Indicators of Competence Based on Essential Psychometric Concepts

Critical elements are defined as the set of single, discrete, observable behaviors that are mandatory for the designated skill, at the targeted level of practice. They represent principles that are essential to ascribe competent performance to a given ability; they are not steps in a procedure, even though they are written in a logical sequence. Critical elements are the criterion-referenced performance equivalent to items on a written test. Criteria for writing them are similar to those for outcomes, although critical elements are more singular, specific and circumscribed. The following are four of the most basic criteria:

1. Begin each critical element with the verb that most succinctly identifies the mandatory aspect of the skill to be demonstrated; on average, four to six critical elements are needed for each skill.
2. Use language that is clear and unambiguous and has commonly accepted, uniform interpretation. Words such as appropriate, proper, recognize, and acknowledge have very divergent interpretations, cannot be objectively assessed, and should be avoided.
3. Include behaviors (actions) at the higher end of the thinking and action spectrum expected at the particular level that subsume lower level action subsets. As used in competency assessment, critical elements are required skills expected of all nurses and therefore, 100% of them must be performed as stated.
4. Include only actions (behaviors) that are essential for documenting competence. That which is essential (must perform) needs to be separated from what is considered ideal (nice to know) during performance examinations; the mandatory elements define the bottom line of actual required performance while the "nice to know" is incorporated into learning experiences but not necessarily included into performance examinations. The baseline of acceptability is not less than sufficient; it is, by definition, "how good is good enough" to be called competent &coparef.htm#151 all 100% of it.

Figure 2 illustrates different types of nursing competencies and related critical elements. Specific wording is adapted to correspond to the level student or practitioner, setting and other conditions. Any ability required for practice that can be defined can be developed with associated mandatory critical elements and assessed objectively.

Most Effective Ways of Learning Competencies

The third question in the framework is challenging as well, but for somewhat different reasons. Discovering and implementing the most effective ways for learners and practitioners to achieve the required competencies means changing some firmly held habits and myths about the roles of teachers and students, how learning is accomplished, and which content is essential for contemporary (not past) practice. Requirements for individual employment and advancement, as well as for professional and institutional accreditation, however, are forcing the issue (Joint Commission, 1996; NLN, 1992). For faculty, making the transition from lecturer to engaging facilitator who uses multiple student-focused interactive learning strategies may be unsettling or confusing, and usually engenders some resistance or conflict, as described in this volume by Bargagliotti, et al. It is not easy to change teaching behaviors as this requires reconceptualizing the purpose of learning, the focus of content and assignments, and performance assessment methods. It also requires a reassessment of the interface between education and real life professional practice as it is now and is likely to become in the near future.

Publications in the 1990s on interactive learning, collaborative learning, case studies, simulations and other useful strategies are too abundant to list here, but can be found easily via ASHE-ERIC Higher Education Reports (including Chaffee & Sherr, 1992; Davis & Murrell, 1993), Change, American Association of Higher Education, Jossey-Bass Publishers, as well as the Journal of Nursing Education, Nurse Educator, and other nursing journals. The publications on teaching, learning and assessing critical thinking written by Kurfiss (1988), Hutchins (1993), Bosworth and Hamilton (1994), and Facione, et al (1994) are extremely useful and explore different methods to promote this essential competence. Classroom Assessment Techniques (second edition), written by Angelo and Cross (1993) contains over 50 different learning and assessment strategies to promote critical thinking and communication skills and is an invaluable resource. The strategies are applicable to nursing education and practice and the book provides rationales and guidelines for using each exercise.