College of Allied Medical Professions Department of Medical Technology Angeles University Foundation Angeles City City
A Formal Written Written Report Report for Health Education: Clinical Teaching
Submitted by: Fautagana! Maria Fautagana! Maria Clarice D. "agman! Joseph "agman! Joseph Bryan . Medina! !earl "ouise R. #roup $% &SMT 'F
Submitted to: Mrs. Ro#ena B. Di$on
September (! )%$*
$%+$ PU,P-S. PU,P-S . -F C"/0/C C "/0/CA" A" "A&-,AT "A&-, AT-,1 -,1 $+ /t is in the the clinica clinicall laborato laboratory ry that that many s2ills s2ills are perfec perfected+ ted+
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Compl Comple% e% psycho psychomot motor or s&ill s&ills s may 'e pract practice iced d initia initially lly in a s&ills s&ills la'oratory( 'ut to 'e mastered( they often re)uire a li*e rather than simulated situation.
)+ /nfa /nfant nte e 3$45 3$45*6 *6!! note noted d that that the the oppo opport rtun unit ity y for for obse observ rvat atio ion n is an essential element of clinical teaching+
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"earner+s need repeated e%perience o'ser*in, patients in chan,in, circ circum umst stan ance ces s so that that they they &no# &no# #hat #hat to loo& loo& for for in chan chan,i ,in, n, situations.
'+ Prob Problem lem7so 7solvi lving ng and and decis decision ion7m 7ma2 a2ing ing s2ills s2ills are also also refin refined ed in the the clinical laboratory 3Fothergill7&ourbonnais 8 9iguchi ! $44*6+
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"earn "earner+s er+s need need practi practice ce usin, usin, these these co,ni co,niti* ti*e e s&ill s&ills s under under the ,uida ,uidance nce of an educa educato torr and and other other profe professi ssiona onall staff staff in realreal-lif life e settin,s.
+ "earner "earners s also gain gain organi; organi;atio ation n and time time managem management ent s2ills s2ills in clinic clinical al settings 3#aberson 8 -ermann! $4446+
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t is in real real clini clinical cal practi practice ce(( #ith #ith the the help help of the instr instruct uctor or(( that that learners find ho# to or,ani$e all the data that 'om'ards them( all the re)uests made of them( and all the intellectual and psychomotor tas&s they must perform. /hey learn to set priorities 'y ha*in, repeated practice in comple% situations.
*+ Cultu Cultural ral comp compete etence nce is a s2ill s2ill that that can be learn learned ed
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"earners may &no# a lot of theory a'out ho# to approach clients from from diffe differe rent nt cultur cultures( es( 'ut they they 'ecome 'ecome comfor comforta ta'le 'le and more more e%pert #ith cross cultural care #hen they care for culturally di*erse clients.
(+ "earner "earners s become become sociali; sociali;ed ed in the clini clinical cal laborat laboratory ory 3Chan! 3Chan! )%%)6+ )%%)6+
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/hey learn #hich 'eha*iors and *alues are professionally accepta'le or unaccepta'le. /hey learn a'out professional responsi'ility. /he clinical clinical la'orato la'oratory ry is a place place #here #here conse)ue conse)uences nces for one+s one+s actions are readily apparent and accounta'ility is demanded. /hey 'e,in to see staff as role models and they ha*e opportunities to interact #ith mem'ers of other disciplines on a professional le*el. De*el e*elop opin in, , a sens sense e of team team mem' mem'er ersh ship ip is one of the the most most
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important ,oals in the clinical la'oratory 0Dunn et al.( 12223. 4tudents also learn ho# to relate to patients professionally and ,ain a patient+s perspecti*e of illness that leads to more carin, 'eha*iors. 0Fother,ill-Bour'onnais 5 Hi,uchi( 67783.
M/SUS. -F T9. C"/0/CA" C"/0/C A" "A&-,AT-,1 "A&-,AT-,1 $+ Student Students s have been been sent sent to the clinica clinicall setting setting to gain gain hen novi novices ces are are given given too much much respo responsib nsibility ility for for patien patientt care+ care+ - E%pectin, too much from fled,lin, learners causes an%iety( instructor fati,ue( and increased chance of error. - "earner+s should not 'e functionin, independently in situations #ith relati*ely hi,h le*els of ris&. - /hey should 'e pro*idin, care in circumstances for #hich they are #ell )ualified and for #hich they ha*e had preliminary ,uidance. - '9ecti*es for 'e,innin, learners should 'e )uite limited( focusin, on specific processes of care. t is only after specific components of care ha*e 'een practiced that the learner is a'le to inte,rate pre*ious learnin, and pro*ide total care. '+ >hen learn learners ers are are supervis supervised ed and evalua evaluated ted more more than than they are are taught+ taught+ - Educators #ho are super*isin, learners in the clinical la'oratory may 'e e%pectin, learners to ;perform< rather than to ;practice.< amount of super*ision super*ision must must ta&e place( place( 'ut the emphasis - A certain amount should 'e on teachin, and ,uidin,( #ith the understandin, that mista&es #ill 'e made. - "earners are at a real disad*anta,e #hen they are constantly a#are that the instructor #as e*aluatin, them 'ecause they cannot do their 'est 9o' of learnin, #hen they &no# they ha*e to simultaneously perform for and e*aluation. - E*aluation of clinical performance must 'e separated from practice time.
