Scenario-Based Lab Skills Assessment

To support program consistency, recognized B.C. HCA programs are expected to use case scenario testing to confirm that students are safe and competent before they go into the clinical setting.

As noted in the suggested course assessment for the Personal Care and Assistance course, skills testing could be accomplished through performance of a scenario simulating the practice environment and may include an opportunity for problem-solving. The specific skills tested and expected level of competency may vary depending upon when the first clinical experience occurs within the program. To support student success, it may be helpful to implement a mid-course assessment and/or pre-testing practice session.

For scenario-based or case study type assessment, it is typical to have at least four client scenarios for skills testing that students could receive in advance for preparation purposes. On testing day, a scenario will be randomly chosen for each student to perform. The student will have a set amount of time (e.g., 45 minutes per student) to complete the scenario. Students will work in pairs with one acting as the client and the other being the HCA.[1] It is important that the student acting as the client play the role seriously. Prompting or cueing by the client is not allowed. With some scenarios, it may be necessary for the HCA to obtain a partner who will be designated the “helper.” Some components of care may be provided on a mannequin or using simulation aids (e.g., torso with a penis or torso with a vulva).

A care plan is often provided for each scenario for the purpose of student testing.

Assessment Criteria

HCA programs may already have skills testing assessment criteria in place. At a minimum, students should demonstrate their ability to:

  • Maintain the comfort and dignity of the client.
  • Maintain the safety of the client, self, and other members of the health care team.
  • Perform in an organized manner.
  • Maintain medical asepsis.
  • Use proper body mechanics.
  • Communicate with the client and other health care team members, where appropriate.
  • Demonstrate competency of the personal care and assistance skills being tested in the scenario.

Evaluation is typically conducted on a satisfactory/unsatisfactory or a pass/fail basis. Programs implementing a mid-course skills assessment may add a “needs improvement” designation, which, if assigned, is followed up with a learning contract.

To ensure fair and reliable student practical skills assessment, there should be established criteria regarding what would constitute unsatisfactory performance. This could include the designation and number of minor infractions that may result in a cumulative fail, or major infractions that may result in an immediate fail.

Elements that may be considered include:

  • Skill testing takes longer than established time allotted for testing.
  • Student leaves client on the side of the bed or leaves client unattended with side rails down.
  • Student rolls client onto the edge of the bed without raising side rails.
  • Student performs a lift transfer incorrectly or no safety check.
  • Student makes offensive or inappropriate comments to the client.
  • Student leaves the client unattended in bed in the high position.
  • Student does not apply brakes to wheelchair, bed, or equipment in an appropriate manner.
  • Student repeatedly (more than once and/or after prompt or without self-correcting):
    • Forgets a portion of the skill.
    • Dresses client haphazardly/with inappropriate assistance from the client (e.g., clothes, TEDS, shoes).
    • Poorly positioning or moving of the client in bed.
    • Does not collect all supplies pre-scenario.
    • Provides care in a way that does not flow smoothly or is disorganized.
    • Does not use the appropriate number of side rails.
    • Performs morning care or perineal care in the incorrect order.
    • Contaminates objects by failing to wash hands, change gloves, touching clean objects with dirty gloves or dropping items on the floor.
    • Does not use proper body mechanics.
    • Forgets to give client an aid (e.g., glasses or hearing aid).
    • Fails to provide a thorough report of the client’s condition.

There should also be details set out in regards to requirements for retesting.

See sample case scenarios and rubrics below.

Rubric 1: Scenario-Based Lab Skills

You are an HCA working in a residential care home. Today you are assigned to provide morning care for Edith Blaise, a 92-year-old woman who has recently fractured her left foot. This morning when you enter Ms. Blaise’s room, she asks you to assist her with a bedpan. Following this, you will assist Ms. Blaise with a partial bed bath, assist her with dressing, and transfer her to her wheelchair using a full mechanical lift.

