD?

 A: Yes you may comment on the student’s performance or confirm

achievement in the shaded competencies. You should not assess students in the non- shaded competencies or undertake the formative review, summative assessment or medicines management. You may sign the EU records and complete the orientation.

Q: I am a registered healthcare professional but I am not a Registered Midwife can I write in the document?

 A: Yes you may write in the additional comments sections and the short

practice placements record. You cannot assess the student in any of the competencies or undertake the formative review or summative assessment. Please remember that you must also complete the signatories page.

Orientation

It is important that students are orientated to each clinical area prior to undertaking any clinical activity.

Some orientation activity must take place on the first day of a placement, other activities may be completed within the first week.

The midwife who undertakes the orientation activity must sign and date the appropriate box.

Planning meetingThe planning meeting is the opportunity to discuss the student’s learning needs, and should happen as soon as possible when they start in a placement area.

Students should complete the first section prior to the meeting, identifying ways that they feel they can be helped to learn most effectively.

The provisional dates for formative review and summative assessments should be agreed and put on this page and the assessment planner.

EU requirements records

The EU records are integrated into the document so that students can record evidence of their clinical experience alongside the record of achievement in the competencies. This enables sign-off mentors to track progress and consider if students have had the appropriate amount of experience prior to assessment.

Students need to complete this section in accordance with the university policy for maintaining confidentiality whilst ensuring verification can occur. Midwives are asked to verify the EU records.

FAQs: EU recordsQ: I am a Registered Midwife but I am not a sign-off mentor. Can I sign the EU record? A: Yes all registrant midwives may sign the EU record pages to verify that they have

supervised the student provide the care documented.

Q: The document asks for a client identifier to be recorded. What is the client identifier? A: In order to protect client confidentiality but ensure verification can occur, the university

will provide guidance for students regarding what should be recorded in this section. Please check with the Link Lecturer for clarification.

Q: How do second year / third year students record their EU records - what number do they record in the box in the new PAD?

A: When students receive the new documents, they should complete the EU totals in the year 1 or year 2 summaries in the OAR. They should then write the next number in the new PAD to indicate accumulative totals.

For example, if at the end of year 2 they had undertaken 64 antenatal examinations, this should be recorded in the OAR year 2 summary, and in the new PAD, the first antenatal examination would be recorded as 65.

How are students assessed?

Sign-off mentors or registrant midwives (shaded sections) sign to confirm when students have achieved the competencies within each cluster section of the PAD.

When all of the competencies have been assessed sign-off mentors need to complete the holistic assessment.

Levels of achievement are outlined in the holistic descriptors within each cluster. When making a judgment about a student’s performance, sign-off mentors should take into account sources of evidence that encompass knowledge, skills, attitudes and the views of those receiving care.

CompetenciesThe competencies have been written based on the NMC essential skills clusters and domains. The un-shaded competencies must be assessed by the sign-off mentor only.

The shaded competencies can be assessed by other midwives that work with the student. The boxes should be completed, signed and dated when the student has achieved the outcome.

Additional commentsMidwives who have signed competencies, but will not be undertaking the formative review or summative assessment, can record their comments in these boxes to contribute to the holistic assessment.

This enables communication between midwives and the sign-off mentor and informs the holistic assessment.

Sign-off mentors can also contact other midwives who have worked with the student to discuss your progress if required.

Service user feedback form

Within each cluster there is a page for students to receive feedback directly from someone they have cared for.

The midwife that works with the student should seek feedback from the woman, or her family, on the student’s behalf.

Midwives may complete the form on behalf of the client and ask them to sign or initial to verify the information.Midwives are also asked to sign on completion for verification purposes.

This feedback may inform the holistic assessment.

Holistic Assessment

Sign-off mentors will assess students on their knowledge, skill and attitude when providing care within each cluster.

The holistic assessment will assess the student’s ability to bring the elements of care together, demonstrating development towards autonomous practice as a midwife.

Formative review

Students are expected to complete their reflection before the formative review (which ideally should be at the mid-point of the allocation).

The reflection is structured to encourage them to consider how their knowledge, attitude and skills have enabled them to develop and achieve the skills and competencies in the cluster.

Students also make a self-assessment against the holistic descriptors. They should do this prior to meeting with their sign-off mentor.

FAQs: Formative reviewQ: Do students have to complete the formative assessment before being

assessed by the sign-off mentor?A: Yes, before the sign-off mentor undertakes the review students should have

completed the self-assessment and have awarded themselves an indicative descriptor.

 Q: What if I disagree with the descriptor the student has awarded

themselves?A: At the formative review the self-assessment reflects the student’s perception

of their performance and ability to bring together the aspects of knowledge, attitude and skill.

You may feel that the student’s performance is more accurately described by a different descriptor, and you should indicate this on the assessment descriptors page. Do not suggest that the student changes their assessment. If different descriptors have been awarded, this should prompt discussion between yourself and the student. Using the words within each of the descriptors, try to identify the areas where you are not in agreement, for further discussion. If you consider that any element of the student’s practice is within the ‘Unsatisfactory’ descriptor then this must be the descriptor awarded overall.

Formative review: sign-off mentor comments

The sign-off mentor completes the review pages indicating what the student has done well, and areas for development.

Comments are required in relation to the student’s knowledge, attitude and skills.

If there are causes for concern, the link lecturer should be contacted immediately these are identified.

Professional values

 Comments are not required in the professional values assessment unless there is anything particular to note.

Comments should be provided if the student has not achieved. The ‘Unsatisfactory’ descriptor must be awarded in the holistic assessment and an action plan written. The Link Lecturer should also be contacted.

