In 1992, a unique partnership was formed between the U.S. Department of Education, the U.S. Department of Labor and the newly formed National Skills Standards Board to fund 22 pilot projects representing different industry sectors. Health care was one of the sectors to receive funding. The award was given to WestEd in partnership with the National Consortium on Health Science and Technology Education (NCHSTE). WestEd (formerly Far West Research Lab) is one of the research laboratories funded by the U.S. Department of Education. Each has an area of specialization, and WestEd has been charged with providing research for assessment and evaluation. NCHSTE is a consortium of health care industry professionals and state-level secondary and postsecondary education representatives whose mission is '... to shape and influence the preparation and employment of the health care workforce.'
Sri Ananda, Ph.D., co-director of assessment and standards development services for WestEd, directed the standards development. 'One key lesson from our effort to develop national health care skill standards is that the process of developing skill standards is nearly as important as the product,' says Ananda. 'There is a right way and a wrong way to develop and validate high-quality standards. The right way capitalizes on the synergy that results from bringing together workers, employers, educators, trainers and the organizations they represent to identify the fundamental skills and knowledge for health care workers in the 21st century.'
Her expertise and experience is recognized across the country as she continues to play a leading role in career-technical education assessment and evaluation design.
The Policy Advisory Committee, comprised of representatives from employer, labor, professional and education groups, was chaired by Nancy Langley-Raynor, co-founder of NCHSTE. Langley-Raynor, who is currently employed as an assessment specialist with the U.S. Department of Education, Office of Adult and Vocational Education, says, 'Quality doesn't just happen; it is the result of careful planning, high standards, intelligent direction, professional commitment and skillful implementation. The preparation of a quality workforce has been a guiding focus of the National Health Care Skill Standards project.'
Led by the Policy Advisory Committee, more than 1,000 individuals representing a combined 100 health care organizations and education institutions participated in the development, review and pilot testing of the standards.
The standards, by title, seem common across all industry sectors. However, further delineation demonstrates that there is uniqueness to the standards within the various industries. Benefits of having nationally validated Health Care Skill Standards include a potential for forging strong links among the various stakeholders within this career cluster. National standards provide a common language, common goals and a common reference point for employers, workers, students, labor, educators and consumers. In addition, career pathway standards have been developed. Grouped by health care functions--diagnostic services, therapeutic services, support services, health informatics and biotechnology research and development--these standards provide the next step in the career preparation learning continuum that leads to specialization and career entry. The determination of the method for organizing the career pathways was the result of a lengthy and contentious debate. Many supported the idea of occupationally specific career paths, such as nursing or pharmacy, while others saw no need for this interim set of standards. After much discussion, it was agreed that the skills and knowledge needed for careers within this broad and diverse industry would be grouped by functions.
Setting the Bar for Accountability
Once all of the standards were in place and validated by field test, it became evident that further delineation was needed. NCHSTE, in partnership with the Utah Office of Education, was the recipient of a second grant, the National Building Linkages projects. These projects, awarded in 1996 and collaboratively sponsored by the U.S. Department of Education, the National Skills Standards Board and the National School to Work Office, were designed to build learning continuums that span the grade levels beginning in elementary school and culminating with professional preparation at a college or university. This project provided resources for developing the accountability criteria for each of the standards.
A 'Setting the Bar Summit' was held in early 1999, convening individuals from across the country. The participants were from colleges, universities, secondary schools, and professional and employer groups. These experts were asked to determine the criteria for measuring each standard. Knowledge and skills within the standards areas are broad and needed more refinement. Students and educators wanted to know precisely, 'How good is good enough to meet the standards?'
The accountability criteria that resulted from the summit 'set the bar,' provided the answer to the question asked, and created guidelines for curriculum design and student assessment. The accountability criteria also inform postsecondary faculty and health care employers as to what can be expected of students completing foundation standards preparation.
The accountability criteria were validated by school-based teams from the 17 states that were members of NCHSTE at the time of standards development.
Career Clusters Identified
In 2000, the U.S. Department of Education recognized the value of the two initial Building Linkages projects, health care and manufacturing, and funded an additional three projects. What had previously been referred to as industry sectors were then renamed 'career clusters.' Finally, the remaining 11 career clusters were funded and asked to create foundation skills and knowledge (standards) and accountability criteria. They, along with the previously contracted five projects, were also asked to create skills and knowledge and accountability criteria for the career pathways.
