Student Performance: Above vs. Below Expectations

DTCC Clinical EducationJason A Dougherty PTA, BS

This Training Module

Thank you for serving as clinical faculty. Thank you also for providing input with regard to what we can do to help you develop as a clinical instructor

This has been compiled in response to feedback from your Effective CI Self Assessment form

Some of these suggestions are constructive with either student experience (students who perform above vs. below expectations)

Students’ Expectations of CI Performance

According to Healey, students will enter their clinical affiliation with these expectations. Patient Interaction▪ Complex and contextual learning focused on patient

care Supportive Learning Environment▪ Strong relationship with a clinical instructor who

models appropriate behaviors such as a commitment to the teaching and advanced communication skills

▪ Environment allows for student self assessment and constructive feedback during diverse clinical experience

CI Expectations of Student Performance

Some students will consistently exhibit the behaviors listed below, requiring less intervention from their clinical instructor

Above Expectations Safe practitioner/maintains confidentiality▪ minimal cues required

Strong behaviors/empathy▪ appropriate communication throughout clinical environment

More autonomous/takes responsibility▪ quickly progresses to greater independence with patient

treatment & clinic procedures Requires higher level of challenge▪ Fear student may become bored

CI Expectations of Student Performance

Some students may also consistently exhibit the behaviors listed here, requiring greater intervention from their clinical instructor

Below Expectations Patient Safety/Confidentiality▪ Requires significant cues with little carryover

Behaviors▪ Maintains inappropriate relationship and/or inappropriate

communication with staff and patients with minimal response to cues. Will not take responsibility for change

Treatment▪ Unable to apply prior teachings while offering no explanation for

decision making Requires a greater amount of input from CI, possibly

taking away from patient care

Examples of Behaviors of Concern

These are just some behaviors that we would find inappropriate Abrasive (disrespect) Inappropriate language

(vulgar/jokes, racially or sexually inappropriate)

Over confident (affiliation is a waste of time)

Distracted or unmotivated (requires cues to do everything, “I don’t know”)

Argumentative Inappropriate dress Lateness or

unexcused absence Unprofessional

(doesn’t follow plan of care, doesn’t complete full treatment, procedural issues)

Lack of preparation (fails to complete assignment/request)

Sample Behavior

Student exhibits behavior

Meet with CI for constructive

input+ Carryover – no longer exhibits*No need for

follow upContinue behavior

Meet with CCCE &

document weekly

progress

+ Carryover – no longer exhibits

*continue to document weekly

Continue behavior

Meet with ACCEDevelop learning

Contract

Continue behavior

+ Carryover – no longer exhibits

*begin daily log*continue to document

weekly

Affiliation Terminated

Algorithm for Student Intervention

Intervention

Both student populations (above and below expectations), require some form of additional intervention. The following slides contain some suggestions for designing the student's experience in response to their level of performance.

Above Expectations

No matter what the theme of your discussion, it is vital to maintain a positive attitude

(+) “ You have been doing really well, let’s try to change your goals to include….

(-) “ You have met all of your goals, I don’t know what else to do with you”

Above Expectations

Don’t assume a high level of performance in every aspect of their clinical affiliation

Example Great with patient

care and maintains a strong, professional relationship with professional staff for 5 weeks. BUT, experiences difficulty with in-service on their last day because of a poor research review or difficulty with public speaking

Above Expectations

Maintain Communication Hourly, Daily,

Weekly, Midterm and Final

Even a strong student will need guidance

They may confuse the CI’s confidence in their skills' as avoidance

Example “My CI was never

available after the first couple days”

“My CI was always in their office”

Above Expectations

Make sure student participates in goal setting (self directed learning). They should not believe they are a passive participant.

Examples They didn’t give me

enough to do They didn’t offer me

anything else.

Above Expectations

Utilize your facility to it’s full potential as an educational site.

Example Surgical

Observation Observation of other

disciplines (OT, Speech)

Care Conferences Community

Programs Research

Opportunities▪ Libraries

Shadow Physicians

Above Expectations

Research topics of interest

Examples Use this time to…▪ Look up articles about

a previous question▪ Research topics for in-

service▪ Develop a case study

Above Expectations

Do not shelter student from difficult patient interactions. These interactions will contribute to your student’s growth

Examples Combative patient Non communicating

patient Patient with

challenging pathology

Below Expectations

The remaining slides offer suggestions for coping with students whose performance may be below your expectations as a clinical instructor. Please remember that you can always contact me should you have any concerns re: student issues.

Jason Dougherty 302-657-5131 office / 302-884-9431 pager jadougherty@christianacare.org /

jdoughe7@dtcc.edu

Below Expectations

Remind student that their learning should be self directed Discuss goals

together▪ Are student and CI

goals similar (expectations)?

