3ClinicalTeaching Handouts

7/31/2019 3ClinicalTeaching Handouts

1/17Gibbons, et al 2002

Stra teg ies For Cl in ica l Teach ing

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Joanne Schupb ach, M.S. , M.A.Rush Univers i t y Medica l Center -Rush Univers i t y

Modera tor : Caro lyn Smaka, Au.D.

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STRATEGIESFORCLINICAL

TEACHING

JoanneSchupbach,M.S.,M.A.

RushUniversity

RushUniversityMedicalCenter

AudiologyOnline

April18,2012

2003 RUSHUniversity MedicalCenter



LEARNINGOUTCOMES

Identifykeyelementsforapositivelearning

environment

Identifyclinicalteachingstrategiesthatenhance

Listspecificteachingtechniquesbaseduponthe

leveloflearner


CLINICALTEACHINGGOALS

Increasestudentsknowledgeandskills

Refinepracticeefficiencyandeffectiveness

Promoteincreasingclinicalindependence

Preparestudentsforoptimalhealthoutcomeswithpatients

Become acompetent,compassionate,independentandcolloborativeclinician


Burns, et al (2006)

CLINICALLEARNING

Nursingisapracticedisciplinewithan

appreciableamountofnursingtheory

originatinginpractice.

Craddock(1993),Phillips,etal(1996a,b)

Learningtheartandscienceofnursingisa

complex,intricateprocessdemanding

competencethatishighlycognitiveandfirmly

rootedinpractice.

Taylor&Dean(1999)




POSITIVELEARNINGENVIRONMENT

Preceptorsmustunderstandthatthoseassignedforpracticumarestudentsandappreciatethe

tentativeness

and

peculiaritiesof

a

clinician

in

training.

AudiologyEducationSummitI(2005)

Successoftheexperienceisbaseduponthetonesetbypreceptorsandthestaff.


Yonge,etal(2002


Theattitudesandbehaviorsofnursesandtheirrelationshipwiththepreceptorsinfluencedhowstaffrelatedtothestudent.

OhrlingandHallbergs(2000) studyofnursesexperiencesaspreceptorsrevealedseveralmainideaswithtrustasakey.



Provocative

Stimulating

Disciplined

Supportive

Nonthreatening

Respectful

Authentic

Supportive

Caring

Noncompetitive


Yonge, etal(2002)Reilly&Oermann (1992)




ProperpreceptorProperpreceptor

preparationpreparation wasoneofthewasoneofthe

mostimportantfactorsmostimportantfactors

related

to

the

success

of

related

to

the

success

of

theexperience.theexperience.

Experience

CredentialsPersonal

Characteristics

Preparation

Yonge,etal(2002)

SkillsKnowledge


AudiologyEducationSummitII

(2006)








Essential

characteristicsof

aqualityclinicalsiteEquipment

Physical environment

Diversity ofExperience

Evidence BasedPractice

SiteCommitment

Staff

Policies andProcedures


AudiologyEducationSummitI(2005)


Teachingspaceisanimportantconsideration.

Notalltraining canbedonebedside(orboothside)

Spaceforthestudentstodowork

Privatespacetoprovideverbalfeedbackisimperative


Yonge, et al (200 5)

STUDENTEXPECTATIONS

Challengethestudentsknowledge

Allowsomeindependence

Allowroomforerrorbutexpectimprovement

Provideencouragement

Communicatewithstudent

Makeexpectationsclear

Showinterestinstudentsgrowth

Beapproachableandnotintimidating




STUDENTEXPECTATIONS

Giveconstructive,specificfeedback

Understandthat

students

learn

at

adifferent

pace

and

to

exhibitpatience

Modelbestpracticesandbeagoodrolemodel

Assiststudentovercomefeelingsofnervousness,lackof

confidenceorfeelingsofbeingoverwhelmed

Developtrust inthestudent


WHATSTUDENTSDONTAPPRECIATE

Discrepanciesacrosssupervisors

Assumptionthatstudentknowssomethingwhatis

beyond whathasbeentaughttodate

Supervisorwhoisdistantorunwillingtofullyfacilitate

studentswork

Supervisortooquicktocorrectamistakeortellmewhat

isthenextstep

Distantornoncommunicativesupervisor

Negativefeedbackdiscussedinfrontofapatient


TEACHINGPRINCIPLES

Learningevolvesovertime

Participation,repetition,reinforcementstrengthenlearning

Varied

learning

activities

enhance

interest

and

retention

Immediateuseofskillsandinformationstrengthensretention

Plannedpreparationforthestudentiscritical


Burns,etal(2006)



