Clinical Education Model Research Articles

Clinical Preceptor Evaluation of Veterinary Students in a Distributed Model of Clinical Education

The study reported here investigates the reliability and validity of a standardized evaluation form used to assess students' knowledge, clinical skills, interpersonal skills, and professionalism during fourth-year clinical rotations in a distributed model of veterinary education. A form designed to assess veterinary knowledge (5 items), clinical skills (7 items), interpersonal skills (3 items), and professionalism (6 items) was used by clinical preceptors to evaluate student performance across different rotations. For the period January--May 2007, 218 evaluations were completed for 81 students; each student was assessed in at least two rotations. Mean scores across the 21 items ranged from 3.42 (SD = 0.61) to 3.87 (SD = 0.37). Construct validity was assessed using exploratory factor analysis. The 21 items loaded on three underlying factors, professionalism, knowledge and clinical skills, accounted for 70.35% of the variance. Internal consistency (Cronbach's alpha) of each subscale was high, ranging from 0.88 for clinical skills to 0.94 for professionalism and 0.96 for the entire tool. Correlations between subscales were significant (p < 0.01), ranging from r = 0.62 to r = 0.76. Preliminary analysis suggests that the evaluation tool has good internal reliability. Construct validity analysis suggests that certain items relating to interpersonal skills and clinical skills were assessing either knowledge or professionalism. Clinical preceptors could differentiate between different skill levels for knowledge and clinical skills. Challenges associated with the assessment of professionalism are discussed.

Evaluation of clinical teaching models for nursing practice

Clinical placements provide opportunities for student nurses to learn experientially. To create a constructive learning environment staff need to be friendly, approachable, available and willing to teach. There must be adequate opportunities for students to develop confidence and competence in clinical skills with a focus on student learning needs rather than service needs of facilities. A popular model for clinical teaching of nursing students is the preceptor model. This model involves a student working under the supervision of individual registered nurses who are part of the clinical staff. This model was failing to meet students' needs in acute nursing practice areas, largely due to Registered Nurse staff shortages and demanding workloads. The students' evaluations led to the trial of a 'cluster' or group model of eight students, with a clinical facilitator who is paid by the university, in each acute nursing ward. Evaluation of twenty nursing students' perceptions of their acute nursing practice clinical placements was conducted using a mixed method approach to evaluate the two models of student supervision. Results indicate that the students prefer small groups with the clinical facilitator in one area. Thus evaluation and feedback from students and the perceptions of their clinical placement is essential.

CeMENT: evaluation of a regional development programme integrating hospital and general practice clinical teaching for medical undergraduates

Objectives To determine the feasibility and effectiveness of shared hospital and general practice clinical teaching for medical undergraduates. Design A multifaceted approach employing quantitative and qualitative techniques. Setting All medical schools in North Thames Region. Subjects Students, GP tutors and hospital specialists. Results The model was successfully adopted in a broad range of clinical specialties in all of the participating medical schools, resulting in a doubling of the involvement of general practice in clinical teaching. Participating students provided an overwhelmingly positive evaluation of the attachments and there was a clear perception of benefit amongst the participating GPs. However, the views of the participating hospital clinicians were less positive and the true nature and extent of the educational impact proved difficult to assess. Conclusions This model of collaborative clinical teaching between hospital and general practice can be implemented in accordance with the project’s key aims, but the enthusiastic involvement of hospital clinicians may be difficult to secure.

In Defense of Cookbooks

Clinical practicum is an important means through which clinicians gain the knowledge and skills needed to provide effective services for a broad variety of clients. Through practicum, student clinicians learn about the practices of the profession. The manner in which this transmission of knowledge occurs, however, is largely unknown. The focus of this paper is to examine the fundamental assumptions that underlie the success of clinical training and integrate it with knowledge from various strands of learning models. Using a cookbook analogy, we examine the studies of learning in different conditions and the literature comparing novice and expert learners. On the basis of these findings, we propose a two-dimensional, phased model of clinical teaching. We then provide examples of how this model can be implemented into clinical training of speech–language pathology students. An added benefit to a phased approach is that the theory-to-practice link is strengthened when students have the opportunity to develop, implement, and test the assessment and intervention proposals in a systematic manner.

Terminology: the historical perspective, evolution and current usage – room for confusion?

Modern palliative care started with St Christopher’s Hospice in 1967 and was initially regarded as ‘terminal care’. This served as a template for a developing model of multidisciplinary clinical care, teaching and research. A decade later, several hospital Palliative Care Teams were established and different terms were used to describe them. An evidence base developed slowly and a medical subspeciality was established, known as Palliative Medicine. Over the last two decades we have seen an expansion in non-hospice palliative care. The terms used to describe this care have been variable and inconsistent. Our challenges in progress involve establishing clear terminology and an evolving improved evidence base, along with a realisation that there are large gaps in patient care.

