Academic programs are challenged to find ways to ensure student readiness for full-time clinical experiences and to equip clinical instructors (CIs) with essential teaching skills. This presentation will share one academic program’s experiences in using a standardized patient examination (SPE), partnered with a CI workshop, to foster student awareness of performance gaps and CI professional development as educators.
Methods and/or Description of Project
Four years ago the Directors of Clinical Education (DCEs) at xxx developed and implemented a strategic plan to provide:
1. CIs with evidence-based feedback and questioning skills.
2. Students with an authentic and immediate CI encounter following a standardized patient examination (SPE).
To achieve both outcomes simultaneously a 4-part workshop was created for CIs that included participation in a SPE.
During the SPE, CIs are partnered with academic faculty (AF) and together they remotely observe student and SP encounters on a monitor. Students take a patient history, perform a systems review, instruct the patient in performance of a mobility intervention, and answer 3 patient questions during a 45 minute encounter. Following the SPE, AF and CIs exchange perceptions of the student performance and identify key points that need to be discussed during the CI-student session that immediately follows. CIs then meet with students and apply feedback and clinical decision making skills s introduced during prior workshop sessions. In addition to the CI’s input, students receive follow-up written feedback from SPs and AF and self-assess their own video-recorded performance during the student encounter.
Two years ago a mentor workshop was developed to support CI professional development across the novice to expert continuum... Mentors view student-SP and student -CI encounters then meet with the CI to share feedback and teaching tips. After reviewing a videotape of the student-CI encounter and other feedback, the CIs convene for a final de-briefing session with the DCEs to share their reflections and thoughts on how to implement skills learned as current and future CIs.
Faculty teams review student performance outcomes from all sources and determine what follow-up activities (e.g. small group labs, short-term ICE, re-take of SPE) are needed to enhance student readiness for upcoming clinical experiences. Students incorporate feedback from the SPE and CI encounter in their goals for clinical experiences and are encouraged to inform their CIs at the outset of the experience of professional strengths and weaknesses.
Since 2012 over 150 CIs from regional clinical affiliate sites have participated in SPEs administered to 264 DPT students prior to participating in full-time clinical experiences. Data from de-briefing sessions, coupled with anonymous reflections from students and CIs, indicate that participation in the SPE is a valuable learning experience for all participants. Students are rarely surprised by challenges that may arise in the clinic and are pro-active in communicating learning needs to CIs. Only two students have failed a clinical experience since implementation of the workshops. Students also have clearer expectations of what CI encounters should “look like” and seek DCE or CCCE support when CI teaching skills in the clinic appear to be lacking. CIs report that the lessons learned in the workshop are carried into practice and student feedback on CIs’ teaching performance following full-time experiences support this assertion. A significant percentage of CIs continue to participate in the SPE and are involved in other simulation and integrated clinical experiences across the curriculum.
Conclusions/Relevance to the conference theme: Shaping the Future of Physical Therapy Education
The inclusion of CIs in the SPE has enhanced student readiness for upcoming clinical experiences and supported CI professional development. The CIs identify gaps in students’ knowledge, skills, and/or behaviors and attitudes not captured by other assessment tools. They apply teaching skills introduced in the workshop to provide a lens on students’ abilities to self-assess, receive feedback, and engage in clinical reasoning. Ultimately, students and CIs carry lessons learned from the authentic encounters during the SPE into future CI-student encounters in the clinic to promote high quality clinical education experiences.
Clinical Education Summit Final Report. http://www.acapt.org/index.php/full-events-list/event/23-clinical-education-summit. Accessed April 12, 2015.
Beckman T, Lee M. Proposal for a collaborative approach to clinical teaching. Mayo Clin. Proc. 2009; 84(4) 329-344.
Julian K, Appelle N, O'Sullivan P, Morrison EH, Wamsley M. The impact of an objective structured teaching evaluation on faculty teaching skills. Teach Learn Med. 2012: 24(1):3–7.
Panzarella KJ, Manyon AT. Using the integrated standardized patient examination to assess clinical competence in physical therapist students. J Phys Ther Educ. 2008; 22(3):24–32.
Paparella-Pitzel S, Edmond S, DeCaro C. The use of standardized patients in physical therapist education programs. J Phys Ther Educ. 2009; 23(2):15–23.
Recker-Hughes C, Dungey J, Miller S, Hansel Walton A, Lazarski J. A novel approach to clinical instructor professional development: a multi-session workshop with application of skills in a student standardized patient exam. JOPTE. 2015; 29(1) 50-59.
Recker-Hughes C, Wetherbee E, Buccieri K, Timmerberg J, Stolfi A. Essential characteristics of quality clinical education experiences: standards to facilitate student learning. JOPTE. 2014; 28 (Supplement 1): 48-55.
Rudolph J, Simon R, Dufresne R, Raemer D. There’s no such thing as “nonjudgmental” debriefing: a theory and method for debriefing with good judgement. Simulation in Healthcare. 2006; 1 (1) 49-56.
Trowbridge RL, Snydman LK, Skolfield J, Hafler J, Bing-You RG. A systematic review of the use and effectiveness of the objective structured teaching encounter. Med Teach. 2011; 33(11):893–903.
Describe the evidence for the use of simulation as a formative assesssment and teaching tool.
Discuss use of evidence-based strategies for the delivery of feedback and questioning to promote deep thinking.
Consider how a standardized patient examination can be used to identify and bridge gaps in student performance before full-time CEs.
Assess benefits of CI participation in a SPE to students and CIs.
Explore ways to modify and implement these activities in your own program.
PowerPoint presentation, videotapes followed by active learning experiences, think-pair-share, questions and answers.
Present evidence for use of simulation as a formative assessment and teaching tool.
Discuss rationale for original development and implementation of SPE at xxxx and pros and cons of use.
Provide overview of the format and content of the CI workshop. Focus on key areas: expectations for student performance (behaviors and skills), sharing feedback and promoting clinical reasoning, participation in a SPE.
Describe role of CI in SPE.
Show video clip of Student-Standardized Patient Encounter.
Audience assesses student performance in role of CI.
Audience role-plays sharing feedback with student using evidence-based guidelines.
Show video clip of CI-student feedback session.
Audience assesses CI teaching skills.
Role-playing of mentor sharing feedback with CI.
Show video clip of mentor-CI meeting.
Discuss follow-up activities for students based on performance in Standardized