Evaluation of the Elusive Affective Domain

This article originally appeared in our November 2016 Newsletter by John Spencer, Customer Support Manager, Lead Medical Educator

Cognitive, Psychomotor, and Affective are the three domains of learning that we must evaluate as instructors. The cognitive domain focuses on knowledge and is easily evaluated using quizzes and tests. The psychomotor domain focuses on the use of motor skills and can be evaluated by standard skills testing. What about the affective domain? This domain focuses on things like motivation, attitudes, perceptions and core values. As instructors, we are required to objectively evaluate our students’ affect; however, many instructors find it difficult to evaluate a student on what many consider to be subjective criteria. The key to an objective affective evaluation is to evaluate often, use an objective assessment tool and to create opportunities that allow the instructor to observe the student for identified behaviors.

It is suggested that instructors evaluate their students’ affect at least twice during a program, once at the midpoint and again at course completion. This is acceptable, but may not be a best practice in longer programs, as it does not provide the student with consistent feedback on opportunities for growth. Affective evaluations provided monthly would provide them with more consistent feedback and allow for a more accurate measurement of their growth.

The assessment tool is very important. Most instructors are probably utilizing an affective evaluation tool designed to measure a student’s professional behavior in eleven key areas. These areas are integrity, empathy, self-motivation, appearance and personal hygiene, self-confidence, communications, time management, teamwork and diplomacy, respect, patient advocacy, and careful delivery of service. Each of these areas should have examples of professional behaviors to be observed and then the student is marked as either being “competent” or “not yet competent.” These forms often provide an area for instructor comments on areas that are marked as “not yet competent.” An example of such a form can be found on the NHTSA website. Such forms are an acceptable assessment tool to use, but they can be viewed as critical and often do not provide the student with feedback for growth in their areas of weakness. Adjusting the scoring system to reference the student’s behavior, instead of labeling them as “competent” or not, helps to make the evaluation more palatable and can even increase the objectivity of the assessment. A system that scores the student based on how often the professional behaviors are observed can achieve this goal while still measuring the student’s competency. An example of such a scoring system could be to score the student using a scale of Always, Sometimes, or Not Observed. For each area that receives a score below “Always”, the instructor should provide examples of when the student failed to demonstrate the professional behavior. The student should then be allowed to write down an action plan outlining how they will work to improve in these areas. This process also helps to increase the objectivity of future evaluations.

Having an objective assessment tool is essential, but the instructor must also have opportunities to observe for the professional behaviors. The students should be informed that they are constantly being evaluated on their affect in all areas of the program. The instructor can observe for the professional behaviors during didactic time by observing students during group work and discussions. The affective domain can also be evaluated during psychomotor skills time by observing how the students work together to master skills. This is also a great time to run scenarios and simulations to observe the students as they interact with simulated patients. Evaluations completed by clinical preceptors can also be used by instructors as they complete the affective evaluations.

Evaluating the student’s affect is an essential part of the education process. It helps to guarantee that only those students that possess professional behaviors become a part of our industry and provide compassionate care to the patients that they encounter.