Chang How Choo¹
Wanzhen Zhao¹, Jasmine Pei Ling Boo², Cheng Jee Goh² and Yee Teng Ong²
1 Nursing Education & Development, Tan Tock Seng Hospital, Singapore
2 Speech Therapy, Tan Tock Seng Hospital, Singapore

Healthcare Assistants (HCAs) are a group of support care staff who attend to patients’ activities of daily living (SkillsFuture, 2023). Many were employed and placed on workplace apprenticeship model, where trainees were assessed using traditional checklists. As there is a growing need for feeding supervision for patients with dysphagia (Poon, Ward & Burns, 2023), this project aims to upskill the competence of HCAs in performing supervised feeding through a blended assessment design, referencing Miller’s pyramid of assessment. 

Miller’s pyramid model consists of four hierarchical levels, representing the progressive stages of a healthcare provider’s clinical competence development (Ramani & Leinster, 2008). The team designed a four-tiered assessment strategy, which include knowledge-based multiple- choice e-quiz, simulated scenario applications, standardised patients exercises and direct observation in clinical areas. Over a period of four months in 2022, nurse educators and speech therapists administered the classroom-based simulated assessments, while nursing clinical champions assessed the HCAs’ observable behaviours in the clinical settings. A subsequent online survey was conducted three months later through convenience sampling to evaluate the efficacy of the implemented strategies. 

The survey gathered responses from 55 HCAs (37%), 55 clinical champions (46%) and 61 nurses across different inpatient areas. The results revealed that all nurses and clinical champions agreed that the tiered assessment methodologies effectively empowered and prepared HCAs for the competency. Additionally, 54 of HCAs (98%) expressed confidence in performing the supervised feeding skill. 

The incorporation of Miller’s pyramid in the tiered assessment design is beneficial for workplace-based assessment, addressing both cognitive and behavioural aspects of clinical competence. This approach instils confidence in skill performance of support care staff. Future research could explore the integration of technology to enhance accessibility in training and assessment, considering the resource and manpower constraints associated with traditional face-to-face classroom simulated assessment. 

Poon, M. M., Ward, E. C., & Burns, C. L. (2023). Adult dysphagia services in acute and subacute settings in Singapore, Speech, Language and Hearing. DOI: 10.1080/2050571X.2023.2240988 

Ramani, S. & Leinster, S. (2008). AMEE guide no. 34 : Teaching in the clinical environment, AMEE Guide, 30, 347-364. DOI: 10.1080/01421590802061613 

SkillsFuture Singapore (2023). Learn about job roles – healthcare assistant / basic care assistant / nursing aide. https://www.myskillsfuture.gov.sg/content/student/en/preu/world-of- work/occupation.html