SUPERVISOR TRAINING & EDUCATION PROGRAM 2013 … · SUPERVISOR TRAINING & EDUCATION PROGRAM 2013...

SUPERVISOR TRAINING &

EDUCATION PROGRAM 2013

(STEP)

This project was possible due to funding made available by Health Workforce Australia

Western and Central Clinical Placement Networks

Supervisor Training and Education Program

Introduction and Program Overview

Dr Patricia Nicholson

Director of Teaching & Learning, Department of Nursing

The University of Melbourne

Introduction to STEPSTEP

Central and Western CPNs – Supervisor Training and Education Program

Welcome

• Central and Western Metropolitan Clinical Placement Network

• Pilot Program ran 3 sessions in Feb – May

• This time – program over 2 days in WMCPN

• Plan for program to run 2 sessions in April & May 2013 at

– Central - University of Melbourne

– Western - Western Centre for Health Research & Education

• Presenters / workshop facilitators



• Day 1

– Preparing a student for the clinical learning environment

– Effective supervision

– Solution-focused placement strategies

– Clinical supervision in a culturally diverse environment

• Day 2

– Assisting students to develop clinical reasoning skills

– Teaching and learning styles and strategies

– Providing effective feedback

– Putting the pieces together

STEP Program Overview STEP


Program aims

• Provide opportunities and strategies for clinicians to develop

their teaching and supervision skills

• Enable clinicians to become effective educators and find

solutions based on their own experiences

• Enable clinicians to design a clinical placement plan for

placements

• Create and develop educational leaders within health settings

and across disciplines

• Acknowledge and address issues relating to diversity (of

students, professionals and patients)



Learning opportunities will be provided to training

participants through:

• Modelling a problem solving process – through active

participation via real and simulated case scenarios

• Providing teaching via a range of academic and health

professionals & incorporate a variety of teaching skills.

• Offering health professionals the opportunity to work

inter-professionally



Interprofessional learning – ‘where interactive learning

takes place between members of different professional

groups’ (Owens et al. 1999, p.278)

- ‘is learning arising from interaction between members

(or students) of tow or more professionals either as a

product of inter-professional education or happening

spontaneously (serendipitous learning) (Barr et al., 2005)

• Clinical educators – persons engaged in clinical

teaching in placement setting

• Also known as field educators, student supervisor





Introduction or reflection

from previous day (15 min)

Lecture (30 min)

Conclusion

(20 min)

Break

Split into 4

groups

(5 min)

Workshop (40 min)

Workshop (40 min)

Workshop (40 min)

Return

(5 min)

• Pre-program evaluation

• Session feedback / comments / suggestions

• Post-program evaluation



• Certificate of Attendance

• CPD points / hours





Western and Central Metropolitan CPN


Module 1 – Preparing a student for the clinical

learning environment Dr Patricia NicholsonDirector of Teaching and Learning, Nursing


Session learning objectives STEP


• Define clinical supervision

• Develop an understanding of the differences

between education and clinical setting

• Briefly explore Models of Supervision in practice

• Identify the roles and responsibilities of the educator

and student

• Review approaches to developing a successful

clinical experience

• Identify generation barriers in the workplace

Clinical Supervision STEP


‘A formal process of professional support and

learning which enables individual practitioners

to develop knowledge and competence,

assume responsibility for their own practice

and enhance consumer protection and safety

in complex situations’

Department of Health. (1993). A vision for the future: The Nursing, Midwifery

and visiting contribution to health and health care. UK: Department of

Health.

Clinical Supervision STEP


“An intensive, interpersonally focused one-on –one

relationship in which one person is designated to

facilitate the development of therapeutic

competence in the other person” Loganbill, et al., 1982

“Provides time out and an opportunity in the context of

an ongoing professional relationship with an

experienced practitioner to engage in guided

reflection on current practice in ways designed to

develop and enhance that practice in the future”Open University, 1998.

Differences between academic and

clinical education setting STEP


• Higher education

– Primary purpose of educating students to attain

core knowledge, skills and behaviours

• Clinical education – practice environment

– Provide cost-effective quality care and education

for patients, clients, and their family and

caregivers

– Dealing with ‘two masters’

viewed as a ‘guide by the side’

Differences between academic and clinical education

setting: Design of the learning experience

STEP


• High education

– ‘Beginning and an end’

– Active adult learning focused on the learner

– Conventional view of ‘sage on the stage’

– Outcome of learning measured by written examination /

written assessment

• Clinical education

– Dynamic and flexible

– Unpredictable

– Constrained by time

– Outcome of learning measured on quality, efficiency and

outcome of care provided

Goal of Clinical Education STEP


Provide an environment that fosters students’

professionalism and encourages the

development of an independent problem

solver and a reflective and competent

practitioner

Clinical Environment STEP


A place where students synthesise the

knowledge gained in the classroom and apply

it to the practical situation

An interaction network of forces within the

clinical setting that influence student learning

outcomes



• A number of forces affecting expected

outcomes

– Increased complexity of care required by patients

– Professional shortages

– Rapid clinical pace

– Multiple healthcare professionals and activities

– Adjustment to the clinical environment

• Merging of thinking skills and performance

skills � anxiety in the student



• Clinical practice setting requirements

– Student feels accepted

– Contributions are appreciated

• Attributed of the staff

– Warmth

– Support in obtaining learning experiences

– Willingness to engage in a teaching relationship

What is the best practice in the clinical

learning environment?