TEACHINGPRINCIPLES

Therolesofstudent,preceptorandfacultymustworkinsynchronyforgoodlearningoutcomes.

ExpectationsofStudent

Studentmustbeanactiveadultlearner

Preceptormustassessthestudentsneeds,developalearningenvironmentconsistentwithprogramgoalsandevaluatethestudentswork


Burns, et al (2006)

ADULTLEARNINGPRINCIPLES

Requiresinvolvementofthelearner

Focusedandinfluencedbythelearnersmotivation

Interactive

Individualprocess

Influencedbythereadinessofthelearner

Mosteffectivewhenorganizedandcommunicatedclearly

Facilitatedbypositiveandimmediatefeedback

Integratedwithknowledge


CaliforniaStateUniversityFullerton

NursingPreceptor

Handbook,

2010

TEACHINGGUIDELINES

Setclearandrealisticexpectations

Teachtothelearnersneeds

Observelearnersperformancesadgivespecificfeedback

Encourageindependentlearningandreflection

Varyyouteachingmethodsindifferentcontexts

Createapositivelearningenvironment

Reflectuponandimproveyourteaching

Makelearningmemorableandfun


CaliforniaStateUniversityFullerton

NursingPreceptorHandbook,2010



LONGITUDINALQUALITATIVESTUDY

Thequalities

of

an

effective

mentor

from

the

studentnursesperspective:findingsfroma

longitudinalqualitativestudy.

M.A.GrayandL.N.Smith(2000)

JournalofAdvancedNursing



Studentsviewedamentorascrucialtotheirlearning

GoodMentors

Enthusiastic Senseofhumor

Patient Goodrolemodels,professional,organized,

caring,selfconfidant

Understanding Goodcommunicator

Friendly RealisticExpectations

Paceteachingtofacilitatestudents

progression

Providesregularfeedback

Involvestudentinactivities Genuinelyinterestedinstudent

Demonstratesconfidenceandtrustin

studentsability

Providesincreasingindependencetothe

student


Gray & Smith (2000)


PoorMentors

Break promises Delegates student to their unwanted

jobs

Lack knowledge and expert ise Often dislike their job and/or student

Demonstrate poor teaching ski lls DistantDemonstrate no structure in their

teaching

Less friendly

Over protect the student by allowing

for observation only

Unapproachable

Throw them into the deep end Int imidate student

Have unreal istic expectat ions Poor understanding of their preceptor

responsibilities


Gray & Smith (2000)




Stude nts list of their future me ntorship

Supportthestudentdontbreathe

downthestudentsneck

Determinethestudentsneedsto

achievelearninggoals

Encourageparticipation

in

patient

care

ratherthanjustallowobservationClarify

expectations

on

both

sides

and

provideopportunitiesforstudentto

achievegoals

Show confidence and trust in the Allow the student inde endence b

studentsabilities

givingmoreguidanceatthebeginning

Developarelaxedr el at io nshi p P ro vi dethestudentwiththebest

learningopportunities

Notassumethestudenthashadcertain

experiences

Arrangeforotherstafftolookoutfor

thestudent

Ascertainfromthestudentattheonset,

thestudentscurrentabilitiesandgoals


Gray & Smith (2000)

CLINICALTEACHING

ChallengesintheClinicalSetting

Rapidpacewithmultipledemandsonthepreceptor

Teachingandlearningisvariableascasesvaryintype,number,complexity

Lackofcontinuit


Limitedtimeforteachingandfeedback

Learningmaynotbecollaborativewithpreceptor

Limitedopportunitiesandtimeforreflection

Learningmaynotbeatanoptimalpaceforthestudent

Burns, et al (2006)