A Conceptual Framework for Clinical Education in Athletic Training

Objective: To develop a model for clinical education in athletic training education based on integration of various allied health professional clinical education models. Background: Clinical education is a critical component of allied health education programs. It allows for the transfer of knowledge and skills from classroom to practical application. Clinical education needs to be structured. In addition the Clinical Instructor (CI) also needs to facilitate athletic training students' development into effective, evidence-based practitioners. Description: A brief discussion on the need for transfer of knowledge in athletic training education is discussed. A review of the various clinical education models from allied health professional education is presented. Finally, a model for athletic training clinical education is presented with implications for practice. Clinical Advantages: As athletic training education continues to develop, a need to formalize clinical education and develop a clinical education model for athletic training is warranted. Focusing on the structure and function of clinical education will continue to move athletic training education forward and will align athletic training education with other allied health professional education programs.

Assessing Reflection and Higher-order Thinking in the Clinical Setting Using Electronic Discussion Threads

Background and Purpose. Students learn both theory and practical application in the classroom. However, for many, these aspects of clinical practice are not fully comprehended until students encounter real-life situations that require them to analyze, evaluate, modify, and apply what they know. Reflection can help students connect classroom knowledge to clinical practice and enable students to engage in higher-order thinking, moving beyond knowledge and comprehension to analysis, synthesis, and evaluation critical for practice. Integral to effective clinical teaching is the ability to assess outcomes. While the literature offers strategies to facilitate reflection and higher-order thinking, little has been written about the assessment process. The purpose of this study was to design and test a method of assessing reflection and higher-order thinking evident in electronic discussion board threads of students involved in virtual action learning sets in the clinical setting. Subjects. Seven entry-level physical therapist students on their final full-time clinical internship participated in this study. Participants were engaged in a collaborative model of clinical education on an acute rehabilitation unit. Methods. Participants were assigned to 2 groups based on the timing of their internship. Both groups received a 2-hour in-service on reflective practice, submitted critical incidents to an electronic discussion board, and participated in an electronic discussion for 4 weeks. Following the discussion board activity, discussion threads were downloaded and analyzed for the presence of the elements of reflection and levels of higherorder thinking using coding schemas previously reported in the literature. The submissions were coded independently by 3 raters and interrater reliability was assessed by percent agreements and kappa statistics. Results. Moderate to almost perfect levels of agreement between raters were achieved for most of the coding schemas used, with interrater prevalence-adjusted bias-adjusted kappa coefficients that ranged from 0.38 to 0.92. Discussion and Conclusion. This study provides a reliable method of assessing reflective thinking and higher-order processing in the clinical setting through the use of electronic discussion boards.

Partners in Practice: A Win-Win Model for Clinical Education

A program of cognitive apprenticeship focusing on problem solving skills through reflection, discussion, and actions shared between novice and experienced students was developed and piloted in a large baccalaureate nursing program in the midwestern United States. The program paired senior students in a leadership course with instructor-led groups of first-year students in the clinical and laboratory setting. Senior students developed leadership skills associated with best practices including preparation, planning, clear communication, feedback, and change, while gaining a better appreciation of individual learning needs. First-year students gained confidence with their knowledge and skills and were able to refine communications with patients, patients' families, and staff members and think more critically about patient care issues. Unanticipated benefits included patient, family, and staff recognition and appreciation for a new model for patient care delivery.

Undergraduate nursing students’ preparedness to “go rural”

This article reports on a theme emerging from a focused ethnography examining the professional socialization of undergraduate fourth year nursing students during a rural hospital preceptored clinical experience. Nursing students and preceptors geographically dispersed over a 640,000 square kilometer rural area participated in this study. Students report student preparedness for the rural hospital setting means to "know what you are getting into". Assisting nursing students to prepare for the rural hospital preceptorship facilitates a positive experience thus increasing the effectiveness of the preceptorship model of clinical teaching. Having a positive rural-based experience also has the potential for recruiting new staff. These preliminary findings suggest that student preparation for the rural hospital preceptorship includes cognitive and psychological preparation, as well as the acquisition of common advanced clinical skills.

Symbiosis: a new model for clinical education

Some of the principles of symbiosis have been implicit in approaches to medical education for some time but they are increasingly difficult to maintain in large tertiary academic medical centres. The case mix of these centres is concentrated in the higher levels of tertiary care, with a predominance of acute and emergency illness. Patients frequently undergo complex technological interventions but, at the same time, have relatively short periods of time in hospitals. There is a new emphasis on patient ‘rights’ and choice, with limits to the number of skills and procedures that students and junior doctors can undertake with patients. There are strong pressures for clinicians to spend more time performing clinical services in the budget-driven management structures of hospitals, often at the expense of time for teaching. Finally, most of the burden of health care is widely distributed beyond hospitals in the community, where chronic disease represents perhaps one of the major challenges for health care systems of the future. If these trends are to continue questions may be raised about the ongoing suitability of some traditional environments for undergraduate and graduate-entry medical courses.