A second Setting the Bar Summit was held in 2002 that included representatives from a number of health care professional organizations and postsecondary faculty. The attendees at this summit were responsible for developing accountability criteria for the career pathway standards. Ten school-based teams from five NCHSTE member states volunteered to participate in the process and validated the accountability criteria.
National HOSA Sponsors Pilot Test
With the validated Health Care Foundation Skill Standards in place and the accountability criteria identified and field tested, the assessment process was ready to be initiated. Schools and employers from the 20 states represented on the NCHSTE Board of Directors completed a review of accountability criteria to determine appropriateness and usability. The review revealed that the foundation skills are included in the course of study for most students in a health science career path, but the accountability criteria would serve to increase the rigor and scope of the content. Item developers from five of the NCHSTE member states were invited to submit test questions for each of the accountability criteria. Psychometrician Susan Jackson reviewed the items for bias and authenticity and built three tests of 100 questions each for pilot testing at the Spring 2001 Health Occupations Students of America (HOSA) National Skills Leadership Conference. Scott Snelson, specialist with the Utah Office of Education and current project director, oversaw the pilot test. Cheryl Keever, 2001 chairman, HOSA, Inc., states, 'HOSA was thrilled to be involved in the validation process for this important endeavor. We were pleased with the number of HOSA members that participated in the voluntary testing event at the National Leadership Conference. The turnout by HOSA members represents our goal in encouraging individual participation in the health care professions.'
A total of 518 students representing 24 states volunteered to take the pilot test. Results were 10 percent scoring above 80 percent, and another 44 percent scoring at higher than 70 percent. Secondary students were 63 percent of the test takers, 12 percent were postsecondary and the remainder did not identify their education levels. Both male (24 percent) and female (76 percent) students participated. Thirteen percent were from urban communities, 29 percent from suburban communities, 30 percent from rural communities and 28 percent were unspecified.
Sharon Lofton, a student from Bloomington, Indiana, enrolled in a secondary health occupations class says, 'Thanks for having this test ... I now know what to ask my teacher.'
Laura Holmes, an allied health student from Norristown, Pennsylvania, comments, 'These questions are very important in the health care field ...'
The pilot test included a survey that helped the test developers make revisions as indicated by the responses. The survey revealed that 44 percent of the students were familiar with the National Health Care Skill Standards, 77 percent believed their curriculum was aligned with the standards, and 49 percent believed the test should be added as a HOSA skill event.
Jennifer Michelle Massey from Covington, Tennessee, answered yes, because she believes that 'All health students should know the contents of this test.'
Test takers were also asked if they thought a certificate of achievement would add value to the test. Response indicated that 52 percent believed it would, 22 percent believed it would not, and 26 percent were unsure.
Celene Robles, a secondary health science student from El Paso, Texas, was one of many students who were in favor of the certificate because, 'It would show how much we have learned.'
Fifty percent of the students agreed they would be willing to pay a $20 fee to take the test.
When asked why she volunteered to take the test, Liliana Caballos, from Oceanside, California, said, 'I took this test to see where I stood regarding the knowledge I have [gained] in the courses I have taken.'
Those participating in the exam were given certificates of participation and NCHSTE pens in appreciation for their time and thoughtful responses. Last, students were asked if questions should be added or removed from the test. Fourteen percent of the students suggested that questions be removed, while nine percent gave suggestions for additional questions that might strengthen the test.
Cami Horton, a postsecondary student from the rural community of Richfield, Utah, commented, 'Some ethical questions should be [added] about child abuse and reporting responsibility ... also questions related to the Good Samaritan Act.'
Several HOSA advisors also completed the test to have a better understanding of the content that students are expected to master in preparation for the certification. For the most part, the advisors felt they were covering most of the content but needed to compare the accountability criteria with the content taught to verify full coverage. A second field test was completed during the spring of 2002, with 2,736 volunteers participating through an Internet-accessible version of the exam. Results were tabulated for further item refinement. The actual assessment is to be available as an online pretest in fall of 2002. The test will include Internet access, immediate results for the test taker, item analysis for the instructor, and a matrix sampling item selection process.
In addition to scenario-based multiple-choice items, a portfolio of student work will be required for students to be eligible to receive a certificate. The portfolio will include such items as a resume, job application, writing sample, service learning/community service project description and a workplace learning experience validation. The portfolio will be verified and maintained by the instructor. The testing company and NCHSTE will endorse the certificate.
The pilot test results revealed that of the 11 foundation standards tested, the weakest area is the Systems Standard. In order to assist teachers with the content and application, a systems expert was contracted to develop a self-contained module on the topic. The systems module is available on CD, and purchasers of the CD have been extremely pleased with the format and content.
