Competency Assessment

Template
Version 1 July 2014

On the original there is a photo in this space.

It has been removed so the document can be e-mails to CRF Cardiff.
Competency Assessment Template
Version 1 July 2014

Copyright 26 June 2014 The UKCRF Network Competency Assessment Template

Project Group - part of the UKCRF Network Education & Training Group

Permission granted to reproduce for personal and education use only on the condition
that authorship of the UKCRF Network Competency Assessment Template Project
Group is acknowledged.

Commercial copying is prohibited.

Chair of the UKCRF Network Competency Assessment Project Group and contact for
this document:
Kornelia Hathaway
Education & Training Manager
NIHR/Wellcome Trust Clinical Research Facility, Box 127
Cambridge University Hospital NHS Foundation Trust
Cambridge, CB2 0QQ, United Kingdom
Tel: +44 (0) 1223 596058
Email: [email protected]
Acknowledgements
The UKCRF Network Competency Assessment Template Project Group gratefully
acknowledges the input of all individuals who contributed to the development of this template
including:
UKCRF Network Strategic Management Team
UKCRF Network Education Group
UKCRF Network Lab Managers Workstream
Contents

Page

1 Introduction to the Competency Assessment Template 1

Why do we have this document? 1
What is the Competency Assessment Template? 1
The boundaries of the Competency Assessment Template 1
Introduction to using the Competency Assessment Template 2
Training 3
Roles and responsibilities 4

Some explanations about assessment, feedback and record keeping 5

2 Template for Single Competency Assessment 6

3 Template for Multiple Competency Assessment 10

4 Examples of a populated Competency Assessment Template 17

Preparation of Blood Films 17
Measuring Adult Height with Portable Leicester Stadiometer 21

5 Guidance notes for populating and using the Competency Assessment

Template 26

6 References 29
Introduction to the Competency Assessment Template

Why do we have this document?

Providing high quality research requires a trained and competent workforce (ICH GCP 1996).
One of the ways of validating staff training is to carry out a competency assessment (EdCaN
2008, Epstein & Hundert 2002). Often the competency assessments have to be written from
scratch because there is none available that matches the activity which has to be assessed.

The UKCRF Network Education Group were tasked by the UKCRF Network Lab Managers
Workstream to create competency documentation that could be adapted for the assessement
of laboratory skills. It became clear at an early stage that there was value in having a generic
competency assessment template. Subsequently, the Education Group established a project
group, the Competency Assessment Template Project Group, to explore and create a generic
competency assessment template that could be populated for any relevant activity that
required competency assessment.

The literature search for this project yielded a plethora of specific competency assessment
documents in a range of vocational education settings, for example: Canadian Society of
Respiratory Therapists (2011), NHS Health Education North West (2013), the University of
North Carolina (2012). However, it appeared that there had not been any work carried out to
create a nationwide generic template to document evidence of competence for clearly defined
practical tasks undertaken by clinical research staff.

With no existing generic template we could reuse, we agreed to develop our own, resulting in
the UKCRF Network Competency Assessment Template.

What is the Competency Assessment Template?

The Competency Assessment Template (CAT) presented here by the UKCRF Network
Education Project Group is a tool that can be utilised in the workplace of clinical research. Its
purpose is to provide a recommended structure which may be populated by staff who have to
write a competency assessment for a given activity in Clinical Research.

The boundaries of the Competency Assessment Template

For the purpose of this document a definition of competency has been adapted from the
Competency Framework for Clinical Research Nurses (Competency Framewok Group 2011):

The ability to demonstrate the application of knowledge, understanding, practical

and thinking skills to achieve effective performance in a practical skill.

The CAT has been designed for those instances where a competency assessment is required
and where there is no existing documentation in place. Where there is already a
Trust or Board policy that determines how competency is assessed it is recommended that
these are used if they are available and appropriate for the task.

1
Millers (1990) pyramid model for
assessing clinical competency (see
Figure 1) is widely referred to in the
literature on competency assessment.
The CAT has been designed to allow
assessment at a level approximating
to the shows how or level 3 of
Millers pyramid (Miller 1990). At this
level the member of staff has full
knowledge and comprehension of the
procedure, shows that they can
discuss the principles in detail, can
perform the procedure competently Figure 1: Miller GE (1990)
without supervision or assistance, but
recognises their own limitations and seeks appropriate advice when necessary.

The CAT is to be used in conjunction with any professional code of conduct relevant to the
staff member and in accordance with ICH GCP. All staff remain accountable for their
professional conduct at all times during training, supervised practice, competency
assessment and in practice following sign-off.

It is recognised that Standard Operating Procedures (SOPs) assist in reproducibility and

consistency of performance of tasks (Amare 2012). However, SOPs do not ensure that
competence has actually been achieved. This does not mean that all SOPs require to be
followed up by a competency assessment. Such a decision will be made locally and will take
into consideration factors such as risk and quality assurance.