General practice: a leading provider of medical student education in the 21st century?

General practice is well placed to become a major setting for medical student education over the next decade. New models of clinical education are required, to take account of changes in the patient population, disease profile and management strategies. While there has been an increase in general practice-based and other community-based education, there is the potential for further expansion. Evidence for the positive role of general practitioners and general practice in medical education is growing, including the benefits of prevocational training in general practice. If GPs are to assume a major role in community-based education of medical students, there will need to be changes in funding structures and supporting resources, particularly at this time of increasing medical student numbers and workforce shortage and maldistribution.

Clinical teaching model for nursing practice

Clinical teaching model for nursing practice

Managerial perceptions of mentor, lecturer practitioner and link tutor roles

Educating pre-registration nurses in clinical practice is a global issue. Within different countries problems exist in educating and supervising students in clinical practice and various models of clinical education are employed. In Wales, United Kingdom, this responsibility is divided between mentors, lecturer practitioners and link tutors. This paper reports on the third phase of a three-phase study in Wales to explore differences between mentors, lecturer practitioners and link tutors, and how they work together to assist students to integrate theory and practice. Four focus group interviews of National Health Service managers and Higher Education managers (n=22) were conducted. Qualitative content analysis revealed four themes: role characteristics and competencies, role differences, role conflict, and future options. The findings suggest a theory-practice continuum along which mentors, lecturer practitioners and link tutors occupy different positions. The article explores these different positions and offers suggestions for future role development.

The Harvard Medical School-Cambridge Integrated Clerkship: An Innovative Model of Clinical Education

The Harvard Medical School-Cambridge Integrated Clerkship (HMS-CIC) is a redesign of the principal clinical year to foster students' learning from close and continuous contact with cohorts of patients in the disciplines of internal medicine, neurology, obstetrics-gynecology, pediatrics, and psychiatry. With year-long mentoring, students follow their patients through major venues of care. Surgery and radiology also are taught longitudinally, grounded in the clinical experiences of a cohort of patients and in a brief immersion experience working directly with an attending surgeon. Students participate in weekly, case-based tutorials integrating instruction in the basic sciences with training to address the common and important issues in medicine, as identified by national organizations. In addition, they participate in a social science curriculum that focuses on self-reflection, communication skills, ethics, population sciences, and cultural competence. In the pilot year (July 2004 to July 2005), HMS-CIC students performed at least as well as traditional students in tests of content knowledge and skills, as measured by National Board of Medical Examiners (NBME) Subject Exams and the fourth-year Objective Structured Clinical Exam, and they scored higher on a year-end comprehensive clinical skills self-assessment examination, suggesting that they retained content knowledge better. From surveys, HMS-CIC students were much more likely to see patients before diagnosis and after discharge and to receive feedback and mentoring from experienced faculty than were their traditionally educated peers. HMS-CIC students expressed more satisfaction with their curriculum and felt better prepared to cope with the professional challenges of patient care, such as being truly caring, involving patients in decision making, and understanding how the social context affects their patients.

Nursing students’ perceptions of learning in the clinical setting of the Dedicated Education Unit

This paper reports a study to explore nursing students' experience of learning in the clinical setting of a Dedicated Education Unit using a communities of practice framework. The Bachelor of Nursing curriculum at the University of Canberra is clinically focused, recognizing the importance of learning to be a nurse in and from practice. A communities of practice framework underpins the philosophy of the Dedicated Education Unit model of clinical practicum. In this exploratory qualitative study, a convenience sample of 25 second and third year nursing students participated in focus group discussions, conducted in 2004, to share their views of learning in the Dedicated Education Unit, a newly established model of clinical education. Three major themes were identified: acceptance, learning and reciprocity, and accountability. Acceptance of students by clinicians assisted students to engage in nursing work. Students acknowledged the importance of peer learning in sharing experiences, reinforcing knowledge and enhancing confidence. Students accepted responsibility for their work and they valued this responsibility, but some questioned whether participation in all aspects of work constituted a learning opportunity. Engagement and participation in the clinical workplace are valuable for nursing students. Strategies to support learning in the workplace can be shared with students and clinicians. Further research to test the theoretical premises of the communities of practice framework in clinical nursing education is required.

