Verbal assessment is a recognised method of confirming learning and understanding across many disciplines and a range of subject areas. This type of assessment examines learner knowledge and skills where they are questioned about a subject area by at least one examiner (Knight et al, 2018; Abuzied and Nabag, 2023). A variety of nomenclature has been used to describe this assessment method, including professional conversation and viva voce (viva); the former is the preferred descriptor, and is used in this narrative.
At a university in the north of England that has been deemed outstanding by Ofsted, student nursing associate (SNA) occupational readiness is confirmed using a structured professional conversation. This evaluates learner knowledge and understanding of the six platforms and two annexes of the Standards of Proficiency for Nursing Associates (NAs) (Nursing and Midwifery Council (NMC), 2018a), applied to a clinical case. Additionally, learners are required to meet other professional practice-related learning outcomes within this timed assessment. They have to demonstrate an understanding of professional behaviours and personal characteristics relevant to the effective delivery of nursing care, including learning and teamworking styles and leadership qualities, learnt and applied throughout a 2-year foundation degree apprenticeship to prepare for NMC registration as an NA (NMC, 2018a).
This assessment methodology has been used since the inception of this apprenticeship at this university and has been found to be an effective method for learners to demonstrate their theoretical knowledge and its application to practice, with most learners articulating their learning well and gaining high marks. The purpose of the professional conversation is to assess occupational readiness.
Occupational readiness
The concept of occupational readiness has been widely studied, with the definition generally understood to be a ‘level of preparedness for future work’ (Li et al, 2022: 2969) and the learner's ability to demonstrate skills, knowledge and behaviours commensurate with the role that they will be undertaking (Caballero and Walker, 2010; Walker and Campbell, 2013).
Psychological variables related to preparedness increase the ability to cope in the workplace alongside having a greater commitment to their profession and remaining in the role (Li et al, 2022).
With the current employment and staffing crisis in the nursing profession (Royal College of Nursing, 2023), ensuring learners are occupationally ready and understanding the concept from the educational perspective could not be more relevant.
Occupational readiness is defined as meeting the requirements of the NA apprenticeship curriculum while being able to apply theory to practice to meet patient care needs (Institute for Apprenticeships and Technical Education (IfATE), 2022).
The Standards of Proficiency for NAs (NMC, 2018a) detail the scope of practice within which SNAs and NAs must practise. The standards for NAs have six platforms and two annexes covering communication and clinical skills (Table 1). Together, these encapsulate the key behaviours and practice scope expectations of the SNA/NA role. SNAs are also expected to uphold the NMC Code (2018b) and behaviours consistently.
| Six platforms |
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| Two annexes: communication and clinical skills |
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Theoretical and practice modules within this NMC-validated apprenticeship are scaffolded across years one and two to build knowledge, a theoretical understanding of nursing practices and the practical skills required to complete the apprenticeship at foundation degree level.
Learning to Learn is the first module in the apprentices' academic and professional journey. It aims to develop students' ability to identify appropriate literature to underpin their academic writing, supporting their development in academic writing skills and emphasising the need for them to critically appraise and question evidence underpinning clinical practice.
Other first-year modules influence the development of personal and professional knowledge and clinical skills while encouraging, through discussion and assessment, the application of theory to practice using a case study and an episode of care example.
Personal and professional development, including self-awareness, leadership, teamworking, learning styles and behaviours expected as a registrant (and during the apprenticeship), is also key to the foundation-level learning.
The second year of study enables learners to progress their understanding of research methodology and knowledge of disease processes while learning to identify and manage the deteriorating patient.
The final module, Professional Development for Nursing Associates, encourages learners to draw together, consolidate and build upon theoretical and clinical knowledge and learning gained throughout their 2-year apprenticeship to support progression to qualification and registration with the NMC while meeting apprenticeship standards (IfATE, 2022).
A strong emphasis on the practice of reflection, using a recognised framework such as that by Gibbs (1988), seeks to further develop learners' sense of their own impact on the care experiences of their patients/clients (as described by Jones et al, 2020), and supports deeper learning and questioning of care episodes and events in practice.
Learners are expected to be able to make decisions and be advocates for their patients and colleagues, so need to be able to reflect effectively ‘on action’ and ‘in action’ (Schön, 1983). They are expected to understand how others, including their peers and patients, process information, make decisions and respond to others. The complexities of human interactions and decision-making processes surrounding health, for example Janz and Becker's health belief module (1984) and the behaviour change theory (Prochaska and Velicer, 1997), as well as effective communication to elicit health behaviour change (Stickley, 2011; Egan and Reese, 2021; Miller and Rollinick, 2023) are revisited during this module. Preparation materials, including those delivered during scaffolding learning in year one, are presented, encouraging students to consolidate their learning across the curriculum to prepare themselves fully for the professional conversation examination.
The teaching within this module encourages learners to consider their ongoing learning after qualification and preparation for revalidation with the NMC 3 years after initial registration, as well as job interview preparedness; it is also key to the university meeting Ofsted's (2023) education provider quality assurance requirements that its learners are prepared for work and supported to progress occupationally.
The assessment format for this module is the structured professional conversation, which examines knowledge, skills and understanding. It assesses occupational readiness.
Preparation for the structured professional conversation assessment
In the weeks leading up to the assessment, learners are appraised of a clinical case study that provides authenticity and relatability to the examination.
