Jill Anderson has compiled this annotated bibliography on the topic. You may want to check out the pages on Student Recruitment and Clinical Placements too, as these are other settings where service users and carers get involved in assessing students.
Morgan and Jones have modified the Kirkpatrick model to create the following suite of domains where there may be changes as a result of service user and carer involvement in nurse education:
A version of this has been used at Portsmouth Hospitals to assess the impact of patients' contributions to the preceptorship programme.
Service users and carers can contribute to both the formative and summative assessment of student nurses. Formative assessment helps people to reflect on their practice, correct any weaknesses and strengthen their work. Service users and carers have role-played the patient while the nurse is taking a clinical history and provided feedback to the student about whether they were put at ease, granted eye contact and treated with kindness and respect. This feedback can, of course, be an anxious time for the student, depending on the skill of the service user in delivering feedback in a supportive rather than crushing or antagonistic manner.
Feedback forms from service users and carers are often treated as an opportunity for formative learning, and it is the student's written reflection on this feedback which contributes to the summative assessment and helps in deciding if the student may continue with their studies. However, in some establishments, where a pattern appears in which the student repeatedly fails to obtain a sufficiently positive feedback from the service users, they can be dismissed from the course.
Summative assessment makes a judgement about whether the student has met a particular level of competence, perhaps in technical skills, such as taking a blood sample, in analytical thinking and critical use of evidence, or in communication.
At the University of Sunderland, for example, service users and carers have been trained and then scored student nurses against the competencies set out in an Objective Structured Clinical Examination OSCE. Failure to meet the standard results in the same consequences for students, whether it is an academic staff member or a trained service user or carer who awards the score.
Stickley et al (2010, 2011) experimented with inviting mental health service users to participate in summative assessment of nursing students. They found that service users they worked with were reluctant to take on the responsibility for formal assessment, students were anxious about transferring power over their future away from accountable professionals, mentors were worried about the additional workload, and everyone was concerned about the impact on the therapeutic relationship.
These concerns were replicated in Scotland in Grey and Donaldson's 2010 literature review and Haycock-Stuart and colleagues' survey of the opinions of student nurses in Scotland. Calman (2006) found that patients were concerned that a fleeting contact with the student would be insufficient grounds to judge their ability.
However, we have also encountered settings where service users and carers sit on Fitness to Practise panels, where they share in the considerable responsibility of occasionally dismissing a student from their studies, thereby showing no reluctance to exercise power. Furthermore, in a penetrating thinkpiece, Malihi-Shoja and her colleagues set out from a service user perspective why failing to fail incompetent students is a serious mistake. Adverse feedback from service users and carers can also provide some robust evidence of attitudes or behaviour where previously there was no more than a subjective concern about the student's suitability for the profession.
As well as providing an illustration of coproduction of a summative assessment, the following example shows how service users and carers can be involved in the whole process, rather than just in one step of it. For one module in the nursing programme at the University of Worcester, the module leader and a service user/carer worked together to:
Where the student produces assessed material, there is usually a Moderation Group to check that different fieldwork supervisors or academic staff are behaving consistently and maintaining fairness across the body of student nurses. The Moderation Group deals with anonymised materials and some learning providers have invited service users and carers to join this group.