$%+) M-D."S -F C"/0/CA" T.AC9/0# $+Traditional method - nstructors accompany ,roups 0=-61 learners3 to a clinical a,ency and assi,n the learners to patients. )+ /nfante 3$45*6 developed a model that relies heavily on 2eeping students in a s2ills laboratory until they are proficient
'+ Pac2er 3$446 contend that more information about clinical practice should be taught in the classroom before learners go to the clinical area+ - Course tau,ht in the classroom( #ith small ,roups of students that #ould permit a lot of interaction #ith the teacher. - Case studies and )uestionin, #ould 'e hea*ily used to apply theories( and students #ould( #ith ,uidance( propose nursin, care approaches and discuss the alternati*es( possi'le outcomes and financial( or,ani$ational( or ethical ramifications. - n the course of discussion( the educator #ould ,uide the learners to thin& a'out settin, priorities( time mana,ement( #or&in, #ith and interdisciplinary team( dele,ation and professional communication. ta&in, the course( course( student+s student+s #ould #ould 'e more self-confident self-confident and - After ta&in, 'etter a'le to handle clinical situations in the real #orld. Preceptorship Models 6.Traditional 6.Traditional Preceptorship - A student is tau,ht and super*ised 'y a practicin, nurse employed 'y the health care a,ency #hile an educator o*ersees the process and indirectly super*ises the student )+ CTA Model - Clinical /eachin, Associate colla'orate #ith educators in teachin, small ,roups of students. - /he educators is more in*ol*ed in the teachin, process than in traditional preceptorships( #ith the staff preceptor( educator and student formin, a learnin, triad. Preceptorship ncrease clinical e%perience for students and e%pose them more of the realitie realities s of the the #or& #or& #orld( #orld( #hich #hich shoul should d reduce reduce reali reality ty shoc& shoc& students to learn learn from practitioners practitioners #ith a hi,h s&ill le*el le*el #hile still still Allo#s students 'ein, ,uided 'y faculty
$%+ ' P,.PA,AT/-0 P,.PA,AT/-0 F-, C"/0/CA" /0ST,UCT/-0 /0ST,UC T/-0 1. Educato Educators rs must must do a lot of planni planning ng before before clini clinical cal instr instructi uction on begins begins 2. Clinic Clinical al agency agency sites sites must must be chose chosen n (metho (methodica dically lly)) 3. Contra Contracts cts must must be be drawn drawn up between between the the school school and and the clin clinica icall agency agency - Data of a written contract includes the availability of conference space par!ing and loc!er space - Contract includes the ma"imum student#faculty ratio evidence of completion of health records and possibly criminal bac!ground chec!s for students and faculty and evidence of malpractice and general liability insurance for students and faculty $. Educato Educatorr shoul should d set set up a meeting meeting with with the the agency agency staf staff f %. Educator Educator can proceed with the final final prepara preparation tion for clinica clinicall instructi instruction(e.g. on(e.g. ma!ing specific assignments for learners on a wee!ly or daily basis) &. 'oldenberg 'oldenberg and and wasiw wasiw (1*) conducted conducted an investi investigation gation of the the criteria criteria used by educators in selecting students+ clinical clinical assignments Three most important criteria used in the selection process: 1. ,tude ,tudent nts+ s+ indi indivi vidua duall lear learni ning ng needs needs 2. -ati -atien ents ts++ nursi nursing ng care care needs needs 3. atchin atching g of patients patients++ needs needs with with student students+ s+ learni learning ng needs needs
$%+ C-0D C -0DUCT UCT/0# /0# A C"/0/C C"/0 /CA" A" "A&-,AT A&-, AT-,1 -,1 S.SS/S.S S/-0 0 6. Preconferences - "earners share some of the results of their research from the pre*ious day - >ood time to ans#er students+ as& )uestions a'out their assi,nments - Help learners or,ani$e their day and prioriti$e the care they must ,i*e - Discusses and plans on patient+s care 1. Practice Session - Follo#s the preconference - Com'inations of strate,ies such as return demonstration #ith e%planation( as&in, and ans#erin, )uestions( and coachin, techni)ues are used - "i&e a chec&list '+ Post Postco conf nfer eren ence ces s - deal opportunity for: ? poin pointi tin, n, out out app appli lica cati tion ons s of of the theor ory y to to pra pract ctic ice( e( ? analy$in analy$in, , the the diffe different rent #ays #ays that that patie patients nts #ith #ith simila similarr illness illness differ differ in their their respon response se to to nursin nursin, , care care and and treat treatment ment ? >roup sol*in,
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? E*aluatin, nursin, care ? "ear "earne ners rs to repo report rt #hat #hat they they !ost !ostco conf nfer eren ence ces s Chal Challe len, n,es es:: ? t is is often often unstruct unstructured ured that that allo# allo# for creati*i creati*ity ty 'ut 'ut can dissol*e into meanin,lessness ? t is is usually usually held at the the end end of of a physica physically lly and and emotio emotionally nally drainin, practice session ? Fe# learners learners seem to 'elie 'elie*ed *ed that that they they lear learned ned e*eryth e*erythin, in, they could ha*e learned durin, their practice time and feel that a postconference is 9ust a 'orin, postmortem session.
