Strategies For Clinical Teaching
Joanne Schupbach, M.S., M.A. Rush University Medical Center-Rush University Moderator: Carolyn Smaka, Au.D.
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STRATEGIESFORCLINICAL TEACHING
JoanneSchupbach,M.S.,M.A. RushUniversity RushUniversityMedicalCenter AudiologyOnline April18,2012
2003 RUSH University Medical Center
Gibbons, et al 2002
LEARNINGOUTCOMES
Identifykeyelementsforapositivelearning environment Identifyclinicalteachingstrategiesthatenhance studentlearning student learning Listspecificteachingtechniquesbaseduponthe leveloflearner
2003 RUSH University Medical Center
CLINICALTEACHINGGOALS
Increasestudentsknowledgeandskills Refinepracticeefficiencyandeffectiveness Promoteincreasingclinicalindependence Preparestudentsforoptimalhealthoutcomeswith patients Becomeacompetent,compassionate,independentand colloborativeclinician
Burns, et al (2006)
2003 RUSH University Medical Center
CLINICALLEARNING
Nursingisapracticedisciplinewithan appreciableamountofnursingtheory originatinginpractice.
Craddock(1993),Phillips,etal(1996a,b)
Learningtheartandscienceofnursingisa complex,intricateprocessdemanding competencethatishighlycognitiveandfirmly rootedinpractice.
Taylor&Dean(1999)
2003 RUSH University Medical Center
Gibbons, et al 2002
POSITIVELEARNINGENVIRONMENT
Preceptorsmustunderstandthatthoseassignedfor practicumarestudentsandappreciatethe tentativenessandpeculiarities ofaclinicianin training.
AudiologyEducationSummitI(2005)
Successoftheexperienceisbaseduponthetone setbypreceptorsandthestaff.
Yonge,etal(2002
2003 RUSH University Medical Center
POSITIVELEARNINGENVIRONMENT
Theattitudesandbehaviorsofnursesandtheir relationshipwiththepreceptorsinfluencedhow staffrelatedtothestudent.
OhrlingandHallbergs(2000)studyofnurses experiencesaspreceptorsrevealedseveralmain ideaswithtrustasakey.
2003 RUSH University Medical Center
POSITIVELEARNINGENVIRONMENT
Provocative Stimulating Disciplined Authentic h i Supportive Caring
Reilly&Oermann (1992)
Supportive Nonthreatening Respectful Promotesinquiry Promotes inquiry Noncompetitive
Yonge,etal(2002)
2003 RUSH University Medical Center
Gibbons, et al 2002
POSITIVELEARNINGENVIRONMENT
Properpreceptor preparation wasoneofthe mostimportantfactors relatedtothesuccessof theexperience.
Preparation
Experience
Personal Characteristics
Credentials
Knowledge
Skills
Yonge,etal(2002)
AudiologyEducationSummitII (2006)
2003 RUSH University Medical Center
POSITIVELEARNINGENVIRONMENT
2003 RUSH University Medical Center
POSITIVELEARNINGENVIRONMENT
2003 RUSH University Medical Center
Gibbons, et al 2002
POSITIVELEARNINGENVIRONMENT
Essential characteristicsof aqualityclinicalsite
Equipment Physical environment Evidence Based Practice Diversity of Experience
Policies and Procedures Staff
Site Commitment
AudiologyEducationSummitI(2005)
2003 RUSH University Medical Center
POSITIVELEARNINGENVIRONMENT
Teachingspaceisanimportantconsideration. Notalltrainingcanbedonebedside(orboothside) Spaceforthestudentstodowork Privatespacetoprovideverbalfeedbackisimperative
Yonge, et al (2005)
2003 RUSH University Medical Center
STUDENTEXPECTATIONS
Challengethestudentsknowledge Allowsomeindependence Allowroomforerrorbutexpectimprovement g Provideencouragement Communicatewithstudent Makeexpectationsclear Showinterestinstudentsgrowth Beapproachableandnotintimidating
2003 RUSH University Medical Center
Gibbons, et al 2002
STUDENTEXPECTATIONS
Giveconstructive,specificfeedback Understandthatstudentslearnatadifferentpaceandto exhibitpatience Modelbestpracticesandbeagoodrolemodel Assiststudentovercomefeelingsofnervousness,lackof confidenceorfeelingsofbeingoverwhelmed Developtrust inthestudent
2003 RUSH University Medical Center
WHATSTUDENTSDONTAPPRECIATE
Discrepanciesacrosssupervisors Assumptionthatstudentknowssomethingwhatis beyondwhathasbeentaughttodate Supervisorwhoisdistantorunwillingtofullyfacilitate studentswork Supervisortooquicktocorrectamistakeortellmewhat isthenextstep Distantornoncommunicativesupervisor Negativefeedbackdiscussedinfrontofapatient
2003 RUSH University Medical Center
TEACHINGPRINCIPLES
Learningevolvesovertime Participation,repetition,reinforcementstrengthen learning Variedlearningactivitiesenhanceinterestandretention Immediateuseofskillsandinformationstrengthens retention Plannedpreparationforthestudentiscritical
Burns,etal(2006)
2003 RUSH University Medical Center
Gibbons, et al 2002
TEACHINGPRINCIPLES
Therolesofstudent,preceptorandfacultymustworkin synchronyforgoodlearningoutcomes.
