Evaluation of a novel scoring and grading model for VP-based exams in postgraduate nurse education

•A novel scoring and grading model for assessing both the clinical reasoning process and clinical decision making was developed.•The scoring and grading model has the possibility of deduction of points if patient safety is not protected.•The semi-automatic assessment module facilitates scoring and offers an opportunity to judge the clinical reasoning process.•The assessment module needs to be further developed in order to better control for unnecessary actions.•Educators must provide learning activities that makes the clinical reasoning process visible.

SummaryFor Virtual Patient-based exams, several scoring and grading methods have been proposed, but none have yet been validated. The aim of this study was to evaluate a new scoring and grading model for VP-based exams in postgraduate paediatric nurse education.The same student group of 19 students performed a VP-based exam in three consecutive courses. When using the scoring and grading assessment model, which contains a deduction system for unnecessary or unwanted actions, a progression was found in the three courses: 53% of the students passed the first exam, 63% the second and 84% passed the final exam. The most common reason for deduction of points was due to students asking too many interview questions or ordering too many laboratory tests.The results showed that the new scoring model made it possible to judge the students' clinical reasoning process as well as their progress.