CLINICALTEACHINGSTRATEGIES

TheBeginner

Observation

Routineanduncomplicatedcases

Thoroughchartreview

Preparingthenecessarycomponentsofevaluation

TheTransitionalLearner

Preceptorstepsback

Lessinputaboutbasics

Studentestablishesbasicprioritiesofassessment

Morecomplexcasesformoregeneralization


Burns, et al (2006)



CLINICALTEACHING

TheCompetentProficientLearner

Solidskillsinmanyareas

Increasedclinicaljudgmentandgeneralization

Moreflexiblethinking

oret mee c ent

Preceptorstepsout

Preceptorfocusesonpatterndevelopmentanduseof

generalrepresentationsacrosscomplexpatients


Burns, et al (2006)

TEACHINGSTRATEGIES

Modelingpassive

Preceptordemonstratesskillswhilestudentobserves

CasePresentationsSelect a case and have student resent relevant informationaboutthecase

CollaborativeLearningsimulations

Preceptorandstudentworktogetherona case

Gibbons,etal(2002)

Gibbons, et al200 2

Burns,etal(2006)

TEACHINGSTRATEGIES

SinkorSwimApproach

Studentisexposedtoavarietyofpatientsandisexpectedtoassesspatientsfairlyindependently

an pu a e ruc ure pproac

Patientsareinitially carefullyselectedbaseduponstudentsskilllevelandpreviousexperience.Casesincreaseinnumberandcomplexityovertime.


Gray and Smith ( 2000)



TEACHINGSTRATEGIES

Reflection

Askquestionstostimulatereflection

Whatareyourquestions?

Whatdidyoulearnfromseeingpatientstoday?

Whattroubled,surprised,movedorinspiredyou

today?


Arseneau,1995, DaRosa,1997,Smith,1997

TEACHINGSTRATEGIES

Selfdirectedlearning

Whatisonethingyouwanttolearnabout?

Selfassessment

.

Specifically,youdidwellon

Onerecommendationforimprovement...

TEACHINGSTRATEGIES

DirectQuestioning

ThinkAloudMethod

Lee

&

Ryan

Wenger

(1997)

OneMinutePreceptorMethod

Neher,etal(1992)




OneMinutePreceptorMethod

LearningGoal Script Studentmakesdecisionregarding

case

Whatdoyouthink?

Probe

for

supporting

findings

and

criticalthinking What

led

you

to

that

conclusion?

Tellthestudentwhatwascorrect. Youdidagoodjobof..andthisis

whyitsimportant.

Correcttheerrors Youdidwellon..butIdisagree

with

Teachageneralprinciple ThekeypointIwantyouto

remember.

Yourownoneminutereflection WhatdidIlearnaboutmyteaching?

Whatdidwelearnfromthis?


Neher,etal(1992)

TEACHINGSTRATEGIES

Assigndirectedreadingsonaspecificclinical

topic

oac ng

Journaling


TEACHINGSTRATEGIES

Feedback

Descriptivespecificsituations/skills

Immediate

Reviewimprovementofspecificskills

Correctmistakes

Bestifgiveninformally

Studentselfassessmentfirstmoremeaningfulifthe

studentselfassessesfirst


Burns, et al (2005)



TEACHINGSTRATEGIES

ClinicalTeachingStrategiesQuestionnaire

Developedthroughacomprehensivereviewofthe

literatureand

series

of

validation

studies

conducted

by

the

facultyandstudentsatVirginiaCommonwealthUniversity.

