Major changes to the assessment of newborn hearing screeners were introduced across England from April 2020.
Staff carrying out NHS newborn hearing screening tests in England previously had to complete an observed structured clinical examination (OSCE) before being able to screen unsupervised. The OSCE was a formalised assessment of competency. It acted as an external verification of internal training standards to ensure staff have the communication and practical skills to work in the NHS Newborn Hearing Screening Programme (NHSP).
Listening to feedback from screeners, the national NHSP team recognised a need to:
- change the format of assessment
- help others assess the competency of staff
- improve alignment of the assessment with the level 3 health screener diploma (HSD) qualification
A working group of local NHSP managers who provided the OSCEs then:
- agreed a new assessment structure and format
- developed a new assessment checklist
- aligned the assessment with individual units of the HSD
- held and evaluated 3 pilots
What has changed
Previously, candidates moved between 10 different ‘stations’ that did not necessarily follow the order of the screening pathway.
The new assessment discussion gives candidates the opportunity to instead think logically through the pathway in the same order that they learn. Feedback from the pilots proved that this structure was far less stressful.
Two assessors provide a balanced assessment of the competency of each candidate. Assessors are experienced staff working within the NHS. To ensure they give an independent objective opinion on competency, they are not able to assess their own staff.
They use the professional discussion to engage with candidates throughout the process, listen to and encourage candidates’ communication skills and evaluate their knowledge and understanding. Competency is assessed against HSD criteria and completed checklists should form part of the candidate’s portfolio of achievement for the HSD.
The new format
The new style OSCE is called an external competency assessment (ECA). Candidates’ knowledge and understanding of the screening pathway is assessed through a professional discussion. Clinical skills are assessed locally, not as part of the ECA.
Before undertaking the ECA, candidates must provide evidence they have:
- successfully completed the NHSP e-Learning module
- locally assessed practical experience of completing equipment quality assurance (QA) checks
- locally assessed practical experience of completing at least 5 of each of the 2 types of newborn hearing screening test – the automated auditory brainstem response (AABR) and automated otoacoustic emissions (AOAE) tests
The ECA has 2 sections:
- Informing parent – neonatal intensive care unit, Well Baby and AOAE screening
- Equipment checks, AABR screening, referral to audiology and information governance
Once both sections have been completed, the assessors will determine if the candidate is competent, based on achieving 80% of the essential criteria. An outcome will be given on the day, so candidates will leave knowing if they are competent or not and why.
If a candidate is not competent, they should complete the whole ECA again within 3 months.
The ECA should be more flexible to deliver so they can be held more widely across the country, as the new structure lends itself to small or large groups as needed. The national programme team will support the development, provision and quality of ECAs and will maintain a national log of candidate outcomes and authorised assessors.
Due to COVID-19, the assessments are being delivered virtually, using video. After some initial technical hitches, it is proving to be an effective way to hold the assessment and may become the ‘new normal’. Twelve screeners have successfully completed the new ECA since April.
A more relaxed process
Giving feedback on one of the pilots, Malisia Adams, a newborn hearing screener from south east London, said:
I feel the new format will allow candidates to reflect on their experiences, knowledge and understanding of their role and responsibilities through a relaxed discussion.
Helen Baldock, NHSP local manager from east Kent, said:
The ECA felt much more relaxed than the previous version. The assessors put me at ease and their interactive style meant I was able to show everything I knew about the NHSP.
From a manager’s perspective, it’s reassuring that candidates will be assessed for both their knowledge and understanding of why certain processes and procedures are important. Providing results and feedback on the day is an excellent idea. This reduces anxiety for candidates and avoids delay in moving to working independently.
More information is provided in the NHSP operational guidance.
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