NVIC 05-04: Assessing mariners' medical first aid proficiency

COMDTPUB P16700.4 NVIC 0 5 0 4 JAN 2 2 2004 NAVIGATION AND VESSEL INSPECTION CIRCULAR NO. 0 5 0 4 Subj: GUIDELINES FOR ASSESSING MERCHANT MARINERS THROUGH DEMONSTRATIONS OF PROFICIENCY IN MEDICAL FIRST AID Ref: (a) International Convention on Standards of Training, Certification and Watchkeeping for Seafarers, 1978, as amended (STCW), Regulation VI/4 paragraph 1 and Section A-VI/4-1 of STCW Code, incorporated into regulations at 46 CFR 10.102(b) (b) Federal Register dated April 23, 2002, Docket No. USCG-2002-12032, Guidelines for Assessing Merchant Mariners Through Demonstrations of Proficiency in Medical First Aid (c) Comments on Table A-VI/4-1, Assessment Guidelines, Specification of minimum standard of competence for persons designated to provide medical first aid, Docket No. USCG-2002-12032-3 and -4, Available at: http://dms.dot.gov

Guidelines for assessing merchant mariners through demonstrations of proficiency in medical first aid. — PURPOSE. This Circular provides the national guidelines for assessing merchant mariners

through demonstrations of proficiency in medical first aid. These guidelines are for use in training programs approved or accepted by the Coast Guard as meeting reference (a) and by designated examiners (DEs) when carrying out their assessments unless alternatives are used as discussed in paragraph 5.c.

Guidelines for assessing merchant mariners through demonstrations of proficiency in medical first aid. — ACTION. Officers in Charge, Marine Inspection (OCMIs), should use this Circular when

establishing that candidates are entitled to hold STCW-95 certificates attesting proficiency as persons designated to provide medical first aid as stipulated in 46 CFR 10.205(i). OCMIs should also bring this Circular to the attention of the appropriate people in the maritime industry within their zones. This Circular is available on the World Wide Web at http://www.uscg.mil/hq/g-m/nvic/. The Coast Guard will distribute it by electronic means only. DISTRIBUTION — SDL No. 140 a b c d e f g h i j k l m n o p q r s t u v w x y z A B 2 2 3 1 C 3 3 D 1 * E 1 2 F G H NON-STANDARD DISTRIBUTION: See Page 3

Guidelines for assessing merchant mariners through demonstrations of proficiency in medical first aid. — DIRECTIVES AFFECTED. None.

DIRECTIVES AFFECTED. None.

Guidelines for assessing merchant mariners through demonstrations of proficiency in medical first aid. — BACKGROUND.

a. The guidance from the International Maritime Organization (IMO) on shipboard assessments of proficiency, MSC/Circular 853, suggests that administrations should develop standards and measures of performance for practical tests as part of a program of training and assessment of mariners. These standards and measures ensure the uniform assessment of mariners without regard to individuality of the DEs and will result in standardization, fairness, and consistency. Enclosure (1) provides an overview of the Coast Guard's policy on assessments of mariners as required by the STCW. b. The Coast Guard tasked the Merchant Marine Personnel Advisory Committee (MERPAC) to recommend national assessment criteria for certification attesting proficiency as a person designated to provide medical first aid. The National Maritime Center (NMC) then used MERPAC's recommendations to develop proposed national guidelines, which we published for public comment in reference (b). Reference (c) contains the public's responses to the request for public comment. MERPAC's recommended guidelines included "knowledge" competencies not included within these national guidelines. These guidelines focus solely on the practical demonstrations of mariners' competency. Out of this process came the final version of the national assessment guidelines contained in enclosure (2).

Guidelines for assessing merchant mariners through demonstrations of proficiency in medical first aid. — DISCUSSION.

a.

All mariners who commence training or sea service required by the STCW on or after August 1, 1998, or all mariners applying for STCW certification attesting proficiency as persons designated to provide medical first aid on or after February 1, 2002, must present documentation demonstrating competence in those skills specified in the table of enclosure (2).