Clinical setting has shifted from learner based to knowledge based

Example/Suggestion Avoid hearing, “you

didn’t show me…”. Instead ask the student, “what do you expect” or “what would you like to accomplish”

Sample Behavior

Below Expectations

Don’t hesitate to provide constructive input Don’t forget the

positive/affirming The sooner the

better Discuss with

student when they prefer to discuss performance – greater self directed learning

Example/Suggestion Provide input re:

behaviors at the end of the day allows student to improve tomorrow

vs.

Wait until Friday, don’t expect change until next week

Below Expectations

Maintain positive approach during constructive input Focus on behaviors

not personal judgment

Use cool off period if necessary▪ Take time to collect

thoughts and compile succinct input to provide to student▪ If not succinct, impact

of input can be lost

Example/Suggestion “Here is what you

did wrong…”vs.

“Here are some areas that could be improved…”

Below Expectations

Use Diagnostic Education Discuss thought

process to figure out where “wrong turn” occurred

Cover all domains of learning. Explain, exhibit & discuss, then ask student to repeat

Discuss patient prior to treatment time and suggest scenarios as well

Example/Suggestion Patient scenario▪ What are symptoms?▪ What is causing

symptoms?▪ What can be done to

quiet symptoms?▪ What can be dome to

alleviate future issues?▪ Ask student to perform

intervention on CI/staff▪ Ask student to do

necessary research prior to treatment

Below Expectations

Use Diagnostic Education (cont) Clarifies early

misconceptions Ask for student

input (self directed)▪ Ask student to use

a daily reflective journal – another opportunity to understand their perspective and though process

Example/Suggestion Avoid hearing, “I

thought we were supposed to…” or “ This wasn’t what I wanted to do…”

Below Expectations

Document, document, document Every time you

document constructive input is another opportunity for the student to improve

Example/Suggestion Weekly log Midterm and Final

Student Performance Evaluation

Learning Contract Meeting Minutes

(with student) Ask student to

compile:▪ Journal▪ Proficiency Checklist

Below Expectations

Consider Environment Student may hesitate

to communicate in front of others

Student may not be comfortable directing input directly to CI▪ Provide every

opportunity for them to talk

Student may need space for paperwork▪ Easily distracted

Example/Suggestion Change environment

for meeting ▪ Cafeteria, coffee shop,

outside Use third party for

communication if needed▪ Student may fear lower

grade if they give CI constructive input

Provide desk, locker, shared office

Below Expectations

Consider CI is always the model for ideal practitioner “Do as I say, not as I

do…”? Maintain continuity if

more than one CI Don’t take for

granted the “small stuff” – give student every opportunity to be comfortable in your clinic

Example/Suggestion CI must exhibit positive

attitude about PT & teaching▪ A 2nd CI may not display

same attitude toward PT and teaching

▪ CI must be a willing CI, not forced to take a student

“Small stuff”▪ Orient student to clinic,

equipment, paperwork and introduce to staff

Below Expectations

Remind student that we must follow legal and ethical codes

Example/Suggestion APTA Delaware State Pennsylvania State

References

Physical therapy clinical instructor educator credentialing manual. (1997). Alexandria, Va: American Physical Therapy Association.

Bransford, J.D., Brown, A.L. & Cocking, R. R. (2000). How people learn: Brain, mind, body and school. Washington D.C.: National academy press.

Cole, B. & Wessel, J. (2006). How clinical instructors can enhance the learning experience of physical therapy students in an introductory clinical placement. Advances in health sciences education, 13, 163-179.

Hanson, K.J. & Stenvig, T.E. (2008). The good clinical nursing educator and the baccalaureate nursing clinical experience: attributes and praxis. Journal of nursing education, 47:1, 38.

Healey, W. (2008). Physical therapist student approaches to learning during clinical education experiences: a qualitative study. Journal of physical therapy education, 22:1, 49-57.

Hirsh, D. A., Ogur, B., Thibault, G. E., & Cox, M. (2007). Continuity as an organizing principle for clinical education reform medical education. The New England journal of medicine, 356:8, 858.

References (cont)

Kelly, S. (2007). The exemplary clinical instructor: a qualitative case study. Journal of physical therapy education, 21:1, 63-69.

Kraft, M. & Neitzke, G. (2000). Communication in medical education: student’s demands. Medicine, healthcare & philosophy, 3, 185-190.

Lasater, K. & Nielsen, A. (2009). Reflective journaling for clinical judgment development and evaluation. Journal of nursing education, 48:1, 40-44.

Sliwinski, M., Schultze, K., Hansen, R., Malta, S. & Babyar, S. (2004). Clinical performance expectations: a preliminary study comparing physical therapy students, clinical instructors & academic faculty. Journal of physical therapy education, 8:1, 50-57.

Wolfe-Burke, M. (2005). Clinical instructors descriptions of physical therapist student professional behaviors. Journal of physical therapy education, 19:1, 67-75.

Wolfe-Burke, M., Ingram, D., Lewis, K., Odom, C. & Shoaf, L. (2007). Generic inabilities and the use of a decision making rubric for addressing deficits in professional behavior. Journal of physical therapy education, 21:3, 13-22.