Please note the CAT should not be confused with a Competency Framework, for example,
that for Clinical Research Nurses (Competency Working Group, 2011). Such frameworks
provide a broadly defined combination of competences that mark out an entire staff group in
the clinical research field. In contrast the CAT was designed so it could be populated and
serve as an assessment document for a well-defined task or activity which a member of staff
is required to undertake in Clinical Research.

Introduction to using the Competency Assessment Template

For ease of use the project group decided to issue the CAT in the following two forms:

Single Competency Assessment to be used for tasks which require a single

competency assessment prior to sign off

Multiple Competency Assessment to be used for tasks which require multiple

competency assessments prior to sign off

The CAT is a blank template designed to be populated with the various components that
together make up the specified task for which a member of staff has to be assessed, for
example, this could be the task of being competent in using a Gilson Pipette. These
components will fall into the categories of knowledge, skills and behaviour.

2
We have provided two examples where a CAT has been populated with the wording for a
competency assessment. One is for Preparation of Blood Films and the other is for
Measuring Adult Height with Portable Leicester Stadiometer. During the draft stages of this
project it has proved very useful to look at such an example while trying to understand the
instructions for the CAT.

If the person populating the template is not the designated expert in the subject, the expert
must authorise the content of the template. A system recording expert authorisation should be
implemented locally.

Ideally the CAT will be produced alongside an SOP for the same task, but the CAT may on
occasion be produced as a stand-alone document. The components of the competency
should reflect the content of any related SOP.

It is recommended that the populated assessment document is reviewed at least every

2 years or when there is a significant change in practice or a change in the related SOP
whichever is earlier. It is suggested that staff members will not need to be reassessed
immediately following the production of a new SOP and CAT but should be made aware of
the change. In the case of significant change in practice, appropriate training should be given
to staff members who have already been signed off as competent and arrangements for
reassessment made as appropriate.

Dependent on the task, it may be sufficient to complete a single competency assessment in

order to be signed off as competent, e.g. use of the centrifuge. For a more complex task it
may be necessary to complete multiple competency assessments prior to being signed off
as competent, e.g. venesection, receiving informed consent.

Detailed guidance has been created outlining how to populate the template prior to
distribution and how to use the template during assessment (see pages 26-29).

Training

The Competency Assessment Tool (CAT) has been designed to aid competency assessment
following appropriate training and supervised practice. It is not a training document, though
evidence of training may be required as part of the competency assessment i.e. as evidence
that a competency component has been achieved. Adequate training should be sourced as
appropriate to the task. Should a period of supervised practice be required following initial
training, this can be supported by another member of staff who has already been assessed
and signed off as competent in the task. A member of staff will only be considered safe and
competent to perform the task autonomously once they have been assessed and signed off
as competent by an assessor.

3
Roles and responsibilities

Assessee - the member of staff undergoing competency assessment.

An assessee:
is accountable for their own practice and competency in the task at every stage of the
training and assessment process
is accountable for the ongoing maintenance of their skills (following sign off as
competent)

Assessor - An individual who has full knowledge and comprehension of the task and has
fully developed their skill without the need for supervision and assistance in more unusual or
complicated situations. They have been deemed fit to act as an assessor by the expert. The
criteria for who can become an assessor will be a local decision.
An assessor:
is accountable for signing off members of staff who demonstrate sufficient knowledge
and skill during competency assessment
must give adequate feedback to those who do not show competence on assessment
must complete all CAT documentation fully at the time of assessment
must devise an action plan for re-assessment if needed, in collaboration with the
assessees line manager as appropriate

Expert - An individual who has extensive knowledge and experience in the field in which they
are regarded as an expert and can demonstrate sufficient evidence to support this. The
criteria for who is regarded as an expert will be a local decision.
An expert:
is accountable for ensuring that the template is populated accurately prior to use
must ensure that all assessors have appropriate experience in order to act as
assessors
can also act as an assessor

Line managers - organisational line manager of member of staff.

A line manager:
must allow access to training and ensure time for any supervised practice needed
prior to competency assessment
will liaise with the assessor, as appropriate, to devise an action plan for re-
assessment if needed

Supervisor any member of staff who has already been assessed and signed off as
competent in the task may supervise another member of staff prior to completing their
competency assessment.
A Supervisor:
must ensure that the member of staff is practising according to local policy and
procedure
is accountable for their own practice whilst supervising others

4
Some explanations about assessment, feedback and record keeping

Practical assessment
This will usually take place during normal practice but may take place as a simulation
exercise as appropriate e.g. role play of the informed consent process. Assessment should
not be undertaken until the assessee has had sufficient training and opportunity for
supervised practice. In order for sign off following competency assessment all components of
the task must be achieved as set out in the CAT. Feedback must be given promptly following
the assessment.

Feedback
If competency is not achieved following assessment then performance feedback should be
given in order to help the assessee to gain the further knowledge or practice required. A plan
for re-assessment should be made and documented. Feedback following achievement of
competency may also be helpful and should be given as appropriate.