STEP


• A culture of learning and teaching at all levels

• Adequately prepared, motivated and orientated learners

• High-quality & consistent supervision by well-trained clinical

educators

• Opportunity to practice and build knowledge and skills

• Attention to adult learning principles

• Identified triggers for the provision of individual; learning

• Established systems for feedback and communication

• Interprofessional learning experiences

Model for Supervision (Queensland's ClinEd, 2010) STEP


Organisational relationship, resources, systems & infrastructure support education

•Learners orientated to environment

•Learners attitude proactive

•Pre-planning: university & service

Model for Supervision STEP



Educators:

* are supported• acquire teaching skills

•Have current knowledge •Have current experience




•Content & practice customised to learning needs

•Adequate time for competency practice •Range of ‘hands-on’ practice & patient cases

•Access to senior staff•Formal & informal learning opportunities




•Adequate time for learners

•Inclusive social environment•Ratio: Staff/ learners•Recognition for teaching contribution




•Learner orientated•Learner meets regularly with mentor•Learner’s knowledge tested

•Learner challenged•Learner respected

•Mentor models professional behaviour




•Education KPIs from CEO •Supportive health service – training

provider relationship•Adequate numbers of computers etc

Framework for best-practice: Queensland Health, 2010

Roles and responsibilities of the educator STEP


• Contribute to the students’ understanding of

and competence in clinical practice

• Provide an environment that fosters students’

professionalism

• Encourage development of an independent

problem solver, reflective & competent

practitioner

• Awareness of the parallels that exist between

role of the practitioner and educator

Roles of the practitioner and educator STEP


Role of the practitioner Role of the educator

Patient referral and taking a patient history Preplanning for the learning experience and

providing an orientation to the clinical site

Performing initial patient evaluation &

problem identification

Assessing students by identifying their

strengths, learning needs and previous

experiences

Determining long-term goals mutually with the

patient

Setting overall learning objectives and

clarifying learning expectations with the

student and academic

Defining short-term patient goals Defining specific student behavioural and

learning objectives

Clarifying patient treatment plan Designing creative student learning experience

Performing patient re-evaluation & assessing

level of progression

Providing formative evaluations & assessing

level of progressions to wards outcomes

Performing patient outcomes assessment and

discharging patients

Providing summative evaluation and assessing

students readiness for progress / entry to

practice

Teaching-learning Model STEP


Teaching-

learning

Model

Patient / one or more

Student Educator

positive attitude

flexibility

communication

compassion

sense of humour

compassion

openness

to ideas

friendliness

Knowledge & ability

professional skills &

Knowledge

Characteristic of a good supervisor STEP


• ‘Knowledge of teaching’

– Use of learning objectives

– Effective questioning

– Responding to questions

– Diagnose the student’s learning needs

– Learn about the students as individuals

Fowler (1995) Characteristic of a good

supervisorSTEP


• Knowledge base

• Teaching / supervisory skills } Three themes

• Relationship skills

• Student perception of a good supervisor

– Capable of forming a relaxed & supportive relationship

– Relevant knowledge and clinical skills

– Can assess learning needs, supervise & evaluate learning

– Is aware of pressures and demands of the course

– Demonstrates effort in ‘putting themselves out to help

the student

Roles and responsibilities of the student STEP


• Active involvement in clinical site selection

Active contribution to the clinical learning

experience

• Articulate learning needs to the educator

• Take responsibility for learning

• Self-accountability

• Provide feedback

Planning for a successful clinical

experience STEP


• An atmosphere that is receptive to students

• Staff who are interested in teaching students

• An opportunity for students to practice

patient care

• Feedback on performance provided

• Clinical assignments to accomplish objectives

• A variety of educational experiences

Planning for a successful clinical

experience plus STEP


• Patient variety

• Talented staff

• Opportunity for students to explore their own

objectives

• Students who are well prepared

• Students who have specific goals

Successful clinical experience STEP


• Provision of student-centered teaching

strategies that encourage activities i.e.

reflection

• Support to encourage autonomy

• Promote problem solving and decision making

• Use of systematic instructional strategies

• Repeat learning opportunities to reinforce

learning

Successful clinical experience STEP


One of the greatest challenges is to find a

balance in the relationship with the

student is between nurturing and

separateness focusing on education and

feedback rather than socialisation to

promote a patient-focused experience

rather than a technique-focused

experience

Approaches to appropriate, creative and

effective teaching methodsSTEP


• Guide students to use available resources to access

information

• Maximise learning opportunities

• Assume responsibility for self-directed & life-long

learning

• Apply critical thinking to solve problems

• Apply skills learned to new situations

• Communicate learning needs effectively

• Enhance observation skills

• Develop as a professional

Designing a clinical learning experience STEP


Clinical Learning Experiences

Expected performance

outcomes

Curriculum performance

outcomes

Coordinated effort

Active involvement

Learning objectives

Settingperformance

expectations

Clinical

experiences

Coherent

learningexperience

Organisationalstructure

Area of patient care

Evaluation of clinical supervision STEP


• Focus group interviews

• Semi-structures interviews

• Delphi technique

• Self-completion questionnaires

– How do we measure quality?

• Simple

• Measureable

• Collectable

• Meaningful

• Effectively applied

Boomers Gen X Gen Y

On-the-job On-the-job; hands on

experience

Learning by ‘trial and error’ on

the job

External training courses Seminars allowing personal

interaction & involvement

Shadowing an experienced

team leader learning through

observation

Seminars Coaching and mentoring Interactive fun activities

Tailored in-house topic-

specific courses

External courses, but less

theory and 70% practical

examples

A ‘free approach’ not step-by-

step or from manuals

Postgraduate studies funded

by employer

Discussion groups with peers

On-line Seminars with speakers who

are experts

“How do like to learn?STEP


Henry, A. (2007). Inspiring tomorrows leaders today. Breaking down generational

barriers at work. Messenger Publishing: China.

Boomers Gen X Gen Y

Professional development for

current job

Personal development and

career management skills

‘Anything and everything’

Managing and motivating

people effectively

Managing and motivating

people to build effective

teams

New skills for future

opportunities

Communication skills Performance management

skills & management of

difficult people

How to grow as a person

Leadership skills Communication skills How to learn in different ways

Emotional intelligence Leadership skills

Technology skills Networking skills

Coaching and mentoring skills Critical thinking skills Hendry, 2007, pg. 119

Conflict management Conflict resolution skills

Managing change

“What do you want to learn at work?”STEP


Case StudySTEP


Reference List STEP


Barr, H., Koppel, I., Reeves, S., Hammick, M., Freeth, D. (2005). Promoting

partnership for health: Effective inter-professional education. Blakewell

Publishers: Oxford.

