Evaluation of a Clinical Teaching Session - Case Study Example

REFLECTIVE EVALUATION REPORT OF A CLINICAL TEACHING SESSION First off, we set the flow of the discussion of this paper. We begin by mentioning the essentials of the case against which we are set to provide and elaborate on suggestions as to how the future clinical teaching can be improved. Coming in-between these two tasks, we shall render our reviewed literature on the subject of clinical teaching and learning an analysis. The “Essentials” of the Case A clinical teaching designed for undergraduate paramedics was held on the topic “How to Evaluate Blood Gases”. The teaching duration was initially pegged at 25 minutes, and the venue was at the hospital. The objectives were to understand and apply evaluation of blood gases. The teaching session began with Pre-Test Case Study. To facilitate the discussion, expressive images were used by the clinical teacher – i.e., the clinician role modeled the techniques of blood gases evaluation. This was followed by the students exercising or doing by themselves these techniques at bed side. At the end of the session, a Post-Test was done. Afterwards, the session was evaluated by peer reviewers, and the following points were emphasized: Recent research finding was not presented. There’s a need for more relevant information (to explain) the basic terms used. The level of provided information was higher than expected (by the undergraduate students) and the students’ level of understanding. There are questions about some strategies used in the session (cf. problem-based learning) – thus, critique the technique by contrasting the learning objectives of this session. The consumed time was longer than planned (35 minutes, instead of 25 minutes). The students were not given chance to work in groups for rich discussion. Questioning technique is to be more effective; and theories underpinning these techniques were not discussed adequately. Consider, too, the following: preparation and planning for the session; delivery, including presentation style and teaching and learning processes; transformative learning (why and how); teaching for learning for clinical setting (what’s most effective); ways to engage students in team work The learner’s performance evaluation; a supportive and safe clinical learning environment (how and why); feedback strategies (how and why); using bloom taxonomy to develop learning objectives and evaluate students’ performance. Should we collapse the above-mentioned evaluation results into general categories (for purpose of easier facility of discussion), we shall have the following (presented as though in a normal sequence): pre-teaching preparations, development of learning objectives, planned allotment viz. actual use of time in teaching, teaching and learning strategies (in clinical setting), delivery of pedagogical materials, the role of clinical learning environment, feedback mechanism in clinical learning, and evaluation of students’ performance. The Reviewed Literature Raisler, et. al. (2003) rightly points out that clinical experts do not automatically become pedagogical experts in clinical setting, unless they are exposed to or have background of teaching strategies. For an excellent clinical teacher is one who is able to integrate into one knowledge about teaching and learning, clinical skills, critical thinking, and evidence-based care into clinical teaching. That such is a demand is intelligible insofar as clinical teaching in itself carries several heavy-weight challenges –for the preceptors, it is how to effect learning in a chaotic and stressful atmosphere; for students, it is how to make sense out of their multiple stresses; and for the clinical faculty, it is to strike the balance between practice and clinical teaching. Won and Wong (2006) observe that, during the last two decades, the structure and function of clinical learning and teaching have undergone significant changes. Nursing students demand quality teaching rather than supervision in the clinical area alone. At the same time, expectations and demands of university nursing faculty also change. Nurse educators are under increasing pressure to engage in scholarly activities. Clinical instruction in baccalaureate nursing programs becomes the primary responsibility of either the inexperienced or part-time, session-al instructors. This pattern of faculty teaching assignment is not without problems. Concerning teaching methods or strategies, we have found Neher, et. al. (1992) describing the so-called Five Micro Skills for Clinical Teaching. These skills are (1) getting commitment, (2) probing for supporting evidence, (3) teaching general rules, (4) reinforcing what is right, and (5) correcting mistakes. The first two micro-skills diagnose the learners’ needs; the last three micro skills are for tailored instruction. Done in a context where time is of premium importance, clinical teaching using Five Micro Skills allots 50% of the time presenting the case (or the diagnosis of the patient); the other 25% of the time is for the clinical instructors to ask questions (this time, what is being diagnosed is the [mind of the] students); and the final 25% is for discussion of the case, providing targeted instruction. This method is meant to render the clinical teacher efficient in effectively assessing, instructing, and giving feedback in clinical teaching sessions. In here, clinical teachers are expected to play different professional roles as expert consultant, joint problem solver, Socratic teacher, and – when appropriate – one-minute preceptor. Melrose (2004), citing authors (of clinical teaching materials), states that undergraduate students value a facilitative approach that includes collaborative and involving activities with time to interact with course content and with one another. That means, clinical learners would rather not prefer to simply stand by and listen or observe. In the concrete, a facilitative approach in clinical teaching accordingly would consist of the following steps: (1) identification of barriers that students are facing – that is, learners appreciate when instructors initiate a process of questioning who the students are, what a clinical environment would like in their eyes, and what challenges and anxieties are present in the learners; (2) consideration of learning styles of clinical students – i.e., it usually pays to ask the students regarding the learning style(s) that they prefer, e.g., vision (reading, charts, illustrations and films), hearing (spoken directions, audio-tapes or musical lyrics), or kinesthetic (handling equipment, moving around, or practicing a skill); (3) collaborative planning of activities – e.g., to augment the conventional clinical teaching approaches such as grand rounds, patient simulations, role plays, skill demonstrations, guided discussion, case studies, overheads, question and answer periods, hand-outs, videos and small group activities (for instance, creating a game for summarization of topics), the following examples may be suggested by the students: software generated crosswords on word or concept definitions; story-telling by students about their personal clinical experiences, or ethical dilemmas where the right and wrong are not easily established; (4) creation of learning community, i.e., learners must be linked – notwithstanding administrative issues like work-overloads, budget restrictions, among others – with the practitioners as the latter would contribute greatly as support group of the former; and (5) research effective clinical teachers’ characteristics, for students are found