Re-assessment following non-achievement of competency components on

assessment
Mechanisms and time-scales for re-assessing should be decided locally. Review with
assessees line manager should be considered.

On-going competency assessment

Competency will usually be re-assessed after a set period of time, two yearly is
recommended but this will depend on the task and local decision. The appropriate re-
assessment period should be clearly marked on the populated competency assessment
document.

Record keeping
A system for maintaining records of competency assessment, whether by individual staff
members or centrally, should be put in place. It is useful to have an SOP outlining the local
procedure for competency assessment and record keeping and this may include the local
decisions regarding criteria for who can take the role of expert, re-assessment mechanisms
etc.

5
Insert Hospital Name/ Logo

Single Competency Assessment for

Insert title of competency here
Staff Group(s):

Version Number & Date: Review Date:

Related to SOP:

Author of Template: Signature: Date:

Designation:
Expert Authorisation: Signature: Date:

Designation:

Name of Assessee:
This is a Single Competency Assessment
Designation:

Assessment
Assessor Name:

Designation:

Signature:

Initials:

Date of Assessment:

Single Assessment Template - page 1 of 4

name of organisation / title of competency / version number / date of version / author of competency 6
Title of Competency Assessment: Insert title
Name of Assessee: Insert name

1
K/S/B Competency Statement Assessment Criteria Assessment
Components of the overall competency Evidence required Achieved Y / N Initials of Assessor
i.e. knowledge, skills and behaviour required
Y / N: Initials:

Assessors comments:

Y / N: Initials:

Assessors comments:

Y / N: Initials:

Assessors comments:

Y / N: Initials:

Assessors comments:

Y / N: Initials:

Assessors comments:

1
K=Knowledge, S=Skills, B=Behaviour Single Assessment Template - page 2 of 4

name of organisation / title of competency / version number / date of version / author of competency 7
Title of Competency Assessment: Insert title
Name of Assessee: Insert name
1
K/S/B Competency Statement Assessment Criteria Assessment
Components of the overall competency Evidence required Achieved Y / N Initials of Assessor
i.e. knowledge, skills and behaviour required
Y / N: Initials:

Assessors comments:

Y / N: Initials:

Assessors comments:

Y / N: Initials:

Assessors comments:

1
K=Knowledge, S=Skills, B=Behaviour
Single Assessment Template - page 3 of 4

Add further lines as required for the competency you wish to populate.

name of organisation / title of competency / version number / date of version / author of competency 8
 Competency Assessment Record
(requiring single competency assessment in order to be signed off as competent)

Insert title of competency here

Assessor Statement
Date of Competency Assessment: Attempt Number:

Have all the components of the competency assessment been achieved: Yes / No (delete as appropriate)

The assessee named below has been assessed as having / not having (delete as appropriate) the appropriate knowledge, skills & behaviours for the above
competency:

Assessor Name: Comments:*

Designation: Signature: Date:

*Where further assessments are required, please specify and consider giving time frame. Where multiple assessments have been attempted and competency has not been achieved, consider
review with line manager as appropriate

Assessee Statement
I agree with the outcome of the competency assessment and where competency has been achieved, I accept responsibility for being competent to undertake
the task/s detailed above and for my ongoing maintenance of knowledge, skills and behaviours:

Assessee Name: Comments:

Designation: Signature: Date:

Reassessment period (if applicable), e.g. every 2 years Reassessment date (for the candidate):

Single Assessment Template - page 4 of 4

name of organisation / title of competency / version number / date of version / author of competency 9
Insert Hospital Name/ Logo

Multiple Competency Assessment for

Insert title of competency here
Staff Group(s):

Version Number & Date: Review Date:

Related to SOP:

Author of Template: Signature: Date:

Designation:
Expert Authorisation: Signature: Date:

Designation:

Name of Assessee Number of achieved competency assessments

required in order to be signed off as comptent:
Designation:

Assessment 1 Assessment 2 Assessment 3

Assessor Name: Assessor Name: Assessor Name:

Designation: Designation: Designation:

Signature: Signature: Signature:

Initials: Initials: Initials:

Date of Assessment: Date of Assessment: Date of Assessment:

Multiple Assessment Template - page 1 of 6

name of organisation / title of competency / version number / date of version / author of competency 10
Title of Competency Assessment: Insert title
Name of Assessee: Insert name
1
K/S/B Competency Statement Assessment Criteria Assessment 1 Assessment 2 Assessment 3
Components of the overall competency Evidence required
i.e. knowledge, skills and behaviour Achieved Initials of Achieved Initials of Achieved Initials of
required Y/N Assessor Y/N Assessor Y/N Assessor
Y / N: Initials: Y / N: Initials: Y / N: Initials:

Assessors comments: Assessors comments: Assessors comments:

Y / N: Initials: Y / N: Initials: Y / N: Initials:

Assessors comments: Assessors comments: Assessors comments:

1
K=Knowledge, S=Skills, B=Behaviour Multiple Assessment Template - page 2 of 6

Add further lines as required for the competency you wish to populate.

name of organisation / title of competency / version number / date of version / author of competency 11
 Competency Assessment Record
(requiring multiple competency assessment in order to be signed off as competent)

Insert title of competency here

Assessor Assessment 1
Date of Competency Assessment: Attempt Number:

Have all the components of the competency assessment been achieved: Yes / No (delete as appropriate)

The assessee named below has been assessed as having / not having (delete as appropriate) the appropriate knowledge, skills & behaviours for the above
competency at this assessment:

Assessor Name: Comments*:

Designation: Signature: Date:

*Where further assessments are required, please specify and consider giving time frame. Where multiple assessments have been attempted and competency has not been achieved, consider review
with line manager as appropriate

Assessee Assessment 1
Assessee Name: Comments:

Designation: Signature: Date:

Multiple Assessment Template - page 3 of 6

name of organisation / title of competency / version number / date of version / author of competency 12
 Competency Assessment Record
(requiring multiple competency assessment in order to be signed off as competent)

Insert title of competency here

Assessor Assessment 2
Date of Competency Assessment: Attempt Number:
Have all the components of the competency assessment been achieved: Yes / No (delete as appropriate)

The assessee named below has been assessed as having / not having (delete as appropriate) the appropriate knowledge, skills & behaviours for the above
competency at this assessment:

Assessor Name: Comments:*

Designation: Signature: Date:

*Where further assessments are required, please specify and consider giving time frame. Where multiple assessments have been attempted and competency has not been achieved, consider
review with line manager as appropriate

Assessee Assessment 2
Assessee Name: Comments:

Designation: Signature: Date:

Multiple Assessment Template - page 4 of 6

name of organisation / title of competency / version number / date of version / author of competency 13
 Competency Assessment Record
(requiring multiple competency assessment in order to be signed off as competent)

Insert title of competency here

Assessor Assessment 3
Date of Competency Assessment: Attempt Number:
Have all the components of the competency assessment been achieved: Yes / No (delete as appropriate)

The assessee named below has been assessed as having / not having (delete as appropriate) the appropriate knowledge, skills & behaviours for the above
competency at this assessment:

Assessor Name: Comments*:

Designation: Signature: Date:

*Where further assessments are required, please specify and consider giving time frame. Where multiple assessments have been attempted and competency has not been achieved, consider
review with line manager as appropriate

Assessee Assessment 3
Assessee Name: Comments:

Designation: Signature: Date:

Multiple Assessment Template - page 5 of 6

name of organisation / title of competency / version number / date of version / author of competency 14
 Competency Assessment Record
Insert title of competency here
Assessor Statement final sign off
All the components of the competency assessment have been achieved on (insert number here) occasions.

The assessee named below has been assessed as having / not having (delete as appropriate) the appropriate knowledge, skills & behaviours
for the above competency:

Assessor Name: Comments*:

Designation: Signature: Date:

*Where further assessments are required, please specify and consider giving time frame. Where multiple assessments have been attempted and competency has not been achieved, consider
review with line manager as appropriate

Assessee Statement final sign off

I agree with the outcome of the competency assessment and I accept responsibility for being competent to undertake the task/s detailed above and for my
ongoing maintenance of knowledge, skills and behaviours:

Assessee Name: Comments:

Designation: Signature: Date:

Reassessment period (if applicable), e.g. every 2 years Reassessment date (for the candidate):

Multiple Assessment Template page 6 of 6

name of organisation / title of competency / version number / date of version / author of competency 15
Two examples have been created to illustrate how the competency assessment template could be populated.
The examples are shown on the following pages.

16
Clinical Research Facility, XYZ

Example of a Competency Assessment Template that has been populated

Single Competency Assessment for
Preparation of Blood Films
Staff Group(s): Clinical Staff

Version Number & Date: Version 1, 29 May 2014 Review Date: 28 May 2016

Related to SOP: Standard Operating Procedure CRF/SOP088 Preparation of Blood Films, Version 1, 10 May 2014

Author of Template: A.Nurse

Signature: A Nurse Date: 22 May 2014

Designation: Acting Senior Sister

Expert Authorisation: Donna Weather Signature: Donna Weather Date: 29 May 2014

Designation: Senior Haematology Sister

Name of Assessee:
This is a Single Competency Assessment
Designation:

Assessment
Assessor Name:

Designation:

Signature:

Initials:

Date of Assessment:

Preparation of Blood Films - page 1 of 4

Clinical Research Facility XYZ / preparation of blood films / V1 / 29 May 2014 / AN 17

Title of Competency Assessment: Preparation of Blood Films
Name of Assessee: Insert name
1
K/S/B Competency Statement Assessment Criteria Assessment
Components of the overall competency Evidence required Achieved Y / N Initials of Assessor
i.e. knowledge, skills and behaviour required
1) Identifies local SOP relating to blood films When prompted with a given scenario, accesses Y / N: Initials:
CRF/SOP088 Preparation of Blood Films and
K demonstrates and demonstrates ability to identify
relevant information Assessors comments:

2) If blood film is performed for a research study: Identifies When prompted with a given scenario, accesses the Y / N: Initials:
the required information in/from the research protocol that relevant CRF study flowsheet (protocol section) that
K relates to blood films for the study in question (e.g. the details the instructions for the blood films
labelling required Assessors comments:

3) Identifies correct equipment required to carry out blood Describes what equipment is needed (or collects Y / N: Initials:
film: these items) and gives rationale for their use
K o Personal Protective Equipment
o Blood Sample Assessors comments:
o Microscope slides (minimum x 2)
o Diff Safe Dispenser
o Tissue for cleaning slides
o Clinical waste sharps bin
4) Identifies risks involved in handling above equipment: Describes both these risks Y / N: Initials:
o Exposure to blood borne pathogens
K o Exposure to air borne pathogens in blood Assessors comments:

5) Conducts appropriate hand hygiene and uses appropriate Demonstrates appropriate hand hygiene being Y / N: Initials:
Personal Protective Equipment (PPE) - in response to undertaken and wears correct PPE (lab coat,
K risk identified above gloves, goggles) and can give relevant rationale for
B their use Assessors comments:

Explains need for Diff-safe and that this avoids need

to open blood tube

*K = Knowledge, S = Skill, B = Behaviour Preparation of Blood Films - page 2 of 4

Clinical Research Facility XYZ / preparation of blood films / V1 / 29 May 2014 / AN

18
Title of Competency Assessment: Preparation of Blood Films
Name of Assessee: Insert name
1
K/S/B Competency Statement Assessment Criteria Assessment
Components of the overall competency Evidence required Achieved Y / N Initials of Assessor
i.e. knowledge, skills and behaviour required
6) Prepares equipment appropriately for task: Explains and demonstrates: Y / N: Initials:
Ensures sample is well mixed That sample needs to be well mixed
K Handles slides with care Careful handling of slides Assessors comments:
Cleans slides with soft tissue Cleaning of slides with soft tissue
Applies Diff-safe to end of blood tube Applying Diff-safe to end of blood tube

7) Applies correct technique to carry out blood film: A: Assessee demonstrates all 6 steps with a real Y / N: Initials:
1. Transfers a small drop of blood from a well life sample
S mixed sample onto clean slide near the frosted
K B: Repeats this process with a different sample Assessors comments:
end
B 2. Holds a second slide (the pusher slide) at a 30-
45 angle and slowly moves it back to touch the C: Repeats this process with a third sample
blood drop
3. Allow the droplet to draw completely across the When a mistake should occur in the process he/she
edge of the pusher slide to ensure a thin film of will start afresh
blood runs along the base
4. Applies gentle pressure (not much more than
the weight of the slide) to the pusher slide and
move in a smooth, quick motion, pushing the
blood away to give a thin film
5. Ensures the smear extends to almost the full
length of the slide
6. Allows to air dry thoroughly while lying flat
8) Correctly labels and packages slide: A: Describes/ demonstrates labelling Y / N: Initials:
Label the frosted end with the participants
S details as per study protocol/ flowsheet B: Describes/ demonstrates packaging
K Assessors comments:
Places slides in appropriate plastic packaging
B for transport

9) Carries out safe disposal of material and hand- hygiene: A: Describes/ demonstrates safe disposal Y / N: Initials:
Disposes of rejected slides and Diff-safe needle
S as per local policy B: Refers to correct local policy
B Assessors comments:
Performs hand hygiene before leaving
laboratory/sample handling room C: Performs relevant hand hygiene before leaving
the room

*K = Knowledge, S = Skill, B = Behaviour Preparation of Blood Films - page 3 of 4

Clinical Research Facility XYZ / preparation of blood films / V1 / 29 May 2014 / AN

19
 Competency Assessment Record
Preparation of Blood Films
Assessor Statement
Date of Competency Assessment: Attempt Number:

Have all the components of the competency assessment been achieved: Yes / No (delete as appropriate)

The assessee named below has been assessed as having / not having (delete as appropriate) the appropriate knowledge, skills & behaviours for the above
competency:

Assessor Name: Comment:*

Designation: Signature: Date:

*Where further assessments are required, please specify and consider giving time frame. Where multiple assessments have been attempted and competency has not been achieved, consider
review with line manager as appropriate

Assessee Statement
I agree with the outcome of the competency assessment and where competency has been achieved, I accept responsibility for being competent to undertake
the task/s detailed above and for my ongoing maintenance of knowledge, skills and behaviours:

Assessee Name: Comments:

Designation: Signature: Date:

Reassessment period : every 2 years Reassessment date (for the candidate):

Clinical Research Facility XYZ / preparation of blood films / V1 / 29 May 2014 / AN Preparation of Blood Films - page 4 of 4

20
Clinical Research Facility, XYZ

Example of a Competency Assessment Template that has been populated

Single Competency Assessment for
Measuring Adult Height with Portable Leicester Stadiometer
Staff Group(s): All staff measuring adult height

th
Version Number & Date: Version 1, Review Date: 18 March 2016
th
19 March 2014
Related to SOP: XYZ/V2/010 Measuring Adult Height with portable Leicester Stadiometer 19 June 2013

Author of Template: B Wilson

Signature: B Wilson Date: 10 March 2014

Designation: Education Lead

Expert Authorisation: T Expert Signature: T Expert Date: 16 March 2014

Designation: Anthropometric Lead

Name of Assessee:
This is a Single Competency Assessment
Designation:

Assessment
Assessor Name:

Designation:

Signature:

Initials:

Date of Assessment:

Measuring Adult Height - page 1 of 5

XYZ / Measuring Adult Height-Leicester Stadiometer / V1 / 19 March 2014 / BW 21

Title of Competency Assessment: Measuring Adult Height with Portable Leicester Stadiometer
Name of Assessee: Insert name
1
K/S/B Competency Statement Assessment Criteria Assessment
Components of the overall competency Evidence required Achieved Y / N Initials of Assessor
i.e. knowledge, skills and behaviour required The assessor will look for answers that relate to the
relevant information in the corresponding SOP and
training
1) Identifies relevant documentation that needs to be Identifies relevant SOP and for study specific Y / N: Initials:
consulted when undertaking adult height requirements of height measurement identifies protocol
K measurement and Case Report Form (or equivalent). Assessors comments:

2) Explains why obtaining accurate measurements of Gives accurate answers to questioning. Y / N: Initials:
height is essential.
Assessors comments:
K

3) Locates the appropriate equipment required to Locates correct equipment to be used. Y / N: Initials:
assemble the Leicester Stadiometer and Discusses purpose and process of validation, including
K/S demonstrates an understanding of any validation checks to ensure equipment is in working order Assessors comments:
processes involved to ensure equipment is in working
order.

4) Able to accurately set up a Leicester Stadiometer with Demonstrates accurate set up of equipment. Y / N: Initials:
due consideration to assembly and positioning of Gives accurate answers to questioning about assembly
K/S Stadiometer. and positioning of equipment. Assessors comments:

5) Enlists the help of a colleague and explains to them Gives correct and clear instructions. Y / N: Initials:
their role.
K/S/B Assessors comments:

*K = Knowledge, S = Skill, B = Behaviour Measuring Adult Height - page 2 of 5

XYZ / Measuring Adult Height-Leicester Stadiometer / V1 / 19 March 2014 / BW

22
Title of Competency Assessment: Measuring Adult Height with Portable Leicester Stadiometer
Name of Assessee: Insert name
1
K/S/B Competency Statement Assessment Criteria Assessment
Components of the overall competency Evidence required Achieved Y / N Initials of Assessor
i.e. knowledge, skills and behaviour required The assessor will look for answers that relate to the
relevant information in the corresponding SOP and
training
6) Knows what the participant will be required to do and Correct and clear instructions given to participant. Y / N: Initials:
is aware of rationale for it.
Assessors comments:
K/S/B Explains clearly to the participant what they will be Provides correct rationale to assessor why these
required to do and supports if necessary. instructions are given.

7) Checks that the participant Has demonstrated these checks to the assessor. Y / N: Initials:
- has taken off heavy outer clothing, shoes and (if Assessors comments:
B required) has rolled up their trousers
- stands in correct position
Ensures the participant to places her/his head in the
correct position and to maintains this hold throughout
the duration of the measurements
8) Knows significance of correct head position and can Correctly names head position and explains what it Y / N: Initials:
explain what it is. involves and why it is used.
K Assessors comments:

9) Explains what they would do if they needed to Gives correct explanations. Y / N: Initials:
measure someone:
Assessors comments:
K a. with braids or dreadlocks
b. wearing a turban
c. wearing a headdress

10) Obtains correct number of measurements required Demonstrates this to the assessor. Y / N: Initials:
(depending on protocol/procedure)
Assessors comments:
K/S/B

*K = Knowledge, S = Skill, B = Behaviour Measuring Adult Height - page 3 of 5

23
XYZ / Measuring Adult Height-Leicester Stadiometer / V1 / 19 March 2014 / BW
Title of Competency Assessment: Measuring Adult Height with Portable Leicester Stadiometer
Name of Assessee: Insert name
1
K/S/B Competency Statement Assessment Criteria Assessment
Components of the overall competency Evidence required. Achieved Y / N Initials of Assessor
i.e. knowledge, skills and behaviour required The assessor will look for answers that relate to
the relevant information in the corresponding SOP
and training
11) Instructs the participant to step off the stadiometer Demonstrates this to the assessor Y / N: Initials:
between each measurement
K/S Assessors comments:

12) Explains why multiple measures are made and states Correct answer to questioning Y / N: Initials:
which values are recorded Assessors comments:
K/S

13) Knows within how many millimetres the Correct answer to questioning. Y/N Initials:
measurements should fall and documents the correct
Documents the measurement(s) correctly.
K/B number of decimal spaces.

14) Knows how to ensure consistency in the results from Correct answer to questioning. Y / N: Initials:
repeated measurements on the same individuals over
K time. Assessors comments:

*K = Knowledge, S = Skill, B = Behaviour Measuring Adult Height - page 4 of 5

XYZ / Measuring Adult Height-Leicester Stadiometer / V1 / 19 March 2014 / BW 24

 Competency Assessment Record
Measuring Adult Height with Portable Leicester Stadiometer

Assessor Statement
Date of Competency Assessment: Attempt Number:

Have all the components of the competency assessment been achieved: Yes / No (delete as appropriate)

The assessee named below has been assessed as having / not having (delete as appropriate) the appropriate knowledge, skills & behaviours for the above
competency:
Assessor Name: Comments:*

Designation: Signature: Date:

*Where further assessments are required, please specify and consider giving time frame. Where multiple assessments have been attempted and competency has not been achieved, consider
review with line manager as appropriate.

Assessee Statement
I agree with the outcome of the competency assessment and where competency has been achieved, I accept responsibility for being competent to undertake
the task/s detailed above and for my ongoing maintenance of knowledge, skills and behaviours:
Assessee Name: Comments:

Designation: Signature: Date:

Reassessment period: every two years Reassessment date for the candidate:

Measuring Adult Height - page 5 of 5

XYZ / Measuring Adult Height-Leicester Stadiometer / V1 / 19 March 2014 / BW 25

Guidance Notes for Populating and Using the Competency
Assessment Templates
Populating page 1 (the front page) of the template
Explanations are given for the lines in the template as they appear on page 1 of the template

Insert Hospital Name / Logo - to be added if required

Insert title of competency here - keep the title short (e.g. the use of dry ice)

Staff Group(s) - state which staff group(s) the competency applies to

Version Number & Date - of the populated CAT which should be on or after the date of the
expert authorisation signature below

Review Date - it is recommended that the populated assessment document is reviewed at

least every 2 years or when there is a change in practice or a change in the related SOP
whichever is earlier (see also page 3)

Related to SOP - if your organisation has a Standard Operating Procedure (SOP) relating to
the competency in question, insert the title, version number and date of the related SOP(s)

Author of template - this may be the expert or another member of staff

Expert Authorisation - the expert confirming the accuracy of the populated template

Name of Assessee - this remains blank until the populated template is used for assessement

Number of achieved competency assessments required in order to be signed off as

competent - Enter required number. This is only relevant for the form that is designed for
Multiple Assessment

Assessment if you are using the Multiple Assessment form, add the required number of
assessments columns to the template i.e. the number of successful competency
assessments required prior to sign off as in the box above

Single Assessment Template - has just one assessor. If competency is not achieved on the
first attempt, a second form should be completed on subsequent assessment

Multiple Assessment Template - has more than one assessment. More than one assessor
may be involved in the overall process. Each assessor should complete the box as per the
assessment number

Footer e.g. the electronic location of the document or Name of Organisation/ Title of
Competency/ Version Number/ Version Date

Populating page 2 (the Competency Statement and Assessment page) of the

template

Title of Competency Assessment: Insert title identical to the title on the front page

Name of Assessee: Insert name remains blank until the populated template is used

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K/S/B when populating the template, identify if each component is K-knowledge, S-skills or
B-behaviour or a combination

Competency Statement the overall task needs to be cut into bite-sized chunks of logical
component parts of the overall competency. These chunks are referred to as competency
statements in the professional literature

A useful way of completing this is to ask yourself, if you were to declare a member of staff as
competent in performing a particular (clinical) task, what knowledge, skill and behaviour has
to be in place? Examples are provided on pages 17-20 & 21-25

NB: the number of Competency Statements required will vary from task to task.
Depending on the number and size of the Competency Statements you will need to
add further template pages as required.

Ideally components stated in the related SOP(s) will correlate with the individual chunks
which will be listed as a set of competency statements

Assessment Criteria details the evidence required for the assessor to be satisfied that the
assessee is competent in each component e.g. GCP certificate, practical demonstration of
skill or explanations given. Evidence may need to be elicited by giving a hypothetical scenario

Assessment, Achieved Y / N, Initials of Assessor and Assessors comments these

boxes remain blank until the populated template is used. Assessor to delete Yes / No as
appropriate & insert initials. Assessor comments may be added e.g. what went well, problems
encountered, how these were solved

Populating the last page of the template (the Competency Assessment Record
page) when using the Single Assessment form:

Competency Assessment Record Insert title here - identical to the title on the front page

Assessor Statement remains blank until the populated template is used

Date of Competency Assessment enter date following the assessment

Attempt Number enter attempt number following the assessment

Have all the components of the competency assessment been achieved: Yes/ No
delete Yes/ No as appropriate

The assessee named below has been assessed as having/ not having delete
having/not having as appropriate

Assessor Name remains blank until the populated template is used. When the form is
being used for an assessment then this box will be completed by person carrying out the
assessment

Comments include comments and time frame for further assessment attempts if
unsuccessful

Assessee Statement remains blank until the populated template is used

27
Assessee Name remains blank until the populated template is used. When the form is
being used for an assessment then this box will be completed by the assessee in agreement
with the assessee statement

Comments comments may be added

Reassessment period enter timeframe as appropriate to the task, e.g. every 2 years

Reassessment date (for the candidate) complete following successful competency

If competency isnt achieved on the first attempt, further copies of the Competency Statement
& Assessment page(s) and Competency Assessment Record page must be completed on
each subsequent attempt and attached to the initial documentation.

Instructions for populating the pages that contain the Competency Assessment
Record on the Multiple Assessment form only:

Add the required number of assessments when populating the template. Complete assessor
and assessee sections following each assessment (same as for Single Assessment see
above). Following achievement of the required number of successful assessments, the final
sign off page will be completed by both the final assessor and assessee.

Assessor Statement final sign off - remains blank until the required number of
assessments are achieved

All the components of the competency assessment have been achieved on (insert
number here) occasions final assessor inserts the number (matching that on page 1)

Assessor Name to be completed following final assessment with comments as appropriate

Assessee Statement final sign off remains blank until the required number of
assessments are achieved

Assessee Name - assessee to complete in agreement with the assessee statement.

Comments may be added

Reassessment period enter timeframe as appropriate to the task e.g. every 2 years

Reassessment date (for the candidate) completed following successful competency

If the assessee needs to complete more than three assessments, further copies of the
Competency Statement and Assessment page(s) and Competency Assessment Record page
must be completed on each subsequent attempt and attached to the initial documentation

Following sign off as competent, records of competency assessment and copies of completed
CATs must be held as per local decision

28
References

Amare G (2012) Reviewing the Values of a Standard Operating Procedure, Ethiop J

Health Sci Vol 22 No 3, 205 8

Canadian Society of Respiratory Therapists (2011) Competency Evaluation

Templates 2011 Respiratory Therapy National Competency Profile
http://www.csrt.com/en/education/pdf/Templates-NCP.pdf (last accessed 24 June
2014)

Competency Working Group (2011) Competency Framework for Clinical Research

Nurses: A tool to promote patient safety and quality data (Online) Available at:
http://www.rcn.org.uk/__data/assets/pdf_file/0019/201466/Research_Nurse_Compete
ncy_Framework_-_Version_2_-_Full_-_Oct_2011.pdf (last accessed 22 June 2014)

Epstein RM, Hundert EM (2002) Defining and assessing professional competence,

JAMA Vol 287 No 2, 226-235

ICH GCP (Online) Available at: http://ichgcp.net/ (last accessed 22 June 2014)

Miller GE (1990) The assessment of clinical skill/competence/performance, Academic

Medicine (supplement) 65, S63-67

Education Framework Cancer Nursing (EDCAN) (2008) Competency assessment in

nursing A summary of literature published since 2000

The University of North Carolina at Chapel Hill, Office of Human Resources (2012)
SPA performance management & competency assessment form
http://hr.unc.edu/form-finder/performance-management-forms/
(last accessed 25 June 2014)

NHS Health Education North West (Dec 2013) ST4 Psychiatry Specialities - National
Recruitment Aug 2014 Intake - Certificate C core competence equivalence report
https://www.nwpgmd.nhs.uk/national_ST4_Psychiatry_Recruitment_certificate_c
(last accessed 24 June 2014)

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Members of the UKCRF Network Competency Assessment Template Project
Group - Version 1 July 2014

Kornelia Hathaway chair of project group

Education & Training Manager
NIHR/Wellcome Trust Clinical Research Facility
Cambridge

Susan Caddy
Education Lead
NIHR/Wellcome Trust Clinical Research Facility
Southampton

Wendy Harman
Senior Research Nurse
Clinical Investigation & Research Unit (CIRU)
Royal Sussex County Hospital
Brighton

Janet Johnstone
Education & Training Officer
Glasgow Clinical Research Facility
Glasgow

Danielle Wilson Marlow

WTCRF Education Coordinator & MSc in Clinical Trials Programme Administrator
Wellcome Trust Clinical Research Facility
Western General Hospital
Edinburgh

30
The UKCRF Network Education Group is part of the UKCRF Network
NIHR Wellcome Trust Clinical Research Facility
Manchester Royal Infirmary
Grafton Street
Manchester
M13 9WL
Telephone: 0161 906 7509
Contact details:
Helen Pidd, Director, [email protected]
Shane Hoy, Operations Manager, [email protected]

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