Teaching In Clinical Settings Research Articles

Bioethics education in clinical settings: theory and practice of the dilemma method of moral case deliberation.

BackgroundMoral Case Deliberation is a specific form of bioethics education fostering professionals’ moral competence in order to deal with their moral questions. So far, few studies focus in detail on Moral Case Deliberation methodologies and their didactic principles. The dilemma method is a structured and frequently used method in Moral Case Deliberation that stimulates methodological reflection and reasoning through a systematic dialogue on an ethical issue experienced in practice.MethodsIn this paper we present a case-study of a Moral Case Deliberation with the dilemma method in a health care institution for people with an intellectual disability, describing the theoretical background and the practical application of the dilemma method. The dilemma method focuses on moral experiences of participants concerning a concrete dilemma in practice. By an in-depth description of each of the steps of the deliberation process, we elucidate the educational value and didactics of this specific method.ResultsThe didactics and methodical steps of the dilemma method both supported and structured the dialogical reflection process of the participants. The process shows that the participants learned to recognize the moral dimension of the issue at stake and were able to distinguish various perspectives and reasons in a systematic manner. The facilitator played an important role in the learning process of the participants, by assisting them in focusing on and exploring moral aspects of the case.DiscussionThe reflection and learning process, experienced by the participants, shows competency-based characteristics. The role of the facilitator is that of a Socratic teacher with specific knowledge and skills, fostering reflection, inquiry and dialogue.ConclusionThe specific didactics of the dilemma method is well suited for teaching bioethics in clinical settings. The dilemma method follows an inductive learning approach through a dialogical moral inquiry in which participants develop not only knowledge but also skills, attitude and character. The role of a trained facilitator and a specific view on teaching and practicing ethics are essential when using the dilemma method in teaching health care professionals how to reflect on their own moral issues in practice.

Development of a Clinical Performance Assessment Tool for an Occupational Therapy Teaching Clinic

Health professional education is experiencing increased accountability from higher education and professional accrediting bodies to produce professionals who are prepared to meet the demands of the complex, fast-paced, ever changing health-care environment. Using competency-based assessment methods to evaluate a student’s performance can assist to decrease the gap between education and practice and ease the critical transition from the classroom to the clinic. A variety of assessment methods that use a CompetencyBased Medical Education (CBME) framework to assess student performance and competency can be found throughout the health professions literature. Because of the lack of literature about the assessment of student performance in occupational therapy education, and because of the inability to find an appropriate assessment tool for the on-site teaching clinics in the author’s program, the author developed a new assessment tool to measure student competency and performance in the clinical education setting. This paper discusses each phase of development; the professional literature used; and the reasoning for domain, item, and scoring selection. The final assessment includes a 5-point rating scale to score 42 items in six domains in order to assess student performance and competency during an occupational therapy teaching clinical education experience.

Resources for Becoming Culturally Competent in a Multijurisdictional Practice: G20 Nations and Associated Legal Traditions

AbstractThis article provides an overview of the importance of cultural competency skills for multijurisdictional practice and a comprehensive list of resources for international business law for G20 nations. Law students today are certain to confront issues of cultural competency in both clinical settings during law school and also during their legal careers as a result of the increasingly global practice of law. This article focuses on cultural competency as an essential lawyering skill in the context of private international law. First, the article will provide a brief history of cultural competency and its inclusion as a type of skills training in a clinical legal education setting at some law schools. Then, the article includes a brief survey of current globalization offerings and initiatives at U.S. law schools. Finally, the article provides a comprehensive list of resources to aid cultural competency and understanding of the legal systems and, further, an authoritative survey of international business resources for G20 countries.