Pedagogies that are found to be effective in many clinical settings: -bservation Assignments - 4upported 'y 4ocial Co,niti*e /heory - 'ser*in, students as they perform s&ills they usually cannot perform
,ounds - n*ol*es a ,roup of learners 5 their instructor *isitin, patients to #hom they+ll 'e assi,ned - purpose is to e%pose learners to additional clinical situations and encoura,e them to consult each
Shift ,eport - Bein, a'le to attend endorsements students to learn learn the uni)ueness uni)ueness of nursin, communication communication - A #ay for students and is a means of professional sociali$ation
"earning Contracts a,reement 'et#een 'et#een instructor instructor and a learner( learner( spellin, spellin, out - A #ritten a,reement the learner+s outcome o'9ecti*es
?ournal >riting - Clinical 9ournals promote acti*e learnin, and reflecti*e practice and are 'uilt on the theory of constructi*ism.
$%+ * .@A"UAT .@A"UAT/0# /0# ".A,0., ". A,0., P,-#,.SS .valuat .valuation ion remains a difficult( su'9ecti*e( time-consumin, and often pu$$lin, chore. t is usually the least fa*orite tas& of nurse educators( yet it is inescapa'le. Why e*aluate@ "earner+s in the clinical area need the feedbac2 and udgment of their #or& /hey need to &no# ho# they are doin, at one le*el 'efore pro,ressin, to the ne%t. /o determine ho# #ell the o'9ecti*es are met. /o certify that they are safe practitioners. Before 'e,innin, the process of e*aluation( the indi*idual educator or ,roup of educators must ma&e se*eral philosophical and practical choices + ? Formative vs+ Summative .valuation ? 0orm referenced vs+ Criterion referenced ? #rading system ? &ehaviors evaluated Formative and Summative .valuation
Formative evaluation is evaluation is the on,oin, feed'ac& to the learner throu,hout the learnin, e%perience. - dentify stren,ths and #ea&nesses - Meet the learnin, o'9ecti*es efficiently - May 'e ,raded or non,raded
Summati Summative ve evaluati evaluation on is a summary e*aluation ,i*en at the end of the learnin, e%perience. #hether the learner has achie*ed the the o'9ecti*es o'9ecti*es - Assess #hether - Results in a ,rade of some type 'ein, ,i*en
Learners have a right to know how they are progressing in their clinical work, and educators can protect themselves against charges that they violated due process of law if they can prove that a learner was kept apprised of clinical progress or lack of it. Formative feedbac2 may 'e ,i*en orally or in #ritin,. ? ral feed'ac& feed'ac& - instruc instructor tor shou should ld &eep &eep notes notes a'out a'out #hat #hat transp transpired ired.. ? Writ Writte ten n feed feed'a 'ac& c& - more more *alua *alua'l 'le e learn learner er can can ta&e ta&e time time to read read and and a'sor' the information and the educator can &eep a copy for future reference.
