Høegh-Larsen Anne Mette, Gonzalez Marianne Thorsen, Reierson Inger Åse, Husebø Sissel Iren Eikeland, Hofoss Dag, Ravik Monika
Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Postbox 235, Kongsberg, 3603, Norway.
Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.
BMC Nurs. 2023 Mar 9;22(1):64. doi: 10.1186/s12912-023-01220-0.
Clinical judgment is an important and desirable learning outcome in nursing education. Students must be able to self-assess their clinical judgment in both the simulation and clinical settings to identify knowledge gaps and further improve and develop their skills. Further investigation is needed to determine the optimal conditions for and reliability of this self-assessment.
This study aimed to compare the same group of students' self-assessment of clinical judgment with an evaluator's assessment in both simulation and clinical settings. The study further aimed to investigate whether the Dunning-Kruger effect is present in nursing students' self-assessment of clinical judgment.
The study applied a quantitative comparative design. It was conducted in two learning settings: an academic simulation-based education course, and a clinical placement course in an acute care hospital. The sample consisted of 23 nursing students. The Lasater Clinical Judgment Rubric was used to collect data. The scores were compared using a t-test, intraclass correlation coefficient, Pearson's correlation coefficient, and Bland-Altman plots. The Dunning-Kruger effect was investigated using linear regression analysis and a scatter plot.
The results showed an inconsistency between student self-assessment and evaluator assessment of clinical judgment in both simulation-based education and clinical placement. Students overestimated their clinical judgment when compared to the more experienced evaluator's assessment. Differences between students' scores and the evaluator's scores were larger when the evaluator's scores were low, indicating the presence of the Dunning-Kruger effect.
It is vital to acknowledge that student self-assessment alone may not be a reliable predictor of a student's clinical judgment. Students who had a lower level of clinical judgment were likely to be less aware that this was the case. For future practice and research, we recommend a combination of student self-assessment and evaluator assessment to provide a more realistic view of students' clinical judgment skills.
临床判断是护理教育中一项重要且理想的学习成果。学生必须能够在模拟和临床环境中自我评估其临床判断，以识别知识差距并进一步提高和发展他们的技能。需要进一步研究以确定这种自我评估的最佳条件和可靠性。
本研究旨在比较同一组学生在模拟和临床环境中对临床判断的自我评估与评估者的评估。该研究还旨在调查邓宁-克鲁格效应是否存在于护理专业学生对临床判断的自我评估中。
本研究采用定量比较设计。研究在两种学习环境中进行：基于学术模拟的教育课程和急症护理医院的临床实习课程。样本包括23名护理专业学生。使用拉斯特临床判断量表收集数据。使用t检验、组内相关系数、皮尔逊相关系数和布兰德-奥特曼图对分数进行比较。使用线性回归分析和散点图研究邓宁-克鲁格效应。
结果表明，在基于模拟的教育和临床实习中，学生对临床判断的自我评估与评估者的评估之间存在不一致。与经验更丰富的评估者的评估相比，学生高估了自己的临床判断。当评估者的分数较低时，学生分数与评估者分数之间的差异更大，表明存在邓宁-克鲁格效应。
必须认识到，仅靠学生自我评估可能无法可靠地预测学生的临床判断。临床判断水平较低的学生可能不太意识到情况确实如此。对于未来的实践和研究，我们建议将学生自我评估和评估者评估相结合，以更真实地了解学生的临床判断技能。
