Utilizing Nurses to Assess Students’ Professionalism, Communication, and Teamwork Skills

Background: Multisource feedback (MSF) can be particularly reliable when assessing professionalism, communication, and interpersonal skills.1 Studies suggest that resident trainees find MSF acceptable and a stimulus for positive behavior change.2 MSF has been successfully implemented in a team-based surgical clerkship, where MSF was deemed feasible and of value to both students and nurses.3 To our knowledge, no studies have yet been published collecting nurse assessments of students longitudinally across clerkships. At our medical school, where peer, resident, and attending feedback systems are already in place, we implemented nurse evaluations of students across four clerkships: medicine, obstetrics/gynecology, surgery, and pediatrics. We sought to determine both the feasibility of collecting nurse evaluations of students across clerkships and the type of feedback nurses provided. Methods: During implementation, we used a 16-item questionnaire of observable professionalism, teamwork, and communication behaviors (Likert 1-5) that was previously created with input from physicians, patients, and nurses.4 During clerkship orientation, students were provided invitation cards containing login instructions and instructed to give at least two nurses in each clerkship an invitation. We measured the number of nurse assessments completed in each clerkship. We also performed a content analysis of the evaluations to determine the areas where nurses were most likely to provide feedback. Results: Nurses completed 240 total assessments (mean 2 per student). The completion rate of invited assessments was 19%. Students typically received ratings of 5 across all items. Qualitative feedback was generally positive. Only 10 assessments included suggestions for improvement (4%). Nurses commented on students’ attitude (n=127), teamwork skill (n=86), professionalism (n=54), communication with patients (n=40), initiative (n=13), and situational awareness (n=5). Conclusions: Our data shows that nurses provide students with qualitative performance feedback across a variety of competencies. The low percentage of completed nurse assessments reflects the implementation challenges we faced. Numeric ratings were not discriminatory while qualitative comments provided concrete observations on students’ skills. Despite the implementation challenges, the nurses’ narrative feedback is important for students to use to reflect on teamwork, professionalism, and communication competency achievement. We will continue efforts to improve the workflow for nurses and provide incentives to improve the completion rate.