ExpectationsofStudent Studentmustbeanactiveadultlearner Preceptormustassessthestudentsneeds,developa learningenvironmentconsistentwithprogramgoalsand evaluatethestudentswork
Burns, et al (2006)
2003 RUSH University Medical Center
ADULTLEARNINGPRINCIPLES
Requiresinvolvementofthelearner Focusedandinfluencedbythelearnersmotivation Interactive Individualprocess Influencedbythereadinessofthelearner Is social Issocial Mosteffectivewhenorganizedandcommunicatedclearly Facilitatedbypositiveandimmediatefeedback Integratedwithknowledge
CaliforniaStateUniversityFullerton NursingPreceptorHandbook,2010
2003 RUSH University Medical Center
TEACHINGGUIDELINES
Setclearandrealisticexpectations Teachtothelearnersneeds Observelearnersperformancesadgivespecificfeedback Encourageindependentlearningandreflection Varyyouteachingmethodsindifferentcontexts V hi h d i diff Createapositivelearningenvironment Reflectuponandimproveyourteaching Makelearningmemorableandfun
CaliforniaStateUniversityFullerton NursingPreceptorHandbook,2010
2003 RUSH University Medical Center
Gibbons, et al 2002
LONGITUDINALQUALITATIVESTUDY
Thequalitiesofaneffectivementorfromthe studentnursesperspective:findingsfroma longitudinalqualitativestudy.
M.A.GrayandL.N.Smith(2000) JournalofAdvancedNursing
2003 RUSH University Medical Center
LONGITUDINALQUALITATIVESTUDY
Studentsviewedamentorascrucialtotheirlearning GoodMentors
Enthusiastic Patient Understanding Approachable Friendly Paceteachingtofacilitatestudents progression Involvestudentinactivities Demonstratesconfidenceandtrustin studentsability Senseofhumor Goodrolemodels,professional,organized, caring,selfconfidant Goodcommunicator Knowledgeable RealisticExpectations Providesregularfeedback Genuinelyinterestedinstudent Providesincreasingindependencetothe student
Gray & Smith (2000)
2003 RUSH University Medical Center
LONGITUDINALQUALITATIVESTUDY
PoorMentors
Break promises Lack knowledge and expertise Demonstrate poor teaching skills Demonstrate no structure in their teaching Over protect the student by allowing for observation only Throw them into the deep end Have unrealistic expectations Delegates student to their unwanted jobs Often dislike their job and/or student Distant Less friendly Unapproachable Intimidate student Poor understanding of their preceptor responsibilities
Gray & Smith (2000)
2003 RUSH University Medical Center
Gibbons, et al 2002
LONGITUDINALQUALITATIVESTUDY
Students list of their future mentorship
Supportthestudentdontbreathe downthestudentsneck Encourageparticipationinpatientcare ratherthanjustallowobservation Showconfidenceandtrustinthe Show confidence and trust in the studentsabilities Developarelaxedrelationship Determinethestudentsneedsto achievelearninggoals Clarifyexpectationsonbothsidesand provideopportunitiesforstudentto achievegoals Allowthestudentindependenceby Allow the student independence by givingmoreguidanceatthebeginning Providethestudentwiththebest learningopportunities
Notassumethestudenthashadcertain Arrangeforotherstafftolookoutfor experiences thestudent Ascertainfromthestudentattheonset, thestudentscurrentabilitiesandgoals
Gray & Smith (2000)
2003 RUSH University Medical Center
CLINICALTEACHING
ChallengesintheClinicalSetting
Rapidpacewithmultipledemandsonthepreceptor Teachingandlearningisvariableascasesvaryintype, number,complexity Lackofcontinuity Limitedtimeforteachingandfeedback Learningmaynotbecollaborativewithpreceptor Limitedopportunitiesandtimeforreflection Learningmaynotbeatanoptimalpaceforthestudent