Undergraduate nursing students' perceptions of the effectiveness of clinical teaching behaviours in Malaysia: A cross-sectional, correlational survey

BackgroundClinical teachers are a critical determinant of the quality of nursing students' clinical learning experiences. Understanding students' perceptions of clinical teachers' behaviours can provide the basis for recommendations that will help improve the quality of clinical education in clinical settings by developing better clinical teachers. ObjectivesTo understand clinical teaching behaviours and their influence on students' learning from the perspective of undergraduate nursing students. DesignA cross-sectional, correlational survey. SettingA nursing faculty in Kuantan, Pahang, Malaysia. ParticipantsA sample of 120/154 (78%) students from Year 2–Year 4 were recruited according to set criteria. MethodsA self-administered questionnaire was employed to collect demographic data, and students' perceptions of clinical teaching behaviours and their impact on learning using the Nursing Clinical Teaching Effectiveness Inventory (NCTEI). ResultsYear 3 and 4 students perceived faculty clinical teaching behaviours positively. There was a significant association between clinical teaching behaviours and their influence on students' clinical learning. Teachers' competence rated as the most significant influential factor, while teachers' personality rated as least influential. ConclusionParticipants were able to identify the attributes of good clinical teachers and which attributes had the most influence on their learning. Overall, they perceived their teachers as providing good clinical teaching resulting in good clinical learning. Novice clinical teachers and nursing students can use this positive association between teaching behaviours and quality of clinical learning as a guide to clinical teaching and learning.

Evidence of Reliability, Validity, and Practicality for the Canadian Physiotherapy Assessment of Clinical Performance.

Purpose: To investigate the internal consistency, construct validity, and practicality of the Canadian Physiotherapy Assessment of Clinical Performance (ACP), a descriptive measure used by physiotherapy students and their clinical instructors (CIs) at the mid- and endpoints of an internship to describe the students' behaviours as observed in the clinical education setting relative to what might be expected of an entry-level physiotherapist. Methods: This multi-centre study piloted the ACP in 10 university physiotherapy (PT) programmes. Both CIs and students undertaking clinical internships completed the ACP and the current tool, the Physical Therapist Clinical Performance Instrument (PT-CPI; Version 1997). Results: CIs assessing PT students' performance during internships representing a variety of areas of practice completed the ACP at the midpoint (n=132) and the endpoint (n=126) of the internship. The end-of-internship sample consisted of 55 junior, 30 intermediate, and 41 senior students. The ACP demonstrated strong internal consistency: Alpha coefficients for each role ranged from 0.94 to 0.99. Aligned items on the ACP and PT-CPI were significantly correlated (r=0.51-0.84). Senior PT students performed significantly better than intermediate students, who, in turn, performed better than junior students (p<0.0001). Effect sizes for midpoint to final scores on the ACP ranged from medium to large (0.40-0.74). Participants were satisfied with the online education module that provided instruction on how to use and interpret the ACP, as indicated by satisfaction scores and qualitative comments. Conclusions: The ACP is a reliable, valid, and practical measure to assess and describe the PT students' behaviours as observed during clinical education relative to what is expected of an entry-level physiotherapist.

Effects of Direct Practice of Newborn Health Assessment on Students’ Nursing Clinical Competence and Self-Efficacy

Purpose: This study was done to examine the effect of direct practice of newborn health assessment on nursing student’s clinical competence and self-efficacy and to propose effective strategies for clinical education on newborn care. Methods: Design was a nonequivalent control group quasi-experimental study. The direct practice program was composed of a lecture, demonstration, drill and feedback using a manikin, and repeated direct practice regarding newborn health assessment. Participants were 65 student nurses taking the pediatric nursing practicum in the nursery room at M hospital. The experimental group (n=33) participated in the direct practice program for newborn health assessment and the control group (n=32) received the traditional practice method. Nursing clinical competence was assessed by two nurse investigators and structured questionnaires were used to measure self-efficacy. Results: The experimental group’s clinical competence was significantly higher than that of the control group (t=-4.82, p=.000). However no significant difference was found between the two groups for self-efficacy (t=1.264, p=.211). Conclusion: These findings indicate that the direct practice program is effective in improving nursing student’s clinical competence, but it was not effective in increasing self-efficacy. Direct practice in various clinical education settings is recommended and longitudinal effects be evaluated.

What do women with breast cancer expect from their treatment? Correlates of negative treatment expectations about endocrine therapy.