ClinEdQ. Framework for best-practice clinical learning environments in

Queensland Health. (2010). Accessed

http://www.health.qld.gov.au/clinedq/Documents/10CEO001.pdf

Department of Health. (1993). A vision for the future: The Nursing, Midwifery

and visiting contribution to health and health care. UK: Department of

Health.

Fenton, P. (2005). Student perceptions of a quality clinical experience:

Findings from the literature and their application to radiation therapy.

The Radiographer, 52(1), 30 – 33.

Maginnis, C., & Croxon, L. (2010). Transfer of learning to the nursing clincal

practice setting. Rural and Remote Health, 10(1313), 1 – 7.

Winstanley, J., & White, E. (2000). Clinical supervision: Models, measures

and best practice. Nurse Researcher, 10(4), 7 – 38.

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Western and Central Clinical Placement Networks


Module 2 – Teaching and Learning Skills

Sevi Vassos Associate Lecturer, Social Work, University of Melbourne

• Unpacking key concepts around Adult Learning

• Exploring Individual Learning Styles and Preferences

• Responding to individual learning styles

• Structured Enquiry – one way of responding to adult

learning needs and variable learning styles

This moduleSTEP


• Adult Learning Principles (Knowles, 1980)

• Experiential Learning (Kolb, 1984)

• Reflective Practice (Schon, 1991)

Adult Learning: Key Theoretical Concepts STEP


• Internally-motivated

• Knowledge and life experiences are

transferred to new learning opportunities

• Goal-oriented

• Learning has to be relevant

• Practically focused

• Like to be respected

(Knowles, 1980)

Adult Learning PrinciplesSTEP


When supervising an adult learner:

• Ensure that the learning program starts with more structure

and progressively leads to less structure

• Support the student through inquiry rather than by giving

them ‘answers’

• Know your learner’s learning style

• Provide regular and specific feedback

• Assist learner to draw on their own knowledge and

experiences in problem-solving and reflecting

Adult Learning Principles in PracticeSTEP


• Engage the learner in a reflective practice process –

action/reflection, rather than merely giving them

opportunities to have a practice experience

• Use live cases as a learning opportunity

• Clearly explain the rationale underpinning the way

you practice in your context

• Encourage expression of ideas and feedback

Adult Learning Principles in Practice (cont’d)STEP


Experiential Learning CycleSTEP


Kolb (1984) & Honey & Mumford (2000)

Honey & Mumford (2000) identify four learning preference

categories:

Learning StylesSTEP


ACTIVISTSLearning by doing

REFLECTORSLearning by

observing the world

PRAGMATISTS

Focused on practice and ideas that work

in the ‘Real World’

THEORISTS

Focused on theories and abstract ideas

• To think on their feet

• To have short sessions

• Plenty of variety

• The opportunity to initiate

• To participate and have fun

Activists like:STEP


• To think before acting

• Thorough preparation

• Researching and evaluating

• To make decisions in their own time

• To listen and observe

Reflectors like:STEP


• Concepts and models

• To see the overall picture

• To feel intellectually stretched

• Structure and clear objectives

• Logical presentation of ideas

Theorists like:STEP


• To see the relevance to their work

• To gain practical advantage from learning

• Credible role models

• Proven techniques

• Activities to be real

Pragmatists like:STEP


+VE

Flexible

Happy to ‘have a go’

Enjoys new environments

Optimistic – unlikely to resist

change

-VE

Will jump in at the deep end

Can take unnecessary risks

Goes into action mode without

sufficient preparation

Gets bored with

implementation

Activists are wondering:

Will I learn something new? Will there be a variety of different activities?

Will it be OK to let my hair down and have fun? Will it be OK to make mistakes?

ACTIVISTS: A closer look STEP


+VE

Careful

Thorough and methodical

Good at listening and

assimilating information

Thoughtful

-VE

Often holds back

Slow to make up their minds

Often too cautious and risk

averse

Not usually assertive

Reflectors are wondering:

Will I get time to think things through? Will I have time to research the relevant information?

Will I be under pressure to get things done?

REFLECTORS: A closer look STEP


+VE

Logical systematic thinkers

Rational and objective

Disciplined in their approach to

work and life

Good at asking probing

questions

-VE

Limited in their lateral thinking

Low tolerance for disorder,

ambiguity or uncertainty

Not keen on subjective and

intuitive approaches – needs a

objective evidence base

Often focused on ‘shoulds’ and

‘musts

Theorists are wondering:

Will I have opportunities to ask questions? Is there a clear structure and purpose? Will I

encounter complex ideas and concepts that will enhance my learning? Are the approaches to be

used and concepts ‘valid’? Will there be other people of a similar calibre to myself?

THEORISTS: A closer look STEP


+VE

Eager to test things out in

practice

Practical and realistic

Down to earth

Straight to the point

-VE

Tends to reject anything that

does not have an obvious

application

Not very interested in theory or

basic principles

Impatient with too much talk

More focused on the task

rather than the relationships

Pragmatists are wondering:

Will I get the opportunity to practice and experiment? Will I get practical tips and techniques?

Will we be addressing real problems? Will I be working with ‘hands on’ experts?

PRAGMATISTS: A closer lookSTEP


Structured EnquiryTheory and Practice

Clinical teaching in line with Adult Learning

Principles

STEP


An approach to ensure that intentional learning

is maximised by:

– Encouraging students to articulate their analysis and

opinion

– Promotes reasoning based on substantive knowledge

Encourages self-directed learning

– Reinforces areas of strength through positive feedback

– Creates a space for critical reflection, providing insight into

alternative approaches

– Promotes transferrable learning by providing guidance on

general principles

Structured EnquirySTEP


1. Getting a commitment to the learning

2. Probe for the substantive knowledge - the evidence-base

3. Teach to general practice principles, concepts and

considerations rather than provide to case-specific

responses

4. Comment on what the student has done well

5. Respond to errors/misunderstandings with immediacy –

capitalise on errors made as ‘teachable moments’

Structured Enquiry ProcessSTEP


Cue: Student presents information on a case to you and asks what to do

next?