The practical demonstrations of skills required by 46 CFR 10.205(p) need to be completed in the presence of, and certified by, a DE.

Unless a mariner demonstrates proficiency in the skills required for competence as a person designated to provide medical first aid in enclosure (2), the OCMI will not issue the STCW certification as stipulated in 46 CFR 10.205(p). b.

A person assessing mariners for STCW certification attesting proficiency as persons designated to provide medical first aid should use either the guidelines in enclosure (2) or an alternative as discussed in paragraph "5. c" when assessing practical demonstrations of proficiency. c. 46 CFR 10.302 gives the Coast Guard authority to approve courses that satisfy regulatory requirements or that substitute for a Coast Guard examination or a portion of a sea- service requirement.

Those who assess the proficiency of mariners may refine these published guidelines and develop innovative alternatives; however, before they use any deviations from these guidelines, they must submit them to the NMC for approval by the Coast Guard.

A training institution submitting a course that leads to certification attesting proficiency as a person designated to provide medical first aid should either state that the guidelines in enclosure (2) will apply or otherwise identify the guidelines to be used. d.

Merchant mariners required to demonstrate proficiency through demonstrations of skills for certification as persons designated to provide medical first aid should use these guidelines for self-study and self-assessment. e.

STCW Regulation VI/4 paragraph 1 requires those persons designated to provide medical first aid on board ships to meet these standards of competence for demonstrations of skills to meet the proficiency in Table A-VI/4, paragraphs 1, 2, and 3 of the STCW Code.

The STCW is not a manning document; it establishes standards for a mariner's professional qualifications.

United States' manning laws or regulations do not require that a vessel have someone specifically designated as a person responsible to provide medical first aid unless required by the vessel's Certificate of Inspection.

It is not the intent of this NVIC to formalize or impose new manning requirements.

This NVIC merely provides guidance for review of medical training courses that may meet the STCW's requirements and acceptance of the qualifications of mariners.

It therefore provides shipping companies an avenue for proving that the person designated to provide medical first aid meets the requirements of STCW.

Guidelines for assessing merchant mariners through demonstrations of proficiency in medical first aid. — DISCLAIMER. While the guidance contained in this document may assist the industry, the

public, the Coast Guard, and other Federal and State regulators in applying statutory and regulatory requirements, the guidance is not a substitute for applicable legal requirements; nor is it itself a rule. Thus, it is not intended to nor does it impose legally-binding requirements on any party, including the Coast Guard, other Federal agencies, the States, or the regulated community. T. H. GILMOUR Assistant Commandant for Marine Safety, Security and Environmental Protection Encl: (1) Assessments of Mariners

(2) Table A-VI/4-1, Assessment Guidelines, Specification of Minimum Standard of Competence for Persons Designated to Provide Medical First Aid Non-Standard Distribution: B:a G-M(1); G-MS(1); G-MSO (4) D:1 CG Liaison Officer MILSEALIFTCOMD (Code N-7CG) (1); CG Liaison Officer MARAD

(MAR-720.2) (1). ASSESSMENTS OF MARINERS 1. ASSESSMENT OF SKILLS. a. Traditionally, in the United States, the Coast Guard has measured mariners' competency through assessments of knowledge. Knowledge-based components of this competency usually involve the recalling of facts or concepts, and written examinations are normally valid and reliable instruments for assessing such components. Historically, the Coast Guard has issued licenses and documents based predominantly on written essay and multiple-choice examinations. Currently, the Coast Guard employs a bank of over 25,000 multiple-choice questions to examine mariners. b. Assessment of understanding is more complex than assessment of knowledge. Understanding involves specific principles and information processes necessary to analyze alternatives, make conclusions, make choices and decisions, or affect outcomes. Because it is a covert characteristic, understanding must be ascertained through assessment of an overt behavior that demonstrates understanding. Ascertainment can employ a variety of mechanisms, ranging from written problems involving calculations or analysis of facts to practical demonstrations requiring diagnostic or analytical reasoning. Many of the Coast Guard's 25,000 written questions for multiple-choice examinations involve problems that assess an understanding; but, in many instances, complete understanding is best measured through actual assessment of a mariner's performance. c. Guidance provided by the IMO on certain assessments of proficiency requires development of standards and measures of performance for practical tests as part of seafarers' training programs. This is a new requirement for many flag-state administrations and their maritime industries. Performance assessment is part of a larger, well-established body of knowledge called instructional system design

(ISD).

