NUR 640 Module 5 Milestone Two Example

Milestone Two: Evaluating Student Performance in Simulation, From Formative Scenarios to a Summative Check

[Student Name]

Southern New Hampshire University

NUR 640: Assessment and Evaluation in Nursing Education

Module Five Milestone Two

[Instructor Name]

[Date]

Milestone Two: Evaluating Student Performance in Simulation, From Formative Scenarios to a Summative Check

Simulation lets nursing students practice rare, dangerous situations without risk to patients, and it lets faculty watch a student's reasoning unfold in a way that busy clinical units rarely allow. It also raises a problem for evaluation. If every scenario is graded, students may perform for the grade and hide uncertainty, which defeats the purpose of learning from errors. If none are graded, faculty lose evidence about competence. Lakemont College of Nursing, a composite associate and baccalaureate program, plans to replace 25% of medical-surgical clinical hours with simulation next year. This milestone designs the evaluation plan for that change, using a postoperative hemorrhage scenario as the example. It argues that simulation should be evaluated mostly formatively, with structured debriefing, and summatively only at defined points with trained raters and a reliable tool.

The Evidence for Replacing Clinical Hours

Hayden et al. (2014) randomized 666 prelicensure students at ten programs to one of three groups: traditional clinical experience with no more than 10% simulation, or 25% or 50% of clinical hours replaced by simulation. At the end of the program, the groups did not differ significantly in clinical competency rated by preceptors, overall knowledge scores or first-attempt NCLEX results, and the differences remained nonsignificant in the first six months of practice. The study did not show that simulation can replace clinical hours under any conditions. Its programs had faculty trained in simulation, enough staff, subject matter experts and debriefing grounded in theory. Lakemont's plan must meet these conditions, and evaluation is part of how the college will know whether it has.

The Scenario and What It Measures

In the example scenario, a 72-year-old man is one day out from a total hip arthroplasty. Over twenty minutes of simulated time, his heart rate rises from 88 to 124, his blood pressure falls from 132/78 to 94/60, he becomes restless and the surgical drain fills with bright red blood. The scenario is designed to measure whether students notice a pattern of hypovolemia rather than isolated numbers, interpret it as bleeding, respond with appropriate actions such as calling the surgeon with an SBAR report, increasing fluids per order and positioning, and reflect afterward on what they did. These map directly onto the four dimensions of the Lasater Clinical Judgment Rubric, which Lasater (2007) derived from watching students in simulation, so the scenario and the tool measure the same construct.

Formative Evaluation and Debriefing

Most scenarios, including the first run of the hemorrhage case, will be formative. Students will be told in writing that these scenarios do not count toward the course grade, that mistakes are expected and that the goal is learning. Faculty will score each student's performance on the Lasater rubric from the video recording and share the scores privately after debriefing as feedback, not as grades. Students will also rate themselves on the rubric, and the comparison will guide their goals for the next scenario.

Debriefing is where most of the learning happens, so its quality is part of evaluation. Lakemont will use Debriefing for Meaningful Learning, a structured method in which faculty guide students to examine the thinking behind their actions, not only the actions themselves, and to consider what they would do if the situation changed. In a study by Dreifuerst (2012), students debriefed with this method showed greater improvement in clinical reasoning than those who received usual debriefing, and they rated their debriefing as higher quality. Debriefers will be trained in the method and observed by a peer twice a term using a checklist of its steps.

The Summative Check

At the end of the rotation, each student will complete one summative scenario, a variation of a case they have practiced, scored independently by two trained faculty from video using the Lasater rubric. The passing standard is Accomplished on noticing and responding, the dimensions most directly tied to patient safety. If the two raters differ by more than one level on any dimension, a third rater will score the video. A student who does not pass will receive remediation and a second attempt with a different scenario, because one performance on one day is limited evidence.

Before the summative scenario is used, the faculty will check that raters agree. Six faculty will score the same four recorded performances, and agreement will be calculated for each dimension. Where agreement is low, raters will discuss the recordings and reach shared understanding of the descriptors. Summative results will never be the only evidence of clinical competence; they will be considered alongside the clinical evaluation tool revised in Milestone One.

Fairness and Psychological Safety

Being recorded and watched can make capable students freeze, and anxiety in a summative scenario may lower scores for reasons unrelated to clinical judgment. Several steps reduce that risk. Every student will complete at least three formative scenarios in the same simulation room, with the same manikin and recording equipment, before the summative check, so the setting is familiar. A prebriefing before each scenario will orient students to the equipment, the patient's background and the rules of the simulation, including that the manikin's findings should be treated as real. Video recordings will be used only for scoring and debriefing, stored securely and deleted at the end of the term. Students with documented accommodations will have them applied, for example extra time to review the chart, as long as the accommodation does not change what the scenario measures.

Evaluating the Simulation Program

Because Lakemont is changing its clinical model, the program itself must be evaluated. The college will compare students in the simulation cohort with the previous cohort on clinical evaluation ratings, course exam scores and, later, licensure pass rates, while recognizing that cohorts differ in many ways. Students will complete a short survey on the quality of debriefing after each scenario. Faculty training records will be reviewed to confirm that every debriefer completed training, since the national study's results depended on it.

Conclusion

Simulation can support both learning and judgment, but not in the same moment. Keeping most scenarios formative, scoring clinical judgment with a tool aligned to the scenario, structuring debriefing with an evidence-based method, reserving summative evaluation for a defined check with trained and calibrated raters and meeting the conditions of the National Simulation Study give Lakemont a plan that protects the learning while producing credible evidence of competence.

References

Dreifuerst, K. T. (2012). Using debriefing for meaningful learning to foster development of clinical reasoning in simulation. Journal of Nursing Education, 51(6), 326-333. https://doi.org/10.3928/01484834-20120409-02

Hayden, J. K., Smiley, R. A., Alexander, M., Kardong-Edgren, S., & Jeffries, P. R. (2014). The NCSBN National Simulation Study: A longitudinal, randomized, controlled study replacing clinical hours with simulation in prelicensure nursing education. Journal of Nursing Regulation, 5(2, Suppl.), S3-S40. https://doi.org/10.1016/S2155-8256(15)30062-4

Lasater, K. (2007). Clinical judgment development: Using simulation to create an assessment rubric. Journal of Nursing Education, 46(11), 496-503. https://doi.org/10.3928/01484834-20071101-04