Structured Enquiry Response: Ask the learner to give you their interpretation

of what the information suggests

Rationale: Encouraging students to articulate their view increases the

student’s commitment to working through issues themselves

Questions you may ask:

What do you think is going on for this client/patient?

What other information do you feel you need?

Getting CommitmentSTEP


Cue: The student looks to you to confirm their view or to suggest alternatives

Structured Enquiry Response: Before offering your view, ask the learner to

articulate what knowledge they are basing their opinion on

Rationale: Asking the learner to articulate their thought process helps you to

identify what the learner knows and where there are gaps

Questions:

What led you to this conclusion?

What else did you consider?

What stopped you from going down that path?

Probe for the Underpinning KnowledgeSTEP


Cue: the learner has articulated what it is he/she needs or wants to know in

working through the specific case or issue

Structured Enquiry Response: Provide general principles, concepts and

considerations and target to the learner’s level of understanding

Rationale: Instruction is more memorable and transferable if offered as a

general rule or principle

Teach to general principlesSTEP


Cue: The learner may not consider what they did effectively

Structured Enquiry Response: Take the first chance you find to comment

on the specific good work and the effect it had

Rationale: Skills in learners are often ‘vulnerable’ because they may not

be well-established yet. Reinforcing the skill establishes competency

Comment on what the student has done well STEP


Cue: Something the learner did or said will have an adverse

impact

Structured Enquiry Response: As soon as the error is made,

find an appropriate space to discuss the situation encouraging

the learner to critically reflect on their thought process and

behaviour. Work with the learner to identify what could be

done differently next time

Rationale: Learners who become aware of their mistakes and

know what to do differently in the future only need

reinforcement

Respond to mistakes with immediacy

as ‘teachable moments’

STEP


Experiential Learning 1:

Task 1: Complete the Honey & Mumford (2000) Learning Styles Questionnaire

to understand your learning (and teaching) preferences

Task 2: Discuss in pairs – What are the implications for your practice as a

clinical educator?

Followed by Facilitated Debrief in Large Group

Session Plan for WorkshopSTEP


• Honey, P. & Mumford, A. (2000). The learning styles helper's guide.

Maidenhead: Peter Honey Publications Ltd.

• Knowles, M. S. (1980). The modern practice of adult education: From

pedagogy to andragogy. Englewood Cliffs: Prentice Hall/Cambridge

• Kolb, D.A. (1984) Experiential learning : experience as the source of

• learning and development. Englewood Cliffs, N.J. : Prentice-Hall

• Schön, D. A. (1991) The Reflective Practitioner: How Professionals Think

(2nd edition), New York: Basic Books.

References STEP


• Centre of Teaching Excellence (NJ, USA) – Clinical Education Teaching

Roles & Styles http://cte.umdnj.edu/clinical_education/clined_role-

styles.cfm

• Clinical Educators’ Resource Kit

http://www.qotfc.edu.au/resource/index.html?page=65340&pid=65374

• Guide to Facilitating Adult Learning – Rural Health Foundation, 2009

http://www.rhef.com.au/wp-

content/uploads/a_guide_to_facilitating_adult_learning.pdf

Some useful online resources STEP


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Central & Western Metropolitan CPN


Module 3 – Solution-focused placement

strategies Dr Pat Nicholson Director of Teaching and Learning , Nursing


• Review monitoring the progress of a student

during clinical placement

• Discuss decisions surrounding assessment of

clinical performance

• Review development of learning objectives

• Process of a ‘failing student’

• Failing a student

Session learning objectives STEP

Central Metro and Western Metro CPNs – Supervisor Training and Education

Program

• Monitoring progress, managing feedback and making

assessment decisions are interrelated activities

– Integral to continuous assessment of practice

– Essential in helping students learn through their practice

to develop clinical competence

– Monitor progress continually

– Provide constant informal feedback

• Formative and summative assessment

– Provision of feedback and assessment decisions that are

based on analysis of assessment evidence

Monitoring progress, managing feedback

and making assessment decisions STEP


Program

• Holding constructive discussions with the student

about clinical experiences that involve the student &

assessor

• Process

– Informal

– Formal

Activity is considered to be the ‘life-blood of learning’

with research suggesting that this is not well

sustained

– Either not done well or as frequently as needed or worse,

not at all

Managing feedback STEP


Program

• Enables students to monitor strengths and

weaknesses of their performance– Aspects associated with success of high quality can be recognised &

reinforced

– Unsatisfactory aspects can be modified or improved

• Can impact on teaching / learning process

• Gives message to students about their effectiveness and self-

esteem

• A major determinant of self-esteem is feedback form

significant others

Students view a good clinical experience to include constructive

feedback

Managing feedback STEP


Program

• Integration of the knowledge, skills, and

attitudes that are required for performance in

a designated role and setting

• Competency is determined in relation to

established / expected standards of

performance as determined by the profession

• Emphasis is on the clinical use of knowledge

and clinical practice

Competence STEP


Program

• Describes the holistic nature of professional practice – not a list of technical tasks

• Defines the scope of practice

• Describes a standard or level of practice

• Contains broad general statement about clinical practice

• Set standard for practice

• Articulate the unique attributes of a discipline

Professional competence STEP


Program

• Consumers know standard of practice required

• Determine eligibility for registration in Australia (refreshers and return to workforce)

• Determine eligibility for registration from overseas

• Assess re-entry and return to workforce

• Assess qualified practitioner to determine whether they are competent to continue their practice

Competence STEP


Program

• A set of observable outcomes expressed as competency statements

• Sets a minimum standard of performance through criterion levels which are used to evaluate performance

• Criteria must be

• demonstrable

• observable

• measurable

Components of competence STEP


Program

• Attributes include knowledge, skills and

attitude

• Performance of a role or set of tasks

• Standards: competency requires the

performance to be of a certain standard

which is used to assess and validate

competence

Terminology STEP


Program

• Behavioral component is a set of observable

actions (both psychomotor & affective)

• Cognitive component is a combination of

perceptions, interpretations and decisions

• Both components are required to achieve

competence

Components STEP


Program

• Quality care is promoted

• Objective data is generated for performance

evaluations

• Clinical competence is determined

• Opportunity for professional development

• Accountability of practice

• Consistency of practice

Why measure competence?STEP


Program

There is a need to demonstrate sufficient evidence of:

• Safety

• Accountability

• Supervision

• Acceptance of responsibilities

• Anecdotal evidence (cues)

Assessment of competenceSTEP


Program

• Professional issues (affective domain) are difficult

to conceptualize and measure objectively

• Focuses on clinical skills & knowledge that are

easy to observe & measure

• Patient population required may be limited

therefore preventing mastery by the learner

• Common to use checklist approach rather than a

varied evaluation approach that suits the

standard being assessed

Limitations of competencies STEP


Program

Domain

Clinical Practice (Enabling and Problem Solving)

Competency Statement

Maintains a physical and psychosocial environment which

promotes safety, security and optimal health

Element

Demonstrates effective and appropriate knowledge of

biomedical equipment

Exemplar or Example

Competency AssessmentSTEP


Program

Performance is directly observable, whereas competence is not

Competence cannot be directly observed therefore the evidence collected needs to be of sufficient quality and quantity to make a sound judgement about the individual’s level of competence (Gonczi, 1994; Gonczi et al., 1993;

Heywood et al., 1992; Wolf, 1989).”

Defining competence STEP


Program

• Observation (direct, indirect)

• Audit of documentation (care plans, plan for the day)

• Journaling situations that reflect elements of competencies

• Interviews (motives, attitudes)

• Paper and pencil test

• Academic record

Sources of evidence STEP


Program

• Valid

• Accurate

• Sufficient

• Consistent

• Authentic

• Current

Criteria for accurate assessment STEP


Program

• Competencies requires a holistic approach

that incorporates the tasks

Competence STEP


Program

• Focus on the practice, not the procedure

• Safety

• Accountability

• Accuracy

• Ability to individualise

• Tasks are performed in safe and effective manner

The successful completion of a task does not necessarily constitute a competence

Holistic assessmentSTEP


Program

• Assessment practice in clinical setting

presents with many problems

• Issue of subjectivity when assessing students

in the clinical setting

Where judgement is required, there will

always be some form of disagreement

Difficulty of assessing clinical practice STEP


Program

• Not viewed as ‘policing’ but a process to assist

student learning, development and progression

• Ongoing assessment activity throughout the

placement

• Progress can be monitored most accurately if the

mentorship is stable

– Keeping abreast of clinical activities

– Development of competence

Monitoring progress STEP


Program

• Keeping track of development of competence

– What is the student learning?

– What clinical activities has the student

participated in?

– How can further learning be facilitated?

• Important factors to consider:

– Prior clinical experience

– Competencies & learning outcomes to be

achieved

– Stage of training of the student

Monitoring progress STEP


Program

Assessment activities to monitor progress STEP


Program

• Crucial to assessment process

• Can be used for ongoing review of the student's

progress

• Review previous clinical situations

• Question future learning opportunities

• ? Difficulties student is experiencing completing

certain activities

• Student self-assessment

• Constructive feedback

Dialogue in assessment STEP


Program

• Discuss student with other assessors

• Is the student progressing?

– Is the student achieving competencies?

– Demonstration of growing level of skill and competence

– Is the performance consistent?

– Is there a demonstration of growing understanding of the

rationale underpinning practice?

– Is there demonstration of development of attitudes and

values appropriate to professional practice?

– Is there demonstration of engagement in EBP and

reflective practice?

Formal assessmentSTEP


Program

• Has the student achieved the competencies?

• Does the assessment evidence achieve validity of

assessment?

• Does the assessment evidence achieve reliability of

assessment?

• Is there demonstration of a sound understanding of

the rationale underpinning the competencies?

• Is the student developing the attitudes and values

appropriate to professional practice?

Summative assessmentSTEP


Program

• Clearly document concerns in assessment forms

early in placement

• Discuss situation with senior practitioner with overall

responsibility for student learning - essential

• Clear and open communication between student,

assessor & HE sector

• Arrange to meet with student as soon as possible

• Consider and discuss the evidence which has led to

this decision

Managing assessment problemsSTEP


Program

• Make sure the student understands the nature of

the problem – has the student heard you?

• Develop a targeted detailed action plan with the

student – clear and unambiguous

• Set deadline and make sure the student understands

them

• Work closely with the student – include other

assessors

• Conduct progress meetings – keep notes

• Weekly progress review if not problems persist

Managing assessment problemsSTEP


Program

• Audience

• Behaviour

• Condition

• Degree

Components of learning objectives STEP


Program

• Audience

• Learner the focus of the objective

• Focused on learner’s intended outcome of learning

• Behaviour

• The action(s) or ability(s) of the learner that indicate

that the intended learning has occurred (states

acceptable level of performance)

• Varying degrees of complexity of behaviours

• Stated in observable, behavioural measurable terms

Characteristics of learning objectives STEP


Program

• Condition

• If the learning is to be demonstrated under specific

conditions these conditions can be indicated in the

objective

• Degree

• If the learning is to be demonstrated to a certain

standard, degree of accuracy or specified quality this

expectation can be written into the objective

• Takes into account learners previous experience

Characteristics of learning objectives STEP


Program

• Simple Objective

– Audience + Behaviour statement

– The learner will describe the benefits of diuretic drugs

• Complex Objective

– Audience + Behaviour statement + degree statement +

condition statement

The student will identify the major muscles of the thigh with

100% accuracy when provided with a diagram

Learning objective example STEP


Program

• Identify goals of learning

• Break goals into components of learning outcomes

• Identify current learner competencies

• Determine outcomes to be addressed in learning sessions

• Write learner-centered objectives for attainment of goals

• Arrange learning objectives in reasonable teaching sessions

Steps in developing learning objectives STEP


Program

111

112

113

• Should not come as a surprise to the student if

formative assessment evidence is used

• Plan of action followed before failing a student

• Legal and ethical issues not failing a student

• Student reactions to being failed

– ‘grieve the loss of what was, perhaps, a dream’

– Managing emotional reaction

• Failure may be a positive experience

Failing a student STEP


Program

• Additional work in dealing with the fail

• Emotional aspect for the assessor

• Personal failure

• Personal dilemma that failing a student is

incongruent with being a health care professional

• Poor preparation as an assessor

• Student manipulation

• Lack of support from colleagues

• Implications of failing 1st or 3rd year student

Failure to failSTEP


Program

• Provide evidence of progress

• Continuous assessment activities (model)

• Early identification of learning difficulties

• Fairer deal is assessment plan is developed &

followed

Do we assign a pass grade lightly and without

misgivings too?