As part of the Health Science Building Linkages project, NCHSTE also developed more than 175 activities spanning grades K-12. These activities integrate the health science foundation skill standards into academic and career tech education coursework. The activities help students gain the skills and knowledge needed to successfully complete the assessment as well as skills needed for making wise career choices.
Each activity is organized by grade span: K-3, 4-6, 7-8 and 9-12.
They are also organized by academic subject: English-language arts, mathematics, science, history-social science, health education, physical education and health science.
Each activity includes identification of the primary and secondary academic connection and identification of the specific academic and health care foundation standard(s) that are addressed. For ease of use, notes on the role of the teacher, education partner(s), industry partner(s) as well as assessment strategies and recommended resources are included. For more information and resources for each activity, links to websites are highlighted.
The development process was extensive, with teams from 17 states participating in the development and pilot testing of the activities. Once the first draft was completed, teams of two from each of the partner states were trained to be coaches at a three-day interactive case-study institute. Each coach was then assigned to guide the pilot test of two learning partnerships that included elementary, middle and high schools, a community college and/or university and appropriate industry partners. Following the field test, a debriefing session was held for the coaches where results were reviewed and activities revised as recommended by the pilot teams.
One recommendation was to strengthen the rigor and complexity of activities supporting math and science standards at the high school level. To accomplish this task, high school science (chemistry, physics, biology) and math (geometry, algebra, calculus) faculty were teamed with University of California and California State University faculty from the schools of nursing, pharmacy, medicine, radiology and physical therapy. Several health care professionals joined the educators, and 15 additional highly rigorous activities were completed and added to the model.
Don Richards, associate director of technical education for workforce development and program accountability with the Kansas Board of Regents and immediate past chair of NCHSTE Board of Directors, attended the developmental session and also participated as a member of the Research Action Team that helped develop the activities and the 'train the trainer' program for professional distribution purposes. According to Richards, 'Too often students are required to learn something without a sense of an application to the world of work, or their own lives. These activities serve as a vehicle to bring health care professionals from the surrounding community into the classroom to help develop, teach and validate the necessity of specific course content.'
The Health Science Building Linkages Model activities have been distributed through professional development to more than 30 states, including Alaska and Hawaii. The distribution has included both in-service sessions for health science and health careers faculty and industry representatives as well as train-the-trainer sessions for those who wish to take on this responsibility. Teachers have been very enthusiastic about the ease of implementation and student response. New activities will be added as available.
Foundation Standards by Title:Academic FoundationsCommunicationsSystemsEmployability SkillsLegal ResponsibilitiesEthicsSafety PracticesTeamworkInformation Technology *Technical Skills *Health Maintenance Practices ** These standards were added later bythe USDE.Sample Standard:EthicsHealth care workers will understandaccepted ethical practices with respectto cultural, social and ethnic differenceswithin the health care environment.They will perform quality health caredelivery.
Standard: Ethics Accountability Criteria
Legal and Ethical Boundaries:
* Differentiate between morality and ethics and the relationship of each to health care outcomes
* Differentiate between ethical and legal issues impacting health care
* Analyze legal and ethical aspects of confidentiality
* Discuss bio-ethical issues related to health care
* Analyze and evaluate the implications of medical ethics
* Report activities and behaviors by self and others that adversely affect the health, safety or welfare of students, patients or co-workers
* Demonstrate fairness and equal treatment of all persons
* Practice responsibly within the Patients' Bill of Rights
* Value patients' independence and determination
Career Path: Biotechnology Research & Development
Standard: Academic Foundations Accountability Criteria for Genetics:
* Describe the basic structure of a chromosome
* Construct a karyotype with human chromosomes
* Differentiate the genetic inheritance of a lethal dominant homozygous trait from a heterozygous disease
Sample Test Item
Standard: Communication In gathering information from a patient, the health care worker distinguishes fact from personal opinion by
A. Active listening
B. A caring attitude
C. Eye contact
D. Selective listening
For more information, contact the National Consortium on Health Science and Technology Education, 2410 Woodlake Drive, Suite 440, Okemos, MI 48864
Phone: (517) 347-3332, fax: (517) 347-4096, or visit www.nchste.org.
Beverly Campbell is the manager of academic and career integration for the California Department of Education, Project Management Team member and co-founder of NCHSTE. Scott Snelson is a health occupations programs specialist with the Utah Office of Education, project director and chair, NCHSTE. Carole Stacy is the director of career services with the Michigan Health Council Project, Project Management Team member and executive director of NCHSTE.