Patients' negative treatment expectations can lead to nocebo-related side effects and non-initiation of treatment. This study aims to identify correlates of treatment expectations in patients with breast cancer before the start of endocrine therapy. Expectations were assessed in a cross-sectional sample of 166 patients with breast cancer after receiving treatment information. Side effect expectations (one item) and treatment necessity-concern balance (Beliefs about Medicines Questionnaire) were assessed. Correlates were analyzed using regression analyses. The structure of treatment expectations was investigated using a network analysis. About 25% of patients expressed negative expectations. Higher side effect expectations were associated with lower treatment efficacy expectations (ß = -0.20, p = 0.01), higher medication overuse beliefs (ß = 0.17, p = 0.01), and a negative treatment appraisal before study treatment information (ß = -0.17, p = 0.02). A negative necessity-concern balance was associated with lower treatment efficacy expectations (ß = 0.36, p < 0.001), lower adherence intention (ß = 0.21, p < 0.001), and no knowledge of tumor's receptor status (ß = 0.21, p < 0.001); furthermore, it was associated with higher medication harmfulness beliefs (ß = -0.16, p = 0.02), negative treatment pre-appraisal (ß = 0.15, p = 0.01), higher somatosensory amplification (ß = -0.14, p = 0.02), and higher education (ß = -0.12, p = 0.02). The most important network node was the concern that endocrine therapy disrupts life. Negative treatment expectations before treatment start are mainly associated with psychological variables. These results are relevant for patient education in clinical settings. To improve expectations, clinicians might emphasize treatment efficacy and discuss general and specific medication concerns. Improving treatment knowledge could also be beneficial. Copyright © 2016 John Wiley & Sons, Ltd.

Twelve tips for successfully implementing logbooks in clinical training

Background: Logbooks are widely used to set learning outcomes and to structure and standardize teaching in clinical settings. Experience shows that logbooks are not always optimally employed in clinical training. In this article, we have summarized our own experiences as well as results of studies into twelve tips on how to successfully implement logbooks into clinical settings.Methods: We conducted both a workshop concerning the importance of logbook training to exchange experiences in teaching practice, organization, didactic knowledge and a literature research to compare our own experiences and add additional aspects.Results: Tips include the process of developing the logbook itself, the change-management process, conditions of training and the integration of logbooks into the curriculum.Conclusions: Logbooks can be a valuable tool for training in clinical settings, especially when multiple sites are involved, when you take our tips into consideration.

Writing a Simulation Scenario: A Step-By-Step Guide

Simulation is becoming a widely used method of helping nurses learn and maintain competency in the clinical area for both staff educators in clinical settings and nursing faculty in academic settings. Designing an effective simulation experience requires thoughtful planning, knowledge of educational principles, and knowledge of best practices in both simulation and clinical practice. An evidence-based strategy for writing a simulation scenario for nurses and other health care providers in any setting is described. A step-by-step process is outlined that incorporates best practices. Examples and suggestions are provided to help readers create quality simulation experiences.

Reciprocal Learning Among Preceptors and Athletic Training Students During Clinical Education, Part I: Frequency and Perceived Value

Research has identified that learning in the clinical education setting can be reciprocal between preceptors and athletic training students. However, the frequency of and the potential benefits to reciprocal learning are not fully understood. The purpose of the current study was to explore the frequency and perceived value of reciprocal learning in clinical education from both the athletic training student and preceptor perspective. Reciprocal learning was identified by preceptors and athletic training students as occurring frequently during clinical education. Preceptors and athletic training students valued the opportunity to learn from one another.

The experience of nursing students of clinical teaching: The impact of clinical experience of instructors

Abstract Background and aim : Despite the recognition of the clinical instructor impact on quality of nursing students' learning, recent research indicate many problems in nursing instructors' performance. Many factors contribute to effective clinical teaching and the instructors' clinical experience may affect their teaching quality. The aim of this study was to explore student nurses' experiences regarding their clinical teachers' experiences in nursing practice . Method and materials: A qualitative approach was used for the study. The study protocol was approved by research committee of the school of medical education. A purposive sample of undergraduate nursing students at their internship placements participated in the study. Data were collected by semi structured interviews. Interviews were recorded and transcribed verbatim. A conventional content analysis approach was used for data analysis. Data saturation was reached by 12th interview . Results : After coding and clustering the data 6 themes emerged. These themes were as below: 1- peace of mind 2- getting interested in nursing 3- effective clinical learning (impact of working with an instructor who has clinical experience) and 4-anxiety 5-no interest in nursing 6- ineffective clinical teaching ( working with instructors without any clinical experience). Conclusion: The clinical background and nursing skills of clinical teachers is a major factor for effective teaching in clinicalsettings.