SummarySTEP


Program

Bastable, S. (2003). Nurse as educator. Principles of teaching and learning fornursing practice. (2nd ed.). London: Jones and Bartlett.

Ferguson, L. 1998). Writing learning objectives. Journal of nursing staffdevelopment, 14(2), 87 – 94.

Gronlund, N.E., & Linn, R. (1990). Measurement and evaluation in teaching. (6th ed.). New York: MacMillan.

Kelly, K. (1992). Nursing staff development. Current competencies, future focus. Philadelphia: Lippencott.

Maier-Lorentz, M. (1999). Writing objectives and evaluating learning in the affective domain. Journal for nurses in staff development, 15(4), 167 –171.

Mellish, J., & Johnson, S. (1986). Evaluation in clinical nursing. Durban: Butterworth.

Nicklin, P.J., & Kenworthy, N. (2000). Teaching and assessing in nursingpractice. An experiential approach. London: Harcourt.

References STEP


Program

Central Metro and Western Metro Clinical Placement Networks


Module 4 - Diversity in Clinical Education

Dr Joan Deegan

Development Manager

Central/Western Clinical School Network

La Trobe University

• Culture Theory (Ting –Toomey, 1999 & Dillard, 2011)

• Literature (international student experience)

• Some in vivo quotes from research on the international student

experience

• Intercultural Communication

• Factors that influence Adaptation

• Assessment

ApproachSTEP

Central Metro and Western Metro CPNs – Supervisor Training and Education Program

• Introduce some theoretical perspectives on culture & cultural

interaction

• Raise awareness of the various ways in which cultural &

linguistic factors impact on student learning in the clinical

environment

• Promote discussion around how theoretical perspectives may

help guide the education & assessment process in the clinical

environment

• Promote awareness of the pivotal role of the facilitator in

creating a positive learning environment

• Key features & purpose of assessment

AimSTEP


• Australia preferred destination for o/s students in Asia Pacific region

• Highest I/N proportion (20.6%) of tertiary degree enrolments of any OECD country (ALTC 2011)

• $5.5 billion per year in the state of Victoria (Asher, 2011) & around $18 billion nationally (Phillimore & Koshy, 2010)

• Third most valuable export after coal & iron ore in Australia & wool & diary in NZ

Importance of Understanding DiversitySTEP


“Multiculturalism is not a subject. It is a

philosophy and must be part of the mental

fabric of teachers/clinicians & students.

It is present every minute of every day.

It is learning how to get along with people who

are different than ourselves.” (Marulis, 2000)

Anti-bias practiceSTEP


• Defined as a complex frame of reference that

consists of patterns of traditions, beliefs,

norms, values, symbols & meanings that are

shared to varying degrees by interacting

members of a community (Ting-Toomey, 1999)

CultureSTEP


• Through communication culture is passed

down, created & modified

• Provides us with a set of ideals on how social

interaction can be accomplished

• Binds people via shared linguistic codes,

scripts etc

Cultural CommunicationSTEP


Some needs are common to all people at all times

• Need to make a living

• Need for social organisation

• Need for knowledge & learning

• Need for normative & metaphysical expression

(Serrat, 2008)

Shared needsSTEP


• Communication in the health care setting

• Coping with social & cultural adjustments

• Understanding expectations & approaches to

WIL (ALTC 2011:5)• Medical terminology is more specific than IELTS reading, writing, listening, speaking. Consequently, can

have high IELTS & still have significant language issues (ALTC 2011:12)

Key Issues identified by ALTC 2011STEP


• Takes place when cultural group membership

factors (norms & scripts) affect our

communication processes

• Defined as: The symbolic exchange process

whereby individuals from two or more

different cultures negotiate shared meanings

in an interactive situation

Intercultural Communication (Ting-Toomey, 1999)STEP


• Being aware of our own & others behaviour in

the situation

• Focusing attention to the process of

communication between ourselves &

dissimilar others

Mindful CommunicationSTEP


• Habitual ways of thinking & behaving without

conscious awareness of our underlying

intentions or emotions

• Consumed by our habits; reactive/defensive

emotions or biased ethnocentric cognitions

Mindless communicationSTEP


• A lot of staff treat the students as if they are

completely stupid, anyone with an accent is

automatically considered an idiot. They will

speak really fast & not repeat themselves and

then they just come & tell me that the student

can’t speak English. Gail (Teacher), PG1:Ln8

Teacher perspectiveSTEP


Identity Regeneration Perspective (Ting-Toomey, 1999):

• A sense of identity loss & identity deprivation with regard to

values, status, profession, friends & possessions

• Identity strain as a result of id rejection by members of the

new culture

• Identity confusion with regards to role ambiguity &

unpredictability

• Identity impotence; not being able to cope with the new

environment

Culture ShockSTEP


• It’s limiting communication with the student. Well absence of

any social communication. Sometimes, it’s limiting

professional communication…it’s the tone, it’s the eye

contact.

• You know two nurses will be having a social conversation and

one of the students will come up because I’ve asked them to

report an abnormal BSL (Blood sugar level), and they’ll leave the

student waiting there, not talking to them until they’re ready

to address them, and that is very, very demeaning to a thirty

or forty-year-old woman, and the grad might be twenty-one

or twenty-two. Gail (Teacher) PG6:Ln1

Limiting communication – teacher perspectiveSTEP


• In contrast to classroom teaching, clinical education takes

place in a complex social environment where a facilitator, in

order to secure appropriate learning opportunities, needs to

have a working knowledge of the needs of patients, students,

clinician colleagues in the clinical unit (Chan, 2001)

• The facilitator/clinician then becomes a significant variable in

establishing a learning environment in the clinical area (Rielly

& Oerman, 1992) & therefore has the potential to be the key

support or the chief barrier to the student’s success (Amaro

et. al. 2006).