Burns, et al (2006)
2003 RUSH University Medical Center
CLINICALTEACHINGSTRATEGIES
TheBeginner Observation Routineanduncomplicatedcases Thoroughchartreview Preparingthenecessarycomponentsofevaluation TheTransitionalLearner h ii l Preceptorstepsback Lessinputaboutbasics Studentestablishesbasicprioritiesofassessment Morecomplexcasesformoregeneralization
Burns, et al (2006)
2003 RUSH University Medical Center
Gibbons, et al 2002
CLINICALTEACHING
TheCompetentProficientLearner Solidskillsinmanyareas Increasedclinicaljudgmentandgeneralization Moreflexiblethinking Moretimeefficient M ti ffi i t Preceptorstepsout Preceptorfocusesonpatterndevelopmentanduseof generalrepresentationsacrosscomplexpatients
Burns, et al (2006)
2003 RUSH University Medical Center
TEACHINGSTRATEGIES
Modelingpassive
Preceptordemonstratesskillswhilestudentobserves
CasePresentations
Selectacaseandhavestudentpresentrelevantinformation Select a case and have student present relevant information aboutthecase
Burns,etal(2006)
CollaborativeLearningsimulations
Preceptorandstudentworktogetherona case
Gibbons,etal(2002)
Gibbons, et al 2002
TEACHINGSTRATEGIES
SinkorSwimApproach
Studentisexposedtoavarietyofpatientsandisexpectedtoassess patientsfairlyindependently
ManipulatedStructureApproach Manip lated Str ct re Approach
Patientsareinitiallycarefullyselectedbaseduponstudentsskilllevel andpreviousexperience.Casesincreaseinnumberandcomplexity overtime.
Gray and Smith (2000)
2003 RUSH University Medical Center
Gibbons, et al 2002
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TEACHINGSTRATEGIES
Reflection
Askquestionstostimulatereflection Whatareyourquestions? Whatdidyoulearnfromseeingpatientstoday? Whattroubled,surprised,movedorinspiredyou today?
Arseneau,1995,DaRosa,1997,Smith,1997
2003 RUSH University Medical Center
TEACHINGSTRATEGIES
Selfdirectedlearning
Whatisonethingyouwanttolearnabout?
Selfassessment
Share a success and a concern or question Shareasuccessandaconcernorquestion. Specifically,youdidwellon Onerecommendationforimprovement...
TEACHINGSTRATEGIES
DirectQuestioning
ThinkAloudMethod
Lee&RyanWenger(1997)
OneMinutePreceptorMethod
Neher,etal(1992)
2003 RUSH University Medical Center
Gibbons, et al 2002
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OneMinutePreceptorMethod
LearningGoal
Studentmakesdecisionregarding case Probeforsupportingfindingsand criticalthinking Tellthestudentwhatwascorrect. Correcttheerrors Teachageneralprinciple Yourownoneminutereflection
Script
Whatdoyouthink? Whatledyoutothatconclusion? Youdidagoodjobof..andthisis whyitsimportant. y p Youdidwellon..butIdisagree with ThekeypointIwantyouto remember. WhatdidIlearnaboutmyteaching? Whatdidwelearnfromthis?
Neher,etal(1992)
2003 RUSH University Medical Center
TEACHINGSTRATEGIES
Assigndirectedreadingsonaspecificclinical topic
C hi Coaching
Journaling
2003 RUSH University Medical Center
TEACHINGSTRATEGIES Feedback
Descriptivespecificsituations/skills Immediate Reinforcingwhatwaspositiveabouttheexperience Reinforcingwhat was positive about the experience Reviewimprovementofspecificskills Correctmistakes Bestifgiveninformally Studentselfassessmentfirstmoremeaningfulifthe studentselfassessesfirst
Burns, et al (2005)
2003 RUSH University Medical Center
Gibbons, et al 2002
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TEACHINGSTRATEGIES
ClinicalTeachingStrategiesQuestionnaire
Developedthroughacomprehensivereviewofthe literatureandseriesofvalidationstudiesconductedbythe facultyandstudentsatVirginiaCommonwealthUniversity.
