Abstract
With emergence of the buzz words “competency-based education” (CBE) nurse educators can determine how to evaluate student competency. Aimed at facilitating competency development, program curriculum can be examined through the lens of Miller’s Pyramid of Clinical Competence (Miller, 1990; Sam et al., 2020; Lavery, 2022; Hampton et al., 2024).
Less than satisfactory certification exam success prompted a high-level meeting with university leadership. A novel question was posed as to how every program course promoted certification success. The graduate program leadership were charged with maximizing core course contributions to certification success. A curriculum review identified underutilization of university provided third-party resources in three core courses which identified an opportunity for program enhancement.
An innovative curricular approach was devised for maximizing contributions of three core courses; advanced pathophysiology, pharmacology, and health assessment - previously referred to by AACN (2011) as the ‘Direct Care Core’ or the 3Ps. The innovative design leveraged university provided third-party resources to promote student competency development prior to entry into the first clinical experience. Restructuring course activities ensured alignment of paid resources with weekly teaching and learning strategies. Student success was supported with assignment of a success coach to facilitate competency development.
With restructuring in place, a decision was made to utilize a national standardized exam as an innovative approach for assessing student 3Ps competencies. This is also known as the clinical proficiency exam which requires a student to achieve the benchmark score before being permitted to enter their first clinical course. Aligned with CBE principles, students who do not achieve the benchmark are provided a success coach and an individualized remediation plan prior to subsequent attempts on the exam.
Implementation of a CBE approach, such as described, provides the opportunity to improve clinical judgment in new graduate and advanced practice nurses (Lewis et al., 2022).
This innovative CBE approach increased certification exam pass rates from an 86% to a 92% at the end of the next year. Certification exam rates continue to increase with each testing cohort utilizing this CBE model. Following launch of this initiative, preceptor evaluations of clinical performance demonstrates positive feedback about the high-level of student competency.
Notes
References:
American Association of Colleges of Nursing. (2011). The Essentials of Master’s Education in Nursing. https://www.aacnnursing.org/Portals/0/PDFs/Publications/MastersEssentials11.pdf
American Association of Colleges of Nursing. (2021). The Essentials: Core Competencies for Professional Nursing Education. https://www.aacnnursing.org/Portals/0/PDFs/Publications/Essentials-2021.pdf
Hampton, D., Melander, S., Tovar, E., Falls, C., Makowski, A., Grubbs, A. B., Chitwood, H., & Scott, L. (2024). Value of Miller’s Pyramid for Clinical Skills Assessment in the evaluation of competency for nurse practitioner students. The Journal for Nurse Practitioners, 20(4), 104952. https://doi.org/10.1016/j.nurpra.2024.104952
Lavery, J. (2022). Observed structured clinical examination as a means of assessing clinical skills competencies of ANPs. British Journal of Nursing, 31(4), 214–220. https://doi.org/10.12968/bjon.2022.31.4.214
Lewis, L. S., Rebeschi, L. M., & Hunt, E. (2022). Nursing education practice update 2022: Competency-based education in nursing. SAGE Open Nursing, 8, 237796082211407. https://doi.org/10.1177/23779608221140774
Miller, G. (1990). The assessment of clinical skills/competence/performance. Academic Medicine (65)9, S63-67 https://journals.lww.com/academicmedicine/abstract/1990/09000/The_assessment_of_clinical.45.asp
Sam, G., Leong, T. M., & Aini, A. (2020). Competence-based frameworks in nursing – a concept analysis. Journal of Applied Learning & Teaching, 3(1). https://doi.org/10.37074/jalt.2020.3.1.3
Sigma Membership
Alpha Beta Iota
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Other
Research Approach
Translational Research/Evidence-based Practice
Keywords:
Competence, Curriculum Development, Teaching and Learning Strategies, Student Competency, Competence
Recommended Citation
Wagner, Patricia and Penick, Julie, "Before the Buzz, it was Competency Based!" (2025). International Nursing Research Congress (INRC). 240.
https://www.sigmarepository.org/inrc/2025/presentations_2025/240
Conference Name
36th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Seattle, Washington, USA
Conference Year
2025
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Before the Buzz, it was Competency Based!
Seattle, Washington, USA
With emergence of the buzz words “competency-based education” (CBE) nurse educators can determine how to evaluate student competency. Aimed at facilitating competency development, program curriculum can be examined through the lens of Miller’s Pyramid of Clinical Competence (Miller, 1990; Sam et al., 2020; Lavery, 2022; Hampton et al., 2024).
Less than satisfactory certification exam success prompted a high-level meeting with university leadership. A novel question was posed as to how every program course promoted certification success. The graduate program leadership were charged with maximizing core course contributions to certification success. A curriculum review identified underutilization of university provided third-party resources in three core courses which identified an opportunity for program enhancement.
An innovative curricular approach was devised for maximizing contributions of three core courses; advanced pathophysiology, pharmacology, and health assessment - previously referred to by AACN (2011) as the ‘Direct Care Core’ or the 3Ps. The innovative design leveraged university provided third-party resources to promote student competency development prior to entry into the first clinical experience. Restructuring course activities ensured alignment of paid resources with weekly teaching and learning strategies. Student success was supported with assignment of a success coach to facilitate competency development.
With restructuring in place, a decision was made to utilize a national standardized exam as an innovative approach for assessing student 3Ps competencies. This is also known as the clinical proficiency exam which requires a student to achieve the benchmark score before being permitted to enter their first clinical course. Aligned with CBE principles, students who do not achieve the benchmark are provided a success coach and an individualized remediation plan prior to subsequent attempts on the exam.
Implementation of a CBE approach, such as described, provides the opportunity to improve clinical judgment in new graduate and advanced practice nurses (Lewis et al., 2022).
This innovative CBE approach increased certification exam pass rates from an 86% to a 92% at the end of the next year. Certification exam rates continue to increase with each testing cohort utilizing this CBE model. Following launch of this initiative, preceptor evaluations of clinical performance demonstrates positive feedback about the high-level of student competency.
Description
Participants will see the path taken to address an at-risk program based on certification exam pass rates by implementation of a competency-based education strategy. The innovative approach towards changing the trajectory of certification success included the use of third-party resources, a standardized exam, and a success coach to support students throughout their advanced practice program. Examples of formative and summative outcomes will be included for purposes of illustrating the journey.