Clinical Education ContextSTEP


• Cultural background

• Different learning styles

• Differing perspectives on involvement e.g.

• Beliefs around authority & authority figures

• Gender e.g. beliefs around gender specific roles

• Language (understanding instructions, questions, expectation)

• Patient/client behaviour in the presence of the student

• Clinician/supervisor behaviour & communication style

• Supervisor level of contentment with the role

• Level of prior preparation & understanding (supervisor & student)

• Culture of the learning environment (how staff relate to each other & to

authority, subordinates, students & clients)

Cultural & Environmental Influences that Affect

Behaviour & Learning in the Clinical Setting

STEP


• The activities of the clinical/field community are

shaped by a number of factors such as:

• Professional discipline (knowledge)

• Rules (professional & organisational)

• Cultural norms (what’s acceptable, normal & what’s not)

• Division of labour

• Power relationships & mediating artefacts such as

technology, language etc. that it uses to pursue an

outcome

Organisational CultureSTEP


• Members of a culture or a community analyse

the language, appearance & gestures of

others & act in accordance with their

interpretations

• It is on the basis of these perceptions, that

they justify their conduct; this conduct can

only be understood in the context in which

people function (Holloway & Wheeler 2002:153)

InterpretationsSTEP


• There are some staff who are very warm and

helpful, but there are also some staff who are

bullying 50% are good & nice & warm, 50%

are raising their eyebrows, looking you from

head to toe. They don’t say it straight forward

but you can feel it. I am a stranger in this

place, something that worries me. Leesa, PG9:Ln9 &

P10:Ln2&3

Student perspectiveSTEP


Tend to be negative

• Confusion

• Hurt/pain

• Anger

• Fear

• Guilt

• Sense of distancing from others

• Loneliness

Feelings generated by experience of being

different (Diller, 2010)

STEP


• Bilingualism is a condition of knowing 2

languages rather than one

• Individuals have 2 language systems, both

overlap & are distinct

• Both relied upon in a number of ways

depending on linguistic & communicative

demands in everyday settings (variations occur from such

variables as age on arrival, language spoken at home, context related anxiety etc.). May

have high level language proficiency, but a low level of cultural knowledge (Devlin, 2002)

The Bilingual Mind (Valdes & Figueroa,1989)STEP


• Bilinguals process information more slowly in

their less familiar language which may

account for their slower speed of response in

some situations

• To achieve communicative competence they

need to achieve interactional competence (when

& how to respond to questions, seek clarification etc.)

BilingualismSTEP


• Difficulties with various aspects of language (Amaro et al. 2006; Omeri et al., 2002; Shakya & Horsfall, 2000).

• Prejudice because of their accents

• Many international students reported

encountering prejudicial behaviours from staff

& patients in the clinical environment (Amaro et

al., 2006)

Some challenges for CALD studentsSTEP


• Fear of making mistakes

• Difficulty understanding & speaking English &

need to translate English back into their native

language to facilitate comprehension (Kilstoff &

Baker, 2006)

• Internalised culture has the potential to

inhibit learning in an educational setting

imbued with very different values and

expectations

Other factors that inhibit learning &

participation

STEP


• When I go to the hospital I am also worried

to[sic] do some of the things because I’m

worried about how it will affect me in the

future, so a lot of confusion is there because

I’m not getting enough knowledge about legal

system. Nanette, PG1:Ln6

Student comments – fear of making mistakesSTEP


• Learning a new vocabulary, & understanding

new concepts have the potential to impede

academic achievement (Shakya & Horsfall,2000)

• Communication anxiety can impact on

academic behaviour

• A student may avoid participating in learning

activities, particularly if it involves speaking

Factors that inhibit learningSTEP


• It’s a big concern for me because some nursing staff is not

friendly when you do handover, some are laughing & some

are doing Ar, Ar, Ar like this (Tape: 217), & it make me feel so

uncomfortable. This have a big impact on me, because I am

afraid to do handover again, maybe I will refuse to do

handover again. It make me nervous because once the nurse

laugh at me then, tomorrow that nurse could be my buddy &

I’m afraid to ask questions. I will keep quiet because I’m afraid

she will laugh at me again. I think this influence me because

once they treat me very bad, of course I’m reluctant to do

some things & sometimes I want to escape. Lei PG12: Ln2, &

4-6

Student’s experience – giving a nursing

handover

STEP


• Fundamental emotion of fear gives rise to

emotional vulnerability & identity insecurity (Host community)

• Individuals fear that their cultural & social

habits & identities are being attacked

• Out-group members bring with them

alternative values, norms; threatening the

fundamental way of existence of the host

organisation

Why Prejudicial Attitudes STEP


• Resentment

• Frustration

• Anger

• Anxiety

Triggered Responses (Host Culture) STEP


• Confront our own biases & ethnocentric

attitudes

• Question where, when & how & why we have

learned those attitudes

• Check the content of our stereotypes against

our actual experience with the individual

STEP


Managing our Responses

• Institutions can either help or hinder the

adaptation process through the degree of

receptivity & helpfulness provided by

members of the host community(Ting-Toomey, 1999; Ward et al., 2001)

• Socio-cultural adaptation is strongly affected

by contact variables such as quantity and

quality of relations with host nationals (Ward et

al., 2001)

Factors that influence adaptationSTEP


• Awareness of our own culture personal &

professional

• Awareness of factors that impact on learning

& adaptation

• Mindful communication

• Clear & concise understanding of subject

outcomes/requirements

• Regular clear concise factual/constructive

feedback

Mindful intercultural awareness & communicationSTEP


Clarifying:

• Beware of nonverbal cues (they are continuous)

• Abbreviations

• Medical terminology, pronunciations, slang

• Share the cultural norms of the clinical unit, &

offering assistance

• At least some positive feedback (Kilstoff & Baker 2006)

Facilitating learningSTEP


Explain links between theory & practice:

Students can go through the day getting great

experience with law, with drug administration

& informed consent [both with legal

implications] but they won’t actually see that

as experience…for the exam. Gail (Teacher), PG8:Ln5

Make linksSTEP


To Main Functions

• Part of a system of accreditation

• Foster student learning (formative &

summative)

• Formative assessment crucial to effective

learning

• Very powerful driver of student’s learning

behaviours

Assessment: PrinciplesSTEP


• Variety of learning opportunities keeps the

student interested

• Knowledge

• Skill

• Teamwork

• Time management

• Reliability

• Communication

Variety of Learning Opportunities/OutcomesSTEP


• Intellectual

• Practical

• Confusion will make the CALD student in

particular very anxious & lead to unproductive

work

Clear understanding of ExpectationSTEP


• Make clear what they are being assessed

against e.g.