Caring for Depression in Older Home Health Patients.

Depression is common in older home health patients and increases their risk of adverse outcomes. Depression screening is required by Medicare's Outcome and Assessment Information Set. The Depression Care for Patients at Home (CAREPATH) was developed as a feasible strategy for home health nurses to manage depression in their patients. The protocol builds on nurses' existing clinical skills and is designed to fit within routine home visits. Major components include ongoing clinical assessment, care coordination, medication management, education, and goal setting. In a randomized trial, Depression CAREPATH patients had greater improvement in depressive symptoms compared to usual care. The difference between groups was significant at 3 months, growing larger and more clinically meaningful over 1 year. The intervention had no impact on patient length of stay, number of home visits, or duration of visits. Thus, nurses can play a pivotal role in the long-term course and outcomes of patients with depression.

Developing Confidence in Uncertainty: Conflicting Roles of Trainees as They Become Educators in Veterinary and Human Medicine.

The important role of medical trainees (interns and residents) as teachers is increasingly recognized in veterinary and human medicine, but often is not supported through adult learning programs or other preparatory training methods. To develop appropriate teaching programs focused on effective clinical teaching, more understanding is needed about the support required for the trainee's teaching role. Following discussion among faculty members from education and veterinary and pediatric medicine, an experienced external observer and expert in higher education observed 28 incoming and outgoing veterinary and pediatric trainees in multiple clinical teaching settings over 10 weeks. Using an interpretative approach to analyze the data, we identified five dynamics that could serve as the foundation for a new program to support clinical teaching: (1) Novice-Expert, recognizing transitions between roles; (2) Collaboration-Individuality, recognizing the power of peer learning; (3) Confidence-Uncertainty, regarding the confidence to act; (4) Role-Interdisciplinarity, recognizing the ability to maintain a discrete role and yet synthesize knowledge and cope with complexity; and (5) Socialization-Identity, taking on different selves. Trainees in veterinary and human medicine appeared to have similar needs for support in teaching and would benefit from a variety of strategies: faculty should provide written guidelines and practical teaching tips; set clear expectations; establish sustained support strategies, including contact with an impartial educator; identify physical spaces in which to discuss teaching; provide continuous feedback; and facilitate peer observation across medical and veterinary clinical environments.

Nurses' knowledge of foot care in the context of home care: a cross-sectional correlational survey study.

This study aimed to explore nurses' knowledge of foot care and related factors in home care nursing. Nurses caring for older people are increasingly confronted with clients who have multiple foot problems and need support with their foot health. The role of nurses in promoting foot health, caring for existing foot problems and supporting older people in foot self-care is especially important in the home care context. However, this entails up-to-date foot care knowledge and practices. A cross-sectional correlational survey study design. Nurses' knowledge of foot care was evaluated using the Nurses' Foot Care Knowledge Test developed for this study. The data were analysed with descriptive and inferential statistics. Nurses (registered nurses, public health nurses and licensed practical nurses) from public home care (n=322, response rate 50%) participated the study. Nurses' knowledge in foot care varied. The knowledge scores were highest for skin and nail care and lowest for the identification and care of foot structural deformities. Longer working experience in the current work place and participation in continuing education explained higher Nurses' Foot Care Knowledge Test scores. Nurses need more knowledge, and hence continuing education, in the foot care of older people to effectively prevent, recognise and care for foot problems and promote independent living in the community. Nurses' have clinically relevant knowledge gaps. Therefore, foot care knowledge of nurses needs to be improved by continuing education in clinical settings. Adequate foot care knowledge among nurses is important to identify, prevent and care foot problems especially in older people.

Attitudes of medical students in Lahore, Pakistan towards the doctor-patient relationship.