to be helped by those with instructors who have positive traits, unwavering commitment to learning process, and know how to build relationships with learners. In addition, Melrose says that two approaches in clinical pedagogy would definitely help: first, a designated time to plan clinical activities – feasibly an hour or two in a week; and, second, encouragement of questions, or invitation to students to articulate issues in clinical setting. Stark’s (2002) study which did attempt to measure the clinical students’ perceptions of clinical teaching as well as clinical consultants’ views of the delivery of undergraduate clinical teaching is helpful in our discussion. With fourth year medical students and consultant clinical teachers as his research participants, he found out that students believed in the importance of consultant teaching and saw consultants as role models. However, they perceived variability in the quality and reliability of teaching between physicians and surgeons. Some traditional teaching venues, especially theaters, are believed to be of little clinical importance. Generally, consultants enjoyed teaching but felt severe pressure from other commitments. They taught in a range of settings and used various teaching strategies, not of all which were perceived to be “teaching” by students. Thus, Stark’s conclusions were, first, while students and teachers are educational partners, they are not always in agreement about the quality, quantity, style or appropriate setting of clinical teaching; second, to enable teachers to provide more high quality teaching, there needs to be support, opportunities and incentives to understand curricular developments and acquire teaching skills. Khatab and Rawling (2008) mention about the advancement over the last ten years on the area of assessment of clinical competence among nurse practitioner programs by widespread use of ob the OSCE (or Objective Structured Clinical Examination). OSCE, which involves the use of procedure stations (which require students to perform a “entire” examination of the subject) and question stations (composed of two forms of viva involving various cognitive activities), is designed as tool for formative and summative assessment, as learning resource, and to identify gaps and weaknesses in clinical skills. Further, on the subject matter of evaluation of clinical teaching process, Snell, et. al. (2001) discuss the importance of the process of evaluation of clinical teaching for the individual teacher and for the program. In their study, measurement principles, including validity, reliability, efficiency and feasibility, and methods to evaluate clinical teaching are reviewed. Theirs was broad enough to include both the perspectives of the learner and of the teacher, the patient and the institutional administrators and payers in the health care system. As a result, each perspective provided specific feedback on factors or attributes of the clinical teacher’s performance in the domains of medical expert, professional, scholar, communicator, collaborator, patient advocate and manger. Teachers are to be evaluated, too, in all domains relevant to their teaching objectives, including knowledge, clinical competence, teaching effectiveness and professional attributes. With this model of evaluation, a connection between teaching and learning about all the expected roles of a physician can be made. This can form the basis for systematic investigation into the relationship between the quality of teaching and the desired outcomes, the improvement of student learning and the achievement of better health care practice. It is suggested that the extent of effort and resources devoted to evaluation should be commensurate with the value assigned to the evaluation process and its outcomes. Towards the Future of Clinical Teaching: Some Recommendations We shall present our recommendations in numbered form – of course, without intent to signify that the first in sequence is the first in importance. 1. Medical practitioners do not necessarily make good clinical teachers. Thus, there is a great need for them to learn teaching strategies and methods and understand learning processes of their students. This is not only on account of there lack of professional training to teach (they were trained for medicine, in the first place), but more so because of the complexity of the entire process of pedagogy. 2. Already now, there are different theories with their corresponding strategies or methods of teaching and learning. They can be applicable, undoubtedly, to clinical setting. Benjamin Bloom has developed one. There is also the Five Micro Skills reported by Neher, et. al. Proceeding from the fact that available are teaching models, the suggestion of Melrose makes sense: that medical practitioners must give time for their preparation for their clinical teaching session(s). Should this become the norm, the dilemma of medical personnel in striking the balance between practice and teaching is likewise solved. The first item (cf. #1) may be ensured by primarily by organizational mandate – that is, a nursing school arranging education training for its clinicians. The second item (cf. #2) is touching more on the domain of the attitude of the clinical instructors. They have accepted the job, in the first place, so it is but logical to assume that they would be serious enough in the fulfillment of their teaching role. 3. Regarding the relationship between the teacher and the learner, it is often observed to be chaotic if not problematic. Students are demanding quality instruction, and not just supervision, in the clinical setting. And, rightly so! For this is the beginning of the recognition of the entirety of the equation (that is, effective education is composite of teacher AND learner). The role of the learners needs to be given recognition. Their quest for instructional approach that befits them and their learning styles needs to be conceded to. That they want the whole clinical pedagogical enterprise to be collaborative and facilitative needs to be acknowledged. 4. In the future, too, the clinical setting needs to be adapted to assume more the “face” of a learning setting. According to various literatures available, that the realities in hospitals do not facilitate learning as it should be is commonly voiced out. Then, how to proceed to simulate the normal school setting? This remains to be seen, but what is important is that there is already an acknowledgement of the inadequacy of hospital or current clinical setting as a context of teaching and learning. This does not mean though that this simulation of classroom setting is forgetful of the limitations that are inherent to the conventional four-walled classrooms. Seen more deeply, usual classrooms are devoid of the elements of the real life – which are most present in hospital setting (in relation to medical training). 5. A support group for clinical learners is a must. This community of supporters is found in the persons of medical practitioners. To date, this is yet to be the thrust of most nursing schools. Why? Well, it’s because medical schools are still focused on resolving the administrative adjustments that would ensue when this arrangement is effected. However, in the future, it is being anticipated that the administrative concerns would cease to be the overriding preoccupation as these would give way to the recognition that the up-and-coming medical learners are in need of role models to support them as they move towards the medical way. References: Irby, D. (1992). 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