No model of clinical education for physiotherapy students is superior to another: a systematic review

Which models of undergraduate/entry-level clinical education are being used internationally in allied health disciplines? What is the effect and, from the perspective of stakeholders, what are the advantages, disadvantages, and recommendations for successful implementation of different models of undergraduate/entry-level clinical education? Systematic review with data from quantitative and qualitative studies synthesised in a narrative format. Undergraduates/entry-level students from five allied health disciplines undergoing clinical education. Six broad models of clinical education: one-educator-to-one-student (1:1); one-educator-to-multiple-students (1:2); multiple-educators-to-one-student (2:1); multiple-educators-to-multiple-students (2:2); non-discipline-specific-educator and student-as-educator. Models were examined for productivity; student assessment; and advantages, disadvantages, and recommendations for implementation. The review found few experimental studies, and a large amount of descriptive research and opinion pieces. The rigour of quantitative evidence was low, however qualitative was higher. Evidence supporting one model over another was largely deficient with few comparative studies available for analysis. Each model proffered strengths and weaknesses, which were unique to the model. There is currently no 'gold standard' model of clinical education. The perception that one model is superior to any other is based on anecdotes and historical precedents, rather than on meaningful, robust, comparative studies.

Universities preparing health professionals for the 21st century: Can something new come out of the traditional establishment?

To address clinical education in chronic disease management, the University of Alberta partnered with the local health authority to develop interprofessional team placements in diabetes chronic disease management. The objectives were to determine a meaningful and sustainable approach to interprofessional team placements. Pre-licensure students from medicine, nursing, nutrition and pharmacy participated in a project-based team experience designed to increase their discipline-specific knowledge of diabetes while enhancing their team process skills. Quantitative and qualitative research methods were used to evaluate project implementation and student outcomes. The majority of students reported learning “a great deal” about the roles of other health professionals and knowledge regarding the management of diabetes from the perspective of other health disciplines. However, several key learning outcomes were not fully accomplished; to enhance student's interprofessional team skills, increase their knowledge of interprofessional team functions and learn how to modify team function in a clinical setting. Creativity concerning relevant projects, varying settings, and differing models of service delivery should be encouraged, and flexibility within the project and process is essential for self-directed learning of student teams. New models of interprofessional clinical education, such as the chronic disease management model used in this study, have potential, if supported by the shift in health science programs culture.

Dedicated education unit: An innovative clinical partner education model

This article describes the implementation and evaluation of the Dedicated Education Unit (DEU) as an innovative model of clinical nursing education. A partnership of nurse executives, staff nurses and faculty transformed patient care units into environments of support for nursing students and staff nurses while continuing the critical work of providing quality care to acutely ill adults. Various methods were used to obtain formative data during the implementation of this model in which staff nurses assumed the role of nursing instructors. Results showed high student and nurse satisfaction and a marked increase in clinical capacity that allowed for increased enrollment. This article reports on a 3-year project to operationalize the DEU concept with 6 nursing units in 3 hospitals. The development of staff nurses as clinical instructors, best practices to teach and evaluate critical thinking in students, and the mix of student learners continue as focus areas.

The Role of Psychiatry in U.S. Air Force Primary Care: Research-Based Models for Clinical Consultation and Education

The integration of mental health treatment with primary care is a U.S. Air Force priority. Unfortunately, manning shortages limit the utility of psychiatry in existing Air Force health care models. In this study, we present efficient and data-driven models for psychiatric involvement with primary care. These models include the use of psychiatrists as clinical consultants and primary care educators. Certain factors are required to implement these models including command support for locating psychiatrists within primary care, data-driven educational approaches, collaborative clinical care, and administrative support.

PRE-TEST AND POST-TEST EVALUATION OF STUDENTS’ PERCEPTIONS OF A COLLABORATIVE CLINICAL EDUCATION MODEL ON THE LEARNING ENVIRONMENT

Objective: This study investigated the impact of a collaborative clinical education model on students’ perception of the psycho-social learning environment. Design: A pre-test and post-test quasi experimental design. Setting: A tertiary referral centre. Subjects: Second and third year undergraduate nursing students were asked to rate their perceptions of the psycho-social learning environment at the completion of the clinical practicum. Tool: The tool used to measure psycho-social perceptions of the clinical learning environment was the Clinical Learning Environment Inventory previously validated in Australian health care contexts. Intervention: A collaborative arrangement with the university and ward staff where eight students are placed on a ward and a ward staff member is paid by the university to be ‘off-line’ from a clinical workload to supervise the students. This is in contrast to thestandard facilitation model where students are placed with registered nurses in different localities under the supervision of a ‘roving’ registered nurse paid by the university. Results: No significant differences were found in pre-test mean scores when comparing wards. Significant differences in post-test scores for the intervention group were identified in the sub scales of Student Involvement, Satisfaction, Personalisation and TaskOrientation. Conclusions: The adoption of a collaborative clinical education model where students are integrated into the ward team and the team is responsible for student learning can positively enhance capacity for student learning during their clinical practicum.