Mock Competencies: An Intervention to Improve Student Outcomes

Nursing students experience high levels of stress during their educational program.  There is an abundance of literature that addresses the impact of stress in nursing students and the effect it has on their learning, performance, and overall well-being. The level of stress experienced by nursing students can have a negative impact on their ability to learn and their academic performance (Chernomas & Shapiro, 2013; Jimenez, Navia-Osorio, & Diaz, 2010). Stress can cause nursing students to question their abilities (Chernomas & Shapiro, 2013). Stress can cause students to feel high levels of anxiety, worry, anger, fear, depression, crying, irritability, feelings of rejection and inadequacy, as well as maladaptive behaviors such as increased consumption of alcohol and withdrawing from others (Reeve, Shumaker, Yearwood, Crowell, & Riley, 2013).  High-stakes testing, where students are required to withdraw from the course or even the program of nursing if they are not successful, makes the experience even more stressful, and has been found to escalate stress-related behaviors, impact performance and overall well-being negatively even months before the testing occurs.  The high level of stress related to testing has caused some students to question their decision to study nursing (Roykenes, Smith, & Larsen, 2014).

Faculty in one nursing program with high stakes teaching and evaluation of psychomotor skills observed that students were exhibiting many behavioral signs of stress while undergoing competency testing. These signs included shaking hands, tears, and emotional outbursts. Faculty also noted a high percentage of student failures in first-round performance evaluations.  Students were allowed three chances to pass the skills check-offs but if unsuccessful, were required to withdraw from the course.  Withdrawing from the course delays progression or can even result in their termination in the nursing program.  Faculty believed that the high number of first-round failures were, at least in part, caused by excessive stress and thought that by reducing stress, overall performance on the skills competencies would improve. The purpose of this presentation is to present research about a pedagogical strategy designed to reduce stress during high-stakes evaluation of nursing students’ psychomotor skills. 

 Lab faculty developed a creative pedagogical strategy designed to reduce stress with skills competencies without lowering standards of performance. Peer-to-peer evaluations in a simulated competency assessment were structured so that students participated in peer-to-peer “Mock Competencies,” prior to undergoing faculty-led competency evaluations The Mock Competencies were set up much like faculty evaluations but student peers provided feedback on one another’s performances.  Students were provided skills guidelines to use as an assessment tool for each of the skills they might be required to perform.

The purpose of this retrospective, descriptive study was to determine whether this pedagogical strategy had an impact on first-round pass rates for skills competency assessments. Pass rates for skill competency evaluations were compared in two clinical courses for four semesters prior to the implementation of Mock Competencies, and for four semesters following implementation. Significant improvement occurred in first-round pass rates in courses utilizing the Mock Competencies.  Faculty also noted a reduction in stress-related behaviors.  In course evaluations, students expressed that the Mock Competencies were beneficial for both learning and evaluation of psychomotor skills.

These results have significant implications for nursing education.  This intervention empowered students and was successful in improving both student performance on high-stakes psychomotor skills evaluations and in decreasing student stress.