Assessment rubrics Students should be demonstrating the majority of the behaviours within

the descriptor section for the overall descriptor to be awarded. Each of the descriptors are made up of an aspect of knowledge, attitude and skill.

If you consider that any aspect of the student’s performance falls within the ‘Unsatisfactory’ band then you must award the ‘Unsatisfactory’ descriptor overall.

At the formative review, this will enable the student to reflect on their performance and help them to identify areas for development before the summative assessment. The Link Lecturer should be contacted and an action plan completed to enable the student to focus on specific development requirements.

Assessment descriptors

The assessment descriptors are different at each academic level and are a combination of statements relating to knowledge, attitude and skills.

The majority of the descriptions within the column must be met to be awarded the overall descriptor.

If any element in the ‘Unsatisfactory’ column describes the student’s level of knowledge, attitude or skill then the ‘Unsatisfactory’ descriptor must be awarded overall.

FAQs: Holistic assessment descriptorsQ: What if the student’s practice meets elements within different

descriptors?

A: You should award the descriptor that most closely matches the student’s performance. The majority of elements must be met within the descriptor. The elements within each descriptor link together and it would be unusual for a student not to meet most of the elements within one descriptor.

 

Q: Are the descriptors the same in all of the PADS?

A: No. There are different descriptors for each academic level

 

Q: What if the student and I don’t agree on the descriptor?

A: The descriptor awarded by the sign-off mentor is the descriptor that will be converted into a grade. The student self-assessment should allow the discussion of expectation and achievement, and facilitate the development of self-awareness and reflection on feedback for the student.

Action plansAn action plan should be completed when:

• any of the competencies have not been achieved by the formative review

• the ‘unsatisfactory’ descriptor has been awarded in the holistic assessment at formative review

•any of the professional values have not been achieved

Summative assessment The summative assessment follows

the same process as the formative review with the student completing a self- assessment prior to the sign-off mentor undertaking the summative assessment.

 

There should be no surprises for the student at this point.

If there were causes for concern, the student should have received written feedback, and an action plan should have been commenced at the formative assessment stage.

The link lecturer should already be involved.

FAQs: Summative assessment

Q: What if the student has not achieved the action plan and therefore does not meet the criteria for a pass?

A: Unfortunately this will mean that the student will fail the assessment, and the practice element of the module at first attempt. The Link Lecturer must be informed and the university processes followed for a further attempt if the university regulations permit. An additional action plan must be written by the sign-off mentor with input from the Link Lecturer, with clear outcomes detailed.

 

Q: Does the summative assessment have to be completed by a sign-off mentor?

A: Yes. Sign-off mentors must ‘make the final judgment that all competencies have been met and that the student is considered proficient’ (NMC SLAiP 2008 p.13), although the evidence that they consider when making this judgment may also come from midwives who do not meet the sign-off mentor standard.

The Ongoing Achievement Record (OAR)

Summary pages

The sign-off mentor should complete a summary page in the OAR after each summative assessment.

 

Midwifery Supervision

There is a page in the OAR for the student and their Supervisor of Midwives to record the annual meetings. This is to introduce students to midwifery supervision and to facilitate a relationship to develop with their supervisor.

The requirements are different in each year/part of the programme to reflect the student’s development towards registration.

 

FAQs: Summaries and gradingQ: How is the overall grade for practice in the PAD calculated? A: When the student submits their PAD and OAR at each progression point,

the calculation of the overall grade will follow university processes. A percentage equivalent for the descriptor will be applied. The descriptor bands match the degree classification boundaries at each university.

Undergraduate programmes:Excellent: First Very Good: Upper second Good: Lower second Satisfactory: Third Unsatisfactory: Fail

PGDip and Masters level programmes: Excellent: Distinction Good: Merit Satisfactory: Pass Unsatisfactory: Fail

Medicines Management

Students are required to complete a medicines management assessment towards the end of each year/part of your programme. This can only be undertaken when they have been assessed summatively in all four clusters.  This assessment can only be completed by a sign-off mentor.

FAQs: Medicines Management assessmentQ: Why does this have to be completed after all of the cluster

assessments? A: There are medicines management skills and competencies in each cluster.

Once these have been passed, students can be assessed in the separate assessment. If the student has passed all of the clusters, they will be in a good position to pass the final medicines management assessment.

 Q: I am not a sign-off mentor. Can I do the medicines management

assessment and ask a sign-off mentor to countersign the document?A: No. This assessment can only be undertaken by a sign-off mentor. Q: The medicines management assessments refer to Midwives

Exemptions. When can a student midwife practise Midwives Exemptions?

A: Student midwives can only supply and administer medicines according to Midwives Exemptions when under the direct supervision of a sign-off mentor. This excludes controlled drugs, which may only be administered by a student midwife if a patient specific direction has been written by a doctor or independent prescriber.

Records of short practice placements

Students may be allocated to short (outreach) placements for example; day assessment units, early pregnancy units, gynaecology clinics, child health, family planning or sexual health clinics.

These pages at the back of the document are for students to record reflections on their learning and for feedback from the person supporting the experience.

Students may also be required to complete these records for their non-midwifery placements. Link Lecturers will be able to advise further.

Records of practice hours

Students are required to provide evidence of their practice hours for NMC registration. The midwife working with the student should verify the hours worked at the end of each shift.

This signature must be from a midwife who has directly worked with the student and be reflected on the duty rota. Students will have specific information from the university regarding how this information is submitted, reported and recorded.