Assessing Clinical Practice Using Practice-based Assessments

Advanced clinical practitioners (ACPs) spend a majority of their time in clinical practice (hence the name)!  In fact when defining the role of an ACP, Health Education England named Clinical Practice as Pillar 1. Therefore, it’s important that we have the tools to assess this clinical practice during training and beyond.  To guide learning, evidence achievements and highlight areas that require additional support, we use a combination of four different practice based assessments (PBAs) to evaluate the clinical practice of our ACP trainees.  For mentors and supervisors, these tools provide some structure for clinical teaching and feedback and for the trainee, developing, or established ACP, they can be used as evidence of clinical competence for their portfolio.  Each one focuses on a different aspect of clinical practice: communication, procedures, clinical decision making and the overall clinical encounter.

Check out our four PBAs and download the forms you can use in your practice by clicking the buttons below. Or keep reading to find out more about all of the PBAs.

Our trainees use these PBAs to meet requirements for university modules, but anyone can use them to get structured feedback on their practice or to have hard evidence of your abilities to place in a professional portfolio. 

Say you need to evidence a clinical case in your advanced practice portfolio.  Or maybe you recognised that you haven’t been getting accurate information from your patient’s during history taking.  When the opportunity comes up in your day to day practice, you can find an assessor to watch that aspect of your care.  Ask them to perform a PBA (you can print off a copy of one of our PBAs available here).  The assessor should observe you undertaking the procedure.  They should record a rating for each competency on the assessment form and provide comments to expand on their ratings.  You’re not quite done yet.  Part of the process is to debrief and go over the feedback together, so you have an opportunity to reflect on your practice.  And just like that, you have hard evidence from that point in time that can be put in a portfolio and used during future performance reviews.

PBAs aren’t intended to just showcase the things you are good at.  Sure, they are meant to acknowledge achievements, but they are really great at identifying areas you can improve upon and showing improvement over time.  By completing several PBAs on the same aspect of care over a period of time, you can show how your practice is evolving.

Have a sit down now to identify the particular areas that you might want evaluated.  Have a look at the four types of PBAs we use and print a few off.  You’ll then be able to spot the opportunity to use them and be ready for it when the time comes.

There aren’t too many requirements here.   Assessors should know how to use the different PBAs and be expert in the clinical problem/task being assessed.  In fact, don’t just use one person as your assessor.  Use different assessors.  They don’t need to have prior knowledge of you but they should be aware of what level of practice you are.  If you are a new trainee, a trainee almost finished with training or a long-standing independent clinician, tell the assessor.  This gives them an idea of where your skills should be at and will aid them in assessing you.

It might be tempting to do cram in a bunch of PBAs just before a performance review, but your ability to showcase your clinical skills will suffer.  You want to be able to evidence a variety of clinical learning experiences and capabilities achievements.

To check how you’re progressing in skill, you could set your own timeline for improvement.  Pick a beginning, middle and end point for that timeline and to complete a PBA at these three points.  Your goal should be to improve that skill and the PBAs can help you get there by giving you specific things to work on.

Patient safety and well-being remains paramount throughout.  Your assessor should ensure that the patient is informed, has provided consent for the PBA and experiences no increased risk or discomfort.  The assessor retains responsibility for patient care throughout and will intervene as the situation requires. 

The most important purpose of the assessment exercise is to provide you with some ‘formative’ feedback (information that forms and develops your practice), offering a significant impact on learning.

Immediately after the assessment, you should take 5-10 minutes to sit down with your assessor in a suitable, quiet environment to have a constructive chat.  Use the scores to identify your strengths and weaknesses and get accurate feedback.  Assessors should expand on the reasons for any ratings below ‘Meets expectations’ and make practical suggestions for remedial steps if it is felt that your progress is insufficient.

Don’t forget this is a two-way street. You should then reflect on the feedback and take a proactive approach to improving practice.  Completing PBAs does not give you the authority or ‘license’ to practice without assistance or direct supervision.  That remains the prerogative of your supervisor who has responsibility for patient care.

Once the procedure is done, the form complete, and feedback given, save your PBA somewhere safe (like your portfolio).  Refer back to it to evaluate your practice and use it when you need to evidence your capabilities.

Chances are you’re getting constant informal feedback from colleagues and patients that you use to inform your practice.  PBAs are just one way you can formalise this feedback.  Feel free to use them to help improve your practice and evidence your capabilities.