65itemsinfivecategories Ongoingorientationtoclinicalexperience

HistorytakingandPhysicalAssessment

DiagnosisandManagement

FeedbackandEvaluation

GeneralStrategies


Sawin, et al (2001)

TEACHINGSTRATEGIES

ClinicalTeachingStrategiesQuestionnaire

29strategies(45%)thatwereusedwithanylevel

ofstudent

36strategiesthatwereusedaccordingtothe

studentslevelofexperience


Sawin, et al (2001)

TEACHINGSTRATEGIES

Orientation

Assurethestudentthereisnodumbquestion

Askwhatthestudentwantstolearn

HistoryandPhysical

Focusonstudentsrecognitionofpatternsinclientdata

Sharereasoningprocessfordecisionwithstudent

Feedback/Evaluation

Regularlyofferstudentsreassuranceandpositivereinforcement

General

Promotepositiveattitudesaboutthepresenceofstudents


Sawin, et al (2001)



TEACHINGSTRATEGIES

Orientation

Reviewchartswithstudentstodiscussexpectations

Historyand

Physical

Holdstudentaccountableforrecognizingsubtlechangesinexam

DiagnosisandManagement

Expectstudenttothoroughlydiscussinterventionplan

Feedback/Evaluation

Assessstudentbyobservingcasehistory/completeassessment

General

Actasabufferbetweenstudentanddemandsofthe

environment


Sawin, et al (2001)

RECOMMENDATIONS

Developgoodpreplanning

Briefinterviewpriortostudentsfirstday

Discussskilllevels,goals,learningstyle

Shareyourhistoryandteachingstyle

Reviewpoliciesandprocedures

Delineateexpectationsclearly


Burns, et al (2005)

RECOMMENDATIONS

Designstudenttimewithpatientsdependinguponskill

level

Developcasepresentationtime

Encouragediscussiontime(evenifonlyafewminutes)

Establishmethodofcommunicationandregularmeetingschedulewithstudent(todiscussperformance,learning,difficultcases,etc)

Developexperiencesthatencompassentirescopeofpractice




RECOMMENDATIONS

Establishofficespaceforstudenttoperformdutiesandtoreflecteffectively

Appointleadpreceptorwhocoordinatesstudentlearningandprovidessupport

Developastructurefordailywork

Coordinatethestudentsclinicaleducationwithotherpreceptors


RECOMMENDATIONS

Allowthestudenttofollowthroughwitheachpatients

entireprocedureortreatmentplan

Askstudenttoestablishgoalsandtoselfevaluateduring

theexperience

Includestudentincontinuingeducationactivities

Givestudenttimetoreflectonexperiences


RECOMMENDATIONS

Reviewstudentsevaluationandtimelinesfromthe

academictrainingprogram

Besurethatallpreceptorsareconsistentwithtraining

philosophyandprocedures(mixedmessagesunderminesuccessof

training)

Evaluateyoursupervisionperiodically




Recommendations

Studentsvalueandappreciate:

Clear

expectations

for

performance Helpfulsuggestions

Immediateandspecificfeedback

Honestyabouttheirperformance

Praise

Beingrespectedandvalued

Encouragedtoselfevaluatebeforethepreceptor

evaluates


PreceptingPractices

Doyouaskthestudentforfeedbackaboutyourperformance?

Doesthestudentcompleteaformalevaluationofyoursupervision?

Doesthestudentfeelcomfortableinprovidingfeedbackaboutyourprecepting?


ClinicalTeachingEffectivenessInventory

Establishesagoodlearningenvironment

Stimulatesindependentlearning

Allowsappropriateautonomy

Organizestimetoallowforbothteachingandclinicalwork

Offersregularfeedback

Clearlyspecifieswhatshouldbelearnedanddone

Adjuststeaching

to

learners

needs

Askquestionsthatpromotelearning

Givesclearreasonsandexplanations

Adjuststeachingtodiversesettings

Coachesonclinicalandtechnicalskills

Incorporatesresearchdataand/orguidelinesintoteaching

Teachesdiagnosticskills

Teacheseffectivepatientandfamilycommunication

Teachesprinciplesofcosteffectivecare


Copeland &Hewson,

2000


17/17

Themostimportantoutcomeofeducationisto

helpstudentsbecomeindependentofformaleducation.

PaulE.Gray

Theonlypersonwhoiseducatedistheonewhohaslearned


.

CarlRogers

Thereisnothingsoeasytolearnasexperienceandnothing

sohardtoapply.

JoshBillings

Thesecretineducationliesinrespectingthestudent.

RalphWaldoEmerson


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3ClinicalTeaching Handouts