• Subject outcomes

• Competency Standards including the various

Domains

• Room for professional judgement, but the

standard must be generally recognised within

a field or profession

Assessment Criteria: Detailed transparent &

justifiable

STEP


• Important function in helping students learn

• Need explanations & suggestions

• Very powerful if written

• Needs to be quick, effective

situational/contextual (one issue & from one person at a time)

Specific & Timely FeedbackSTEP


• Transparent

• Demonstrably fair & reasonable; particularly

when associated with accreditation

• CALD students in particular simple, clear

wording

• Tasks such as oral presentations can be

particularly difficult for CALD students

Should be undertaken with an awareness that the assessor

could be called upon to justify the outcome

STEP


• Needs to be carefully planned & structured

• Students need to be systematically prepared

• Each understanding their role in the process

Group ActivitiesSTEP


• If certain areas of knowledge & skills are not

understood by large numbers of students this

signals need for urgent attention

Systematic analysis of student performance can help

i/d areas of curriculum needing improvement

STEP


A literature review: Levy et. al. 2009 examining

student perceptions of C/I skills they found

most helpful (Across many A/H disciplines involving teachers &

student perspectives)

• Matching clinical teaching skill to student

understanding & experience

• Good communication skills

• Constructive feedback

• Help student develop self confidence

Student perception of supervisor effectivenessSTEP


Knowledge may be the key to eroding ignorance,

but it takes a good dose of empathy to move

from intellectual understanding to

compassionate action(Miller, 2001)

Thought for todaySTEP


Ascher, C. (1998). Assessing bilingual students for placement & instruction. ERIC/CUE Digest No. 65. ERIC

I/D ED322273. Retrieved 14/3/2012 from

http://www.cshe.unimelb.edu.au/assessinglearning/03/intstaff.html

Asher, L. (2011). Victorian Government response to Commonwealth’s Knight Review (Press Release) Downloaded from www.premier.vic.gov.au 10/5/2012

Assessment: An explanation of the principles. Retrieved 13/32012 from:

http://www.cshe.unimelb.edu.au/assessinglearning/03/intstaff.html

Australian Bureau of Statistics http://www.abs.gov.au/ausstats/[email protected]/mf/3101.0

Chan, D. (2001). Development of an innovative tool to assess hospital-learning environments. Nurse

Education Today, 21, 624-631. Retrieved 18/7/2006 from http://www.idealibrary.com

Deegan, J. & Simkin, K. (2010) Expert to novice: Experiences of professional adaptation reported by Non-

English Speaking Nurses in Australia. Australian Journal of Advanced Nursing (27) 3

Devlin, M. Assessing students unfamiliar with assessment practices in Australian higher education. Excerpt

from: McInnis, J. & Devlin, M., (2002). Assessing learning in Australian Universities: Ideas strategies &

resources for quality in student assessment. Centre for the Study of Higher Education. Retrieved

15/3/2012 from http://www.cshe.unimelb.edu.au/assessinglearning/03/intstaff.html

Delahaye, B. (2005). Human resource development: Adult learning and knowledge management (2nded.).

Sydney: Wiley.

Diller, J. V. (2011). Cultural diversity: A primer for the human services (4th.ed.). Cengage: Australia

ReferencesSTEP

Central Metro and Western Metro CPNs – Supervisor Training and Education Program19/07/2013 164

Holloway, I., & Wheeler, S. (2002). Qualitative research in nursing (2nd Ed.). Melbourne: Blackwell Science.

Levy, L. S., Sexton, P., Willeford, S., Barnum, M. G., Guyer, S., Gardner, G., Fincher, A.L. (2009). Clinical

instructor characteristics, behaviours and skills in Allied Health Care Settings: A literature review. Athletic

Training Education Journal 4 (1), 1-13

Marulis, L. (2000). Anti-Bias teaching to address cultural diversity. Multicultural Education 7 (3) 27-30

Miller, H. M. (2001). Teaching & learning about cultural diversity. The Reading Teacher 54 (4) 380-381.

Phillimore, J. & Koshy, P. (2010). The economic implications of fewer international higher education

students in Australia. Australian Technology Network of Universities. Final Report.

Serrat, O. Culture theory (2008). Knowledge Solutions.

Ting-Toomey, S. (1999). Communicating across cultures. New York: Guilford Publications.

Valdes, G,. & Figueroa, R., (1989). The nature of bilingualism & the nature of testing: towards the

development of a coherent research agenda. Prepared for the National Commission on Testing & Public

Policy. Unpublished manuscript. University of California Berkley & University of California (Cited in Ascher,

1990)

Ward, C., Bochner, S., & Furnham, A. (2001). The psychology of culture shock (2nd Ed.). Philadelphia:

Routledge.

Ziguras, C., McBurnie, G. (2011). International Student Mobility in the Asia Pacific: From globalization to Regional Integration. In: Marginson, S. , Kaur, S. & Sawir, E. (Eds.). Higher education in the Asia Pacific:

Strategic responses to globalisation. New York: Springer.

ReferencesSTEP

Central Metro and Western Metro CPNs – Supervisor Training and Education Program19/07/2013 165

• http://www.cshe.unimelb.edu.au/assessinglearning/03/intstaff.html

• http://www.intstudentsup.org/

The latter is particularly useful

Useful LinksSTEP


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