Responding to the real problem of sustainable resuscitation competency with real assessment. Mixed-methods evaluation of an authentic assessment program

Abstract Introduction : The sustainability of resuscitation skills is a widespread concern, with a rapid decay in competence following training reported in many health disciplines. Meanwhile, training programs continue to be disconnected with real-world expectations, and teaching and assessment designs remain in conflict with the evidence for sustainable learning. This study aimed to evaluate a programmatic assessment pedagogy employing entrustable professional activities (EPAs) and the principles of authentic and sustainable assessment. Methods : We conducted a prospective mixed-methods sequential explanatory study to understand and address the sustainable learning challenges faced by final-year undergraduate paramedic students. We introduced a program of five authentic assessment episodes based on actual resuscitation cases, each integrating contextual elements that featured in these real-life events. The student-tutor consensus assessment (STCA) tool was configured to encapsulate an entrustable professional activities (EPA) framework. Each test produced dual results: a student-led grading component and an assessor score based on the level of trust they attributed the student to work unsupervised and meet with the expectations of the workplace. Students and assessors were surveyed about their experiences with the assessment methodologies and asked to evaluate the program using the Ottawa Good Assessment Criteria. Results : Eighty-four students participated in five test events, generating both assessor-only and student-led STCA results. There was a reported mean score increase of 9% across the five tests and an 18% reduction in borderline or below scores. No statistical significance was observed among the scores from eight assessors across 420 unique tests. The mean student consensus remained above 91% in all 420 tests. Both student and assessor participant groups expressed broad agreement that the Ottawa criteria were well-represented in the design, and they shared their preference for the authentic methodology over traditional approaches. Conclusion : In addition to confirming local sustainability issues, this study has highlighted the validity and reliability concerns that exist with conventional resuscitation training designs. We have successfully demonstrated an alternative pedagogy which responds to these concerns, and which embodies the principles of sustainable learning, quality in assessment practice, and the real-world expectations of professionals.