Within this body, assessment methodologies range from the simple and straightforward to the complex and difficult.

For the purposes of STCW, the Coast Guard believes the simplest and most straightforward approach works best and has decided to develop a set of national guidelines.

In these, a performance standard has three components: the conditions, the behavior, and the criteria.

The first establishes the conditions under which the candidate demonstrates the knowledge, understanding, or proficiency.

The second specifies the precise set of knowledge, understandings, or skills (the 'behaviors') that is recalled, demonstrated, or performed.

The third are the particular standards against which we measure an applicant's behavior to determine whether the performance is minimally competent. d.

The third component is normally expressed in terms of "measures" or combinations of "measures," such as a time limit or requirement, a specific sequence, a number or a percentage, a tolerance, or a degree of conformance or accuracy required.

For highly critical skills, the criteria may require precise answers, require exact sequences of actions, or have very small tolerances of errors or degrees of conformance.

For instance, missing just one step of a sequence may constitute failure because that step was critical to achieving the final outcome.

In less-critical skills, wider tolerances or degrees of conformance may pass; however, in every case the applicant must demonstrate the minimal level of competence set forth in the criteria. 2.

DEVELOPMENT OF STANDARDS. a.

While the STCW Code gives broad guidance on the standards of performance and methods of assessment, the responsibility for the development of specific performance standards for each competency lies with the training provider.

Development of valid and reliable performance standards is a resource-intensive effort.

To minimize cost to the industry, promote uniformity, expedite the development process, and provide valid examples of these new performance standards, the Coast Guard asked that the Merchant Marine Personnel Advisory Committee (MERPAC) develop recommendations for a set of these standards. b.

MERPAC developed the core elements of a set of these standards and forwarded them to the Coast Guard.

We reviewed the initial recommendations and compared them to the requirements of the STCW.

We incorporated the final products into the proposed national assessment guidelines and published them in the Federal Register for public comments.

After considering the comments, we have made them the standards for identifying minimum levels of competence during demonstrations of a mariner's proficiency. c.

We encourage companies and maritime training institutions to use the national guidelines for assessment of STCW proficiencies in training programs submitted for our approval or for acceptance by a recognized quality-standards system.

They should use them during STCW proficiency assessments conducted by their DEs.

They may develop alternative assessment standards; however, they may not use these in accepted or approved training programs until the National Maritime Center of the Coast Guard has reviewed and approved them. 3.

WRITTEN EXAMINATIONS. a.

Written examinations used in training programs under the STCW deserve particular emphasis.

Companies and maritime training institutions should review their written instruments for assessing each knowledge-based and understanding- based competency from the STCW to ensure they include at least one question for each competency in the appropriate table from Part A of the STCW Code. b.

Companies and maritime training institutions should also have multiple questions for addressing each knowledge-based and understanding-based competency from the STCW to afford candidates a fair opportunity to demonstrate minimum ability.

If only one question assessed a required knowledge or understanding, an incorrect answer would constitute a failure to have demonstrated the knowledge or understanding and would leave the candidate ineligible to have that competency certified by the DE, unless the DE used an alternative method.

Accordingly, it would be preferable for the assessment to contain several questions.

For example, in a written multiple-choice examination, if four questions concerned the same critical knowledge and if the performance standard were a score of 70%, three correct answers and one incorrect answer would meet the requirements for minimum competency.

In this case the mariner would qualify as competent for that knowledge.