Writt Written en format formati*e i*e e*alu e*aluati ation on notes notes are are often often calle called d anecdota anecdotall records records or clinical progress notes+ Tomey omey 3)%%%6 ad*ocates recordin, o'ser*ations of #hat the learner says or does includin, the date( a description of the incident( and comments. "ac&in, such #ritten documentation( the instructor #ho is called on to 9ustify a summati*e e*aluation is on sha&y ,round. 0-,M7,.F.,.0C.D A0D C,/T.,/-0 C ,/T.,/-0 ,.F.,.0C.D ,.F.,.0C .D .@A"UAT/-0 .@A"UAT/-0 0orm7referenced evaluation evaluation a learner is compared #ith a reference ,roup 0orm7referenced of learners either those in the same cohort or in a norm ,roup. E*aluati ation on and and ,radin ,radin, , are relat relati* i*e e to the perform performance ance of the - E*alu group harac cter teri$ed i$ed as( as( bel belo o< aver averag age! e!B B ave avera rage ge!B !B or abo above ve - Chara average+B nless the e*aluat luatio ion n tool ool is specif ecific ic a'ou a'outt #hat averageB - unle 'eha*iors are li&e( the process may 'e unreliable+
Criterion7referenced evaluation i s that #hich compares the learner to #elldefin defined ed perfo performa rmanc nce e crite criteria ria rather rather than than compa comparin rin, , him or her to other other learners. - Defines the 'eha*ior e%pected at each le*el of performance 0Cottrell et al.( 67=3. - Fairer than norm-referenced education. - >radin, is less su'9ecti*e #hen criteria are spelled out and each learner is held to that standard.
#,AD/0# S1ST.MS 1 most common options for ,radin,: ? Assi Assi,n ,nin in, , let lette terr ,ra ,rade des s ? sin, sin, passfa passfailil or satisfa satisfactory ctoryuns unsatis atisfact factory ory approac approach h ,ines 3$4('6 stron,ly 3$4('6 stron,ly asserted that clinical ,rades should al#ays 'e ,i*en on a pass passfai faill or satisf satisfact actory oryun unsat satisf isfac actor tory y 'asis 'asis since since ;human ;human 'eha* 'eha*ior ior of any description is much too comple% to permit such fine discriminations< as re)uired in assi,nin, numerical or letter ,rades. Sources of evaluation data: nstructor( students( administrators !atients( a,ency staff Records Conferences bet
Conference should 'e held at the half #ay throu,h and the end of the e*aluation period. !ositi*e feed'ac& must 'e ,i*en alon, #ith the ne,ati*e.
$%+ ( C"/0/CA" .@A"UAT/-0 .@A"UAT/-0 T--"S /he instrument or tool used for clinical e*aluation should meet the follo#in, specifications: 6. /he /he item items s shou should ld deri deri*e *e from from the the course or unit obectives+ 1. /he ite items mus must 'e measurable in measurable in some #ay. t must 'e possi'le to collect substantiating data+ . /he /he items items and and instru instructi ction on for for use shou should ld 'e clear to all that must use the tool. . /he too tooll sh should uld 'e 'e practical in practical in desi,n and len,th. 8. /he too tooll mu must 'e 'e valid and reliable 0Carpenito reliable 0Carpenito 5 Duespohl( 67=63.
/he educator is is in a position of po#er o*er the learner. /he learner should should recei*e due process in all aspects of e*aluation and its /he outcome. process includes the consistent application application of fair criteria 'ased on - Due process includes e*idence and professional 9ud,ment 04canlan( Care 5 >essler( 12263. Educators must ta&e clinical e*aluation *ery seriously and do all they can to 'e sure the process is clear clear!! unde underst rstand andabl able e to the the learn learners ers and professionally ustifiable+ “Working with learners in the clinical laboratory is a hectic, demanding and sometimes anxiety-producing experience. Yet, it is also the aspect of teaching that often brings the greatest satisfaction and reward. ,.F.,.0C.S: De oun,( 4andra 01223. /eachin, 4trate,ies for Gurse Educators. pp. 1=18 nfante( M. 4. 067=83. /he clinical la'oratory in nursin, education 01 nd ed.3. Ge# or&: Wiley. !ac&er( J. ". 06773. Education Education for clinical practice: An alternati*e approach. !ac&er( Journal of Gursin, Education( 073( 66-6 Rines( A. 0673. E*aluatin, student pro,ress in learnin, the practice of nursi nursin, n, 0Gurs 0Gursin, in, Educa Educatio tion n Mono, Mono,rap raph3. h3. Ge# or&: /eacher acher Colle Colle,e ,e(( Colum'ia ni*ersity. >a'erson( . B.( 5 ermann M. H. 067773. Clinical teachin, strate,ies in nursin,. Ge# or&: 4prin,er >olden'er,( . 5 #asi#( C. ". 067==3. Criteria used for patient selection for nursin, student+s hospital clinical e%perience. Journal of Gursin, Education( 1I03( 18=-18.
Ha#rani&( !. 012223. /he de*elopment and testin, of a community health nursin, clinical e*aluation tool. Journal of Gursin, Education( 703( 1-1I. Chan( D. 012213 012213 De*elop De*elopment ment of clinical clinical learnin, learnin, en*iron en*ironment ment in*entory in*entory:: Chan( sin, the theoretical frame#or& of learnin, en*ironment studies to assess nursin, nursin, student+ student+s s percept perceptions ions of the hospita hospitall as a learnin, learnin, en*ironment. en*ironment. Journal of Gursin, Education( 6013( 7-I8.
