Achieving Excellence in Clinical Teaching

1
Achieving Excellence in Clinical Teaching

• Wayne State University
• College of Nursing

2
Acknowledgements

• We gratefully thank and acknowledge the
  University of Illinois-Chicago for sharing this
  presentation with us.
• Special thanks to Dr. Carrie Klima for her
  creativity, wisdom and sense of humor.

3
Clinical Teaching Strategies
4
What is this?
5
(No Transcript)
6
Answers???

• A. The rings of Saturn
• B. A new plan to reduce traffic congestion
• C. A model for precepting students
• D. A new approach to teach cervical dilitation

7
A model of clinical precepting!
the circle of safety
8
Faculty Boundary of Safety
9
Remember some basic principles

• Caring for patients is a shared experience
• Roles and responsibilities change over time
• Students should learn within environments that
  are conducive to learning
• Students learning styles vary and need to be
  respected

10
Students are

• Nervous
• Anxious
• Eager to please
• In need of positive feedback
• Always challenging

11
Preceptors are

• Busy
• Eager to teach
• In need of positive feedback

12
The Circle of Safety

• Strives for consistency
• Eliminates the need for students to try and
  memorize faculty preferences
• Considers the faculty and student boundaries
• Allows flexibility
• Requires rationales for actions and management
  plans

13
Some examples

• PROM
• Cervical ripening
• Analgesia/anesthesia
• Birth
• Speculum insertion
• contraception

14
(No Transcript)
15
What Is Evidence-Based Practice?
16
What is evidence based practice ?

• The conscientious, explicit, and current best
  evidence in making decisions about the care of
  individual patients.
• David Sackett MD, author of Evidence based
  Medicine How to practice and teach EBM. (1997)

17
History of evidence based practice

• Dr Archie Cochrane (1972 article)
• Perinatologists at Oxford University in England
  published Effective Care in Pregnancy and
  Childbirth (1989) a two-volume work.
• Cochrane Collaboration, with multiple centers in
  the US and Europe.

18
Types of Evidence

• Professional guidelines
• ACOG - practice and technical bulletins
• AWHONN guidelines
• Clinical practice protocols
• U.S. Guide to Clinical Preventive Services

19
Level I Evidence

• The Gold Standard
• At least one properly controlled randomized
  clinical trial.
• A study where people who are alike in all
  relevant ways are randomly assigned to treatment
  or control groups

20
Level II Evidence

• II-1 Controlled trials without randomization
• II- 2 Well-designed cohort and case control
  studies
• II-3 Cross-sectional studies, studies with
  external control groups, or ecological studies

21
Level III Evidence

• Evidence derived from report of an expert
  committee, which itself used a scientific approach

22
Evidence-Based Health Care
Patient preferences
Evidence based care
Expertise, skills, judgment
Best available evidence
23
(No Transcript)
24
The Art of Practice in an Evidence-Based World

• What is The Art of Practice?
• Are The Art of Practice and Evidence- Based
  Practice mutually exclusive?

25
The Art of Practice in an Evidence-Based World

• Skills of artful practice
• Acute perceptive abilities
• Deep listening to speech and the body
• Control of self to match timing, touch, and
  communication with the moment
• Ability to change roles (authoritative with
  health team to manage environment facilitative
  with the women being served
• (Milree Keeling, JMWH, 2002, Backpage)

26
The Art of Practice in an Evidence-Based World

• Precepting Students
• Being a Model
• Being a Learner

27
Successful Interactions
28
Goal Setting

• Institutional goals
• Compatibility institution/student/preceptor fit
• Issues time, room, patient load
• Workable solutions
• Preceptor goals
• Personal
• Professional

29
More Goals

• Adult learner goals
• Multiple learning sources
• Experience
• Example
• Discussion
• Student goals
• Assessing learner style
• Mutually agreeable goals

30
Sabinas Top 10 teaching strategies

• 1 Orientation
• 2 Clear expectations
• 3 Role modeling behavior
• 4 Attitude
• 5 Learning and teaching
• principles

31

• 6 Development of critical thinking
• 7 Time management skills
• 8 Feedback
• 9 Evaluation
• 10 Action plan

32
Orientation

• Good orientation most important
• Basics
• Personal
• Safety
• Facility
• Personnel
• Services
• Community
• Patients
• Resources

33
Expectations

• Clear expectations and parameters
• Realistic expectations
• Appropriate student preparation
• Preceptor preparation
• Safety boundaries and parameters

34
Role modeling

• Role modeling behaviors
• Professional characteristics
• Respectful
• Intentional actions
• Deliberate explanations of actions

35
Attitude

• Non-threatening
• Relaxed
• Sense of humor
• Flexibility
• Self assessment

36
Learning

• Fundamental knowledge
• Application by thinking, acting
• Integration connecting, building learning
• Human dimensions
• Motivation
• Caring
• Learning how to learn

37
Teaching Strategies

• Demonstration of skills,techniques, behaviors
• Adequate time to observe skills in action
• Involvement of clients
• Opportunities

38
Critical Thinking

• Complex process
• Thinking
• Reasoning skills
• Decision making
• Emphasis on asking questions
• Process questions
• Problem solving approaches

39
Feedback and Evaluation

• Observation
• Small segments
• Linking feedback
• Specificity to actual behavior
• Sandwich technique
• Positive/critical/positive
• Non judgmental

40
Action Plan

• Self assessment reflection
• Linking specific feedback
• Setting goals for next experience

41
Stressors

• Time
• Stressful students
• Stressful patients
• Coping strategies
• Resources

42
Assessing Clinical Performance
43
Storytelling.
44
The Faculty

• Wish to thank all of you for your expertise,
  devotion, time and effort in educating the
  midwives and nurse practitioners of the future.