I view assessment as integral to the learning process and think feedback needs to be timely, constructive and relevant. Students who rely on techniques such as memorization usually complete tasks for assessment purposes only whereas students who adopt deeper reflective approaches are more inclined to understand ideas and make connections. This is why I encourage students to learn from their assessments and my feedback and to become more autonomous.

 

Fieldwork Placement Formative Assessment through Observation, Questioning and Reflective Storytelling

I am responsible for assessments of clinical placements in first year and third year. I start by conducting regular observations of each student linked to the competencies required in their fieldwork placement. In the next phase I use strategic and/or challenging questioning to facilitate deep learning about the knowledge and skills they have acquired as a result of working in a ‘real life’ context. I also share stories from my own experience to make a point or clarify a situation. Through observations, questions and the modelling of different ways to tell clinical stories, I prepare them to tell their own stories. Students at first year level do not necessarily understand what type of story is likely to demonstrate their abilities. I therefore scaffold their stories with a series of reflective questions such as:

Year 1: Reacting to situations and identifying issues

• Tell a story about a time that you really felt connected in a meaningful way with a client and were able to make a difference to their wellbeing.
• Tell me a story about a clinical situation that left you feeling concerned for or troubled about a client’s environment and realising for the first time that there can be ethical dilemmas in practice.

Year 3: Bringing about change and creating mutually beneficial partnerships

• Tell me a story about a placement where you felt challenged but through reflective conversations with interested parties were able to gain insights and bring about significant and sustainable change to your practice
• Tell me a story where you were able to view a situation from multiple perspectives which led you to set up an innovative service for clients

Midway through the placement I provide formative feedback through a 90 minute conversation. This mid-way assessment informs the parameters for the second half of their placement. I pay close attention to the stories students bring to their supervision and midway evaluation. Stories enable me to understand how the student has connected with individuals over a period of time. A student who is not able to communicate with others will not include the client in their stories. By the end of a first year placement I want to know if a student can begin to identify what success might look like for their client and whether or not it has been achieved. I provide a series of exemplars and models of good practice and link students with one another to discuss and establish what makes a satisfactory outcome. The final story is prompted by these exemplars, and specific tasks that have been set up during the formative assessment phase to demonstrate the safety and efficacy of the clinical treatment process.

By third year I expect students to establish their capacity for professional discernment through the story they select to work through. I also want them to discuss their experience from various positions of difficulty right through to coming up with effective solutions. Students also have to identify flaws in their clinical reasoning and articulate how they recognized and rectified these. There are no surprises at the time of these final assessments. They know what is expected because I prepare them from their first day to think, reflect, discuss, reflect again, tell stories and articulate their insights and significant learning. Students also practice marking each other’s assessments, and their own prior to the final assessment. Through the telling of the final series of stories the student demonstrates and reveals that they are ready to take their place as a professional.

Not all students pass this assessment the first time. While it’s always hard to fail a student, it’s good to be reminded that an authentic and robust approach to assessment ultimately benefits the students as demonstrated in a quote from an email I received from a student in 2015.

 

Hello Mary

I don’t know if you remember me from year one? I just wanted to say thank you for not passing my fieldwork 2, at the time I was annoyed but now looking back I am really grateful. I am currently completely the other half of third year with only two papers left.

After that year I took it a lot more seriously and I have such amazing fieldwork experiences since and I also have a two year old. Now I take every experience seriously in my degree and give everything 100 percent. If you had passed me wouldn’t have learnt that life lesson. So thanks.

 

Assessing Students Understanding of Visual Impairment

Teaching students about visual impairment has been one of the great challenges of my recent career. I tend to develop advocacy projects in areas that require  significant new development in NZ. In the past this has been reflected in my advocacy and ethical querying of the ACC system. More recently it has been expressed in the area of visual impairment. This is an area where NZ is effectively at the level of a developing nation. I have been involved in petitions and special committees to advocate for services. Now I have heeded the advice given by Krister Inde (Father of Vision Rehabilitation Services), which is that I should ‘start where I am’. As an educator this means that I made the decision to start by educating health professionals. In the first instance I began the level 8 30 credit course; more recently I have been developing an EduBit whereby I can provide interprofessional education for health professionals, aimed at helping them to integrate simple concepts and practice into their service area. This has required the development of an outcomes based curriculum, where nothing is wasted and everything can be translated into practice immediately. I don’t believe that anyone has done this before.

In this assignment I ask students to write an essay that demonstrates their understanding of a specific visual impairment in terms of how it will impact on activity. Students are expected to articulate fluently about the anatomy and physiology of the condition. In addition, they explain what they have learned about the condition through doing an extended exercise in vision simulation; how they have been influenced by talking to people with the condition; and what they have absorbed through their studies of the experience through accounts in the humanities. I challenge students to understand what it means to love an activity reading and to develop macular degeneration (M.D).  In class I refer them to materials like poem in a book Through Our Eyes , written by a woman with M.D in which she writes  “(The lines) are no longer straight. They wave, undulate, snake and dip. Words rollercoaster across the page. My stomach lurches with each new assault as my eyes try to make sense of them, as my vision unravels.”

Simulation done alongside a curriculum that includes client voices and art/literature/film enhances empathic capacities. The students have to draw together materials in a completely new way and they tend to produce deeply creative work, some of which is worth publishing because it is so innovative.

Home Assessments

The capacity to do a rapid home assessment is a key competency of any OT. I assess student competence to carry out a home lighting assessment. In order to do this students go to a client’s home and with the client through all the rooms to assess the lighting quality in relation to the activities undertaken in these different spaces, e.g reading in the lounge and washing up in the kitchen. Students then develop a ‘lighting in the home’ prescription which details the best fittings and bulbs that addresses the client’s priorities and budget. This lighting prescription includes a summary of the assessment and includes costs, illustrations and details of how the lighting can be purchased. The prescription is sent to the client in an accessible format. One week later the student follows up with a phone call to check whether the client has had any problems with the lighting prescription. If necessary they will intervene again to ensure that everything possible has been done. Finally a satisfaction survey is sent to the client.

The satisfaction survey from the client is an essential part of the student assessment. I also view the lighting prescription, photographs taken of the home and the client notes. The student’s clinical reasoning is assessed in an oral process using a marking rubric.  Written, visual, oral components make up the assessment.