Background. A good doctor–patient relationship is the centre stone of modern medicine. Patients are getting increasingly aware about exercising their autonomy and thus modern medicine cannot deliver all its advances to the patients if a good doctor–patient relationship is not established. We initiated this study with the aim to assess the leaning of medical students, who are the future physicians, towards either a doctor-centered or a patient-centered care, and to explore the effects of personal attributes on care such as gender, academic year, etc.Materials & Methods. A cross-sectional study was conducted between July and Sep 2013. CMH Lahore Medical and Dental College Ethical Review Committee approved the study questionnaire. The study population consisted of 1,181 medical students in years 1–5 from two medical colleges. The English version of Patient Practitioner Orientation Scale (PPOS) was used to assess attitudes of medical students towards doctor–patient relationship. PPOS yields a mean score range of 1–6, where 1 signifies tendency towards a doctor centered relationship and 6 signifies patient-centered relationship. The relationship between PPOS scores and individual characteristics like gender, academic year etc. were examined by multiple regression.Results. A total of 783 students formed the final sample (response rate = 92%). Mean PPOS score of the entire sample was 3.40 (± .49 S.D.). Mean sharing sub-scale score was 3.18 (± 0.62 S.D. Mean caring sub-scale score was 3.63 (± 0.56 S.D.). Characteristics associated with most patient-centered attitudes were advanced academic year, having a clinical rotation, foreign background and studying in a private college. Gender, having doctor parents, relationship and residence status had no bearing on the attitudes (p > 0.05).Conclusion. Despite ongoing debate and the emphasis on a patient-centered curriculum, our study suggests that the current curriculum and its teachings are not producing the results they are designed to achieve. Students should be adequately exposed to the patients from the beginning of their medical education in clinical settings which are more sympathetic to a patient-centered care.

Prediction Of VO2 Peak Relative To Fat-free Mass In Adolescents

VO2Peak is typically expressed relative to total body mass. The unit of expression for VO2Peak (mL/kg/min) is used for assessment in clinical, athletic, and physical education settings. However, expression of VO2Peak relative to fat-free mass (FFM) provides a more accurate assessment of cardiorespiratory function independent of fat mass (FM). PURPOSE: The purpose of this study was to develop prediction models to estimate VO2Peak relative to FFM (mL/kg FFM/min) from both the one-mile run/walk (1MRW) and the Progressive Aerobic Cardiovascular Endurance Run (PACER) in adolescents. METHODS: The sample consisted of 90 adolescents (38 girls, 52 boys; Mean Age = 14.7 ± 1.3 years) recruited from local middle and high schools. Each student completed the 1MRW and PACER, in addition to a maximal treadmill VO2Peak test. FFM was obtained by subtracting FM from total body mass. FM was estimated using percent body fat (%BF) computed using the Slaughter et al. equation via two-site skinfold thickness. Multiple linear and polynomial regressions were used to develop two separate models using 1MRW or PACER to predict VO2Peak (mL/kg FFM/min). Additional predictors examined included Height, Age, Sex, and an Age x Sex interaction term. RESULTS: The developed 1MRW model was VO2Peak (mL/kg FFM/min) = (−14.15 × 1MRW time) + (0.66 × 1MRW time)2 + 125.60 (R = 0.59, R2 = 0.34, SEE = 7.14 mL/kg FFM/min), and the PACER model was VO2Peak (mL/kg FFM/min) = (0.19 × PACER laps) + 45.98 (R = 0.56, R2 = 0.32, SEE = 7.24 mL/kg FFM/min). No other predictor variable entered into the models significantly increased the predictive accuracy. When VO2Peak was expressed relative to total body mass (ml/kg/min) the predictive accuracy increased for both the 1MRW (R = 0.83, R2 = 0.68, SEE = 4.69 mL/kg/min) and PACER (R = 0.79, R2 = 0.64, SEE = 4.98 mL/kg/min) models. CONCLUSION: Both the 1MRW and PACER aerobic capacity prediction models were able to explain approximately one-third of the variance in measured VO2Peak when expressed relative to FFM. Since physical performance is biased toward total body mass and the measurement of FFM using two-site skinfold thickness may have large measurement error, use of the traditional expression of VO2Peak relative to total body mass was more strongly associated with 1MRW and PACER performance than VO2 Peak relative to FFM.