‘Tom’ presents with a health condition and healthcare needs. Learners are expected to examine the learning in which they have engaged over the programme and apply their understanding of the patient's requirements across the six platforms and the two annexes of the Standards of Proficiency for NAs (NMC, 2018a). They are not informed of the examination questions but are aware of the learning outcomes for the module, which have been raised as learning and reflection points throughout the module and preparation for the examination. Learners are also advised that, at the time of the summative examination, they will be provided with a short, unseen additional piece of information related to the clinical case that they must consider in their responses to the examination questions.
A peer-assessed formative assessment is completed in class, Learners, in self-allocated groups, discuss Tom's needs in the clinical case, which will be used for the professional conversation examination, and provide feedback to each other, a method of learning described by Boud et al (1999), Topping and Ehly (2001) and Stenberg et al (2021). Learners are encouraged to comment and make notes during the peer-peer reciprocal learning, a strategy that has been found to have positive effects on learning outcomes, particularly where the tutor is involved in the discussion, as is the case here (Choi et al, 2021). Ko et al (2022) argue that peer-peer learning is as effective as independent learning. The apprentices have already gained a range of clinical experiences, knowledge and skills on their base and alternative placements, so the formative assessment provides them with opportunities to both learn and to share their knowledge and experiences related to the clinical case study. Following peer-peer feedback, learners are offered the opportunity to write up the in-class group work for formative assessment by the module leader. This is not formally marked but feedback to support revision is provided.
In addition to the clinical case study and to meet the other learning outcomes for this module, learners are expected to revisit resources delivered across the 2-year curriculum. These include accountability, health promotion and health surveillance, communication styles, managing patient handover, the ABCDE (airway, breathing, circulation, disability and exposure) approach to resuscitation (Resuscitation Council UK, 2021), monitoring a patient's condition, teamworking, learning and leadership styles, as well as assessing and managing risk, all of which are elements of the NMC Standards of Proficiency for NAs (2018a). Their learning is structured to allow these components to be explored further within the last two lectures of this final programme module.
The examination brief and learning resources for this module are clear and structured to encourage learners to engage with all elements required to pass the professional conversation examination. Examination preparation information provided is specific and detailed to ensure that all learners have the same opportunity to prepare to a high standard.
The assessment, which is aligned to Ofsted's stretch and challenge principles (Daly et al, 2012) involves a range of structured, open questions designed to elicit from the learners their depth of understanding and knowledge, and their ability to critically appraise, analyse and make decisions, enabling all, irrespective of underlying academic ability, to achieve their personal potential.
Additional module resources are structured to provide challenge to more able learners to enable them to showcase their depth of knowledge and understanding and articulate this to a high standard during the examination.
Examination process
For 3 minutes before the examination begins, learners are permitted to write short notes as an aide-memoire to refer to during the examination. In the examination, they are expected to meet specified module learning outcomes:
During the examination, the apprentice learner is expected to demonstrate they can apply their knowledge, skills, behaviours and attitudes using examples from practice, exploring differing approaches to clinical situations through reflection on personal experience and self-knowledge. The assessment allows them to demonstrate personal and professional attributes such as compassion, care, communication, courage, commitment and competence (Department of Health, 2012) in relation to clinical situations, assuring employers of their professional competence and occupational readiness.
Ensuring validity and reliability
Although there have been some suggestions that the examination of knowledge through oral methods can have poor validity (the test not measuring what is intended) and reliability (the results cannot be depended upon) and be subjective, the advantage of this type of assessment is that examiners are able to assess each learner's application of knowledge to clinical situations and their level of clinical reasoning (Abuzied and Nabag, 2023).
To increase internal valdity and reliability of the professional conversation:
The examination itself is scored up to 95% of the total mark, with a maximum of 5% of the total being awarded for accurate referencing in a citation list submitted before the examination. The references relate to the subject areas being examined and are expected to be presented in the APA 7th format (https://apastyle.apa.org) and referred to by the learner during the examination.
Examiner perspective
Feedback from an examiner shows the examining experience has been positive:
‘The planning and organisation of the assessment is a straightforward process for examiners to follow. The exams run smoothly due to the pre-planning and clear guidance of expected time allocation per question. This, however, does require careful consideration to ensure the learner has sufficient opportunity to answer all questions, whilst not disturbing the flow by interrupting. With a clear link to both the NMC (2018a) platforms and the learning outcomes, the examiner can accurately assess the learners' occupational readiness.’
The course external examiner commented in her feedback:
‘This is an excellent assessment which consolidates prior learning and enables students to demonstrate their understanding and application of programme content to their practice … The assessment prepares students well for the challenges of the nursing role and I am sure there will be many high achievers who positively influence nursing practice in the future.’
Conclusion
The professional conversation examination is authentic and prepares learners for future NMC revalidation, as there is a strong emphasis upon reflection, professional decision-making, professional practice and demonstrating the NMC Code ‘in action’ (external examiner, email dated 2 October 2023). It allows learners to showcase their knowledge around learning and leadership styles and their application to practice and teamworking as well its importance to patient outcomes, self-awareness and the learner's knowledge. It will also demonstrate their knowledge of how they need to continue to develop and learn after qualification, in addition to applying the standards of proficiency (NMC, 2018a) to clinical practice.
SNAs' success rate using this assessment format is high. Learners evaluate the module and their preparation for professional conversation examination positively.