Nursing education is shifting towards a
competency-based model, as outlined in the American Association of Colleges of
Nursing's 2021 Essentials. This means that nurse practitioner (NP) students
need to demonstrate mastery of key knowledge, skills, and abilities required
for practice. How can NP programs effectively assess competency development?
One helpful framework highlighted in a recent journal article is Miller's
Pyramid of Clinical Competence.
Miller's Pyramid includes four ascending levels of
competence: knows, knows how, shows how, and does. This builds from a
foundation of core knowledge to being able to demonstrate and apply skills in
practice. Here's a quick overview of what each entails:
- Knows:
Factual knowledge assessed through multiple-choice questions or written
reports
- Knows
How: Understanding principles and being able to explain concepts
- Shows
How: Demonstrating skill in a simulated setting
- Does:
Performing the skill effectively in an actual clinical environment
As students progress through an NP program, they
should be evaluated at each tier. Assessment strategies may include written
exams, oral questioning, OSCEs with simulated patients, direct observation in
clinicals, and student reflective journals. Faculty can determine at what
levels additional coaching is needed.
Hampton et al (2024) also discusses adding a fifth
peak to the pyramid - the "is" level - which represents embodying the
professional identity and core values expected of a practicing NP. This reminds
programs that technical skills alone don't suffice; the affective domain is
critical too.
In conclusion, Miller's Pyramid provides an excellent
rubric for staging the attainment of competencies in NP education. Aligning
teaching and evaluation methods to the different levels empowers students with
the knowledge, skills, and professional disposition necessary to provide safe,
high-quality care. As NP roles continue advancing, so too must preparation to
match responsibility. This model offers an evidence-based approach.
Hampton D., Melander, S. Tovar E., Falls C., Makowski A.,
Ballard Grubbs A., 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), https://doi.org/10.1016/j.nurpra.2024.104952.
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