Reflective Observation in the Clinical Education Setting: A Way to Promote Learning

Context Clinical experiences help athletic training students gain real-time learning experiences by engaging in patient care. Observational learning has been identified as important to athletic training student development, yet little is known about its effectiveness. Objective To explore the athletic training students' perspectives on their experiences in the clinical education setting, particularly examining the effectiveness of observational learning. Design Qualitative study. Setting Commission on Accreditation of Athletic Training Education (CAATE)-accredited undergraduate programs. Patients or Other Participants Twenty-four athletic training students (7 juniors and 17 seniors) from 4 National Athletic Trainers' Association (NATA) districts volunteered to participant in our study. The average age was 21 years (range, 20–23 years). Main Outcome Measure(s) Participants responded to a series of open-ended questions by journaling their thoughts and opinions through the secure Web site QuestionPro. Questions examined clinical education experiences and learning preferences. The resulting data were analyzed using a general inductive procedure, and credibility was established by employing peer review, member checks, and multiple analyst triangulation. Results Our analysis revealed that observational learning can benefit students when academic standing is considered, the circumstances are right, and it allows for directed mentoring. Our participants valued opportunities to engage in observational learning, as long as it was limited and purposeful. Conclusions All 24 participants identified themselves as hands-on learners who preferred to be actively engaged during their learning experiences, but who also valued opportunities to observe their preceptors demonstrating and modeling appropriate skills and behaviors before engaging in the same practices themselves. Today's student, the millennial, appears to favor visual learning, which may partially explain why our cohort of athletic training students described observational learning as advantageous in certain situations.

Faculty development for clinical education in the age of international accreditation: A case study of &quot;Teaching in Clinical Settings: A Practicum Course&quot; at McGill University

Faculty development for clinical education in the age of international accreditation: A case study of &quot;Teaching in Clinical Settings: A Practicum Course&quot; at McGill University

The effective use of feedback in health professions teaching

The purpose of this review is to define feedback and provide informed commentary on how feedback should be given to health professions learners during the educational process. The purpose of feedback is to enhance and improve student learning; this is in contrast to grading, which has the purpose of summarizing what a student has learned during a given educational experience. Feedback is highly influenced by other characteristics of the educational setting (e.g., clarity of objectives, context of learning, timing, and specificity). Both students and faculty members have a responsibility to seek and provide feedback within the context of the teaching relationship. Surprisingly few research studies exist concerning how feedback impacts learning outcomes. Surveys have shown that feedback is highly desired by students and yet often felt to be inadequately given. Simultaneously, faculty members often feel that feedback given is of good quality but has not been recognized by students. Factors that impede good feedback in the clinical teaching setting include teacher preparation, student characteristics, the learning environment and time pressures. There is evidence that student expectations concerning the type of feedback they desire change over time, i.e., as the student progresses through the curriculum. It is strongly suggested that the quality of feedback impacts student learning, perhaps more than any other aspect of the teaching process. Best practices associated with giving and receiving feedback have been identified, but faculty development in this regard may be lacking. Recommendations to students and faculty members alike may help alleviate problems with the feedback process and serve to facilitate more effective learning. Keywords: Feedback; Formative feedback; Clinical teaching; Student learning. Revista HUPE, Rio de Janeiro, 2014;13(4):67-72 doi: 10.12957/rhupe.2014.13957

A SURVEY ON COMMUNICATION SKILLS OF UNDERGRADUATE STUDENT OF SHAHID BEHESHTI UNIVERSITY OF MEDICAL SCIENCES، FACULTY OF REHABILITATION IN IN THE ACADEMIC YEAR 2011-2012

Background and Aim: Communication are described as a major feature for people working in primary health care these skill is a key component of the clinical competencies and is helpful for patient adherence. The purpose of this research was to assess communication skills of undergraduate student of shahid Beheshti University of Medical Sciences ،Faculty of Rehabilitation in in the academic year 2011-2012 Materials and Methods: in this cross-sectional study a questionnaire were used that was written base on the method of Calgary - Cambridge and had modified for Persian culture and language. Physiotherapy and occupational therapy professors answered this questionnaire base on their observation and evaluation of their student while communication with their patients. The population of this study was 89 undergraduate students from Shahid Beheshti University of Medical Sciences، Faculty of Rehabilitation in the academic year 2011-2012 that was in 6-8 semesters. 53 students were studying occupational therapy and 36 students were studying physiotherapy. Results: The results show that most of the students were gained average score in the communication skills questionnaire and there was no significant difference between physiotherapy student and occupational therapy students. Conclusion: Considering the obtained results, it can be said that communication skills of rehabilitation students is deficient and considering the importance of such skills, necessity of their education in clinical settings before contacting real clients is revealed. Key words: communication skill training- rehabilitation student