65itemsinfivecategories
Ongoingorientationtoclinicalexperience HistorytakingandPhysicalAssessment DiagnosisandManagement FeedbackandEvaluation GeneralStrategies
Sawin, et al (2001)
2003 RUSH University Medical Center
TEACHINGSTRATEGIES
ClinicalTeachingStrategiesQuestionnaire
29strategies(45%)thatwereusedwithanylevel ofstudent 36strategiesthatwereusedaccordingtothe studentslevelofexperience
Sawin, et al (2001)
2003 RUSH University Medical Center
TEACHINGSTRATEGIES
Orientation
Assurethestudentthereisnodumbquestion Askwhatthestudentwantstolearn
HistoryandPhysical
Focusonstudentsrecognitionofpatternsinclientdata
DiagnosisandManagement Diagnosis and Management
Sharereasoningprocessfordecisionwithstudent
Feedback/Evaluation
Regularlyofferstudentsreassuranceandpositivereinforcement
General
Promotepositiveattitudesaboutthepresenceofstudents
Sawin, et al (2001)
2003 RUSH University Medical Center
Gibbons, et al 2002
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TEACHINGSTRATEGIES
Orientation
Reviewchartswithstudentstodiscussexpectations
HistoryandPhysical
Holdstudentaccountableforrecognizingsubtlechangesinexam
DiagnosisandManagement g g
Expectstudenttothoroughlydiscussinterventionplan
Feedback/Evaluation
Assessstudentbyobservingcasehistory/completeassessment
General
Actasabufferbetweenstudentanddemandsofthe environment
Sawin, et al (2001)
2003 RUSH University Medical Center
RECOMMENDATIONS
Developgoodpreplanning Briefinterviewpriortostudentsfirstday Discussskilllevels,goals,learningstyle Shareyourhistoryandteachingstyle Reviewpoliciesandprocedures Delineateexpectationsclearly
Burns, et al (2005)
2003 RUSH University Medical Center
RECOMMENDATIONS
Designstudenttimewithpatientsdependinguponskill level Developcasepresentationtime Encouragediscussiontime(evenifonlyafewminutes)
Establishmethodofcommunicationandregularmeeting schedulewithstudent(todiscussperformance,learning,difficult
cases,etc)
Developexperiencesthatencompassentirescopeof practice
2003 RUSH University Medical Center
Gibbons, et al 2002
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RECOMMENDATIONS
Establishofficespaceforstudenttoperformdutiesandto reflecteffectively Appointleadpreceptorwhocoordinatesstudentlearning andprovidessupport Developastructurefordailywork Coordinatethestudentsclinicaleducationwithother preceptors
2003 RUSH University Medical Center
RECOMMENDATIONS
Allowthestudenttofollowthroughwitheachpatients entireprocedureortreatmentplan Askstudenttoestablishgoalsandtoselfevaluateduring theexperience Includestudentincontinuingeducationactivities Givestudenttimetoreflectonexperiences
2003 RUSH University Medical Center
RECOMMENDATIONS
Reviewstudentsevaluationandtimelinesfromthe academictrainingprogram Besurethatallpreceptorsareconsistentwithtraining philosophyandprocedures(mixedmessagesunderminesuccessof
training)
Evaluateyoursupervisionperiodically
2003 RUSH University Medical Center
Gibbons, et al 2002
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Recommendations
Studentsvalueandappreciate:
Clearexpectationsforperformance Helpfulsuggestions Immediateandspecificfeedback Honestyabouttheirperformance Praise Beingrespectedandvalued Encouragedtoselfevaluatebeforethepreceptor evaluates
2003 RUSH University Medical Center
PreceptingPractices
Doyouaskthestudentforfeedbackaboutyour performance? Doesthestudentcompleteaformalevaluationof yoursupervision? Doesthestudentfeelcomfortableinproviding feedbackaboutyourprecepting?
2003 RUSH University Medical Center
ClinicalTeachingEffectivenessInventory
Establishesagoodlearningenvironment Stimulatesindependentlearning Allowsappropriateautonomy Organizestimetoallowforbothteachingandclinicalwork Offersregularfeedback Clearlyspecifieswhatshouldbelearnedanddone j g Adjuststeachingtolearnersneeds Askquestionsthatpromotelearning Givesclearreasonsandexplanations Adjuststeachingtodiversesettings Coachesonclinicalandtechnicalskills Incorporatesresearchdataand/orguidelinesintoteaching Teachesdiagnosticskills Teacheseffectivepatientandfamilycommunication Copeland&Hewson, Teachesprinciplesofcosteffectivecare 2000
2003 RUSH University Medical Center
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Themostimportantoutcomeofeducationisto helpstudentsbecomeindependentofformaleducation. PaulE.Gray
Theonlypersonwhoiseducatedistheonewhohaslearned howtolearnandchange. how to learn and change CarlRogers Thereisnothingsoeasytolearnasexperienceandnothing sohardtoapply. JoshBillings Thesecretineducationliesinrespectingthestudent. RalphWaldoEmerson
2003 RUSH University Medical Center
2003 RUSH University Medical Center
Upcoming Seminars April 2012
4/25/2012 The Innovations of Mead Killion (2 hour)
Hosted by Marshall Chasin, with Laurel Christensen, Patty Niquette, Catherine Palmer, & Larry Revit 5/02/2012 Single Sided Deafness: Tunnel of Care Michael Valente 5/09/2012 What Determines Speech Understanding Donald Schum
Gibbons, et al 2002
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