Depending on the case scenario, each required skill could be evaluated as follows:

Skill performed Unsatisfactory
(Indicate where applicable with a check mark)
Satisfactory
(Indicate where applicable with a check mark)
P=PASS
F=FAIL
R=Redo
Assists with a bedpan □ Ineffective organization and prioritization (did not gather required supplies and managed time improperly) □ Effective organization and prioritization (gathered required supplies and managed time properly)
□ Did not perform skill following correct lab procedures □ Performed skill following correct lab procedures
□ Performance of skill was unsafe □ Safe performance of skill
□ Improper medical asepsis □ Proper medical asepsis
□ Incorrect body mechanics □ Correct body mechanics
□ Inadequate communication with client □ Adequate communication with client
□ Does not attend to client comfort and/or support dignity □ Attends to client comfort and supports dignity
Instructor Comments
Partial bed bath □ Ineffective organization and prioritization (did not gather required supplies and managed time improperly) □ Effective organization and prioritization (gathered required supplies and managed time properly)
□ Did not perform skill following correct lab procedures □ Performed skill following correct lab procedures
□ Performance of skill was unsafe. □ Safe performance of skill
□ Improper medical asepsis □ Proper medical asepsis
□ Incorrect body mechanics □ Correct body mechanics
□ Inadequate communication with client □ Adequate communication with client
□ Does not attend to client comfort and/or support dignity □ Attends to client comfort and supports dignity
Instructor Comments
Assists with dressing □ Ineffective organization and prioritization (did not gather required supplies and managed time improperly) □ Effective organization and prioritization (gathered required supplies and managed time properly)
□ Did not perform skill following correct lab procedures □ Performed skill following correct lab procedures
□ Performance of skill was unsafe □ Safe performance of skill
□ Improper medical asepsis □ Proper medical asepsis
□ Incorrect body mechanics □ Correct body mechanics
□ Inadequate communication with client □ Adequate communication with client
□ Does not attend to client comfort and/or support dignity □ Attends to client comfort and supports dignity
Instructor Comments
(sample skill)

Transfer from bed to wheelchair

□ Ineffective organization and prioritization (did not gather required supplies and managed time improperly) □ Effective organization and prioritization (gathered required supplies and managed time properly)
□ Did not perform skill following correct lab procedures □ Performed skill following correct lab procedures
□ Performance of skill was unsafe □ Safe performance of skill
□ Improper medical asepsis □ Proper medical asepsis
□ Incorrect body mechanics □ Correct body mechanics
□ Inadequate communication with client □ Adequate communication with client
□ Does not attend to client comfort and/or support dignity □ Attends to client comfort and supports dignity
Instructor Comments

Download Rubric 1: Scenario-Based Lab Skills Assessment [PDF]

Note: This sample tool has been included to align with Suggested Course Assessment 3 in the Healing 3: Personal Care and Assistance Course.

Rubric 2: Scenario-Based Lab Skills

You are an HCA working in a residential care home. Today you are assigned to provide morning care for Edith Blaise, a 92-year-old woman who has recently fractured her left foot. This morning when you enter Ms. Blaise’s room, she asks you to assist her with a bedpan. Following this, you will assist Ms. Blaise with a partial bed bath, assist her with dressing and transfer her to her wheelchair using a full mechanical lift.

Depending on the scenario, and the using following criteria (NI = Needs improvement [may be used for mid-point testing], NS = Not Satisfactory, S = Satisfactory) the rubric could be used as follows:

1. Maintains the comfort and dignity of the client NI NS S
Examples and comments

 

2. Maintains the safety of the client, self, and other members of the health care team NI NS S
Examples and comments

 

3. Communicates effectively with the client and other members of the health care team, where appropriate NI NS S
Examples and comments

 

4. Provides care in an organized manner, gathers supplies, and manages time appropriately NI NS S
Examples and comments

 

5. Maintains medical asepsis and infection control throughout the scenario NI NS S
Examples and comments

 

6. Uses proper body mechanics throughout the scenario NI NS S
Examples and comments

 

7. Performs personal care and assistance skills competently (scenario specific) NI NS S
Examples and comments

 

i. Assist with bedpan (performed according to correct lab procedures)

NI NS S
Examples and comments

 

ii. Partial bed bath (performed according to correct lab procedures)

NI NS S
Examples and comments

 

iii. Transfer from bed to chair using full mechanical lift (performed according to correct lab procedures)

NI NS S
Examples and comments

 

Instructor Name                               Instructor Signature                                Date                                 

Student Name                                 Student Signature                                 Date                                

Download Rubric 2: Scenario-Based Lab Skills Assessment [PDF].

Note: This sample tool has been included to align with Suggested Course Assessment 3 included in the Healing 3: Personal Care and Assistance Course.


  1. The program may choose to have an instructor or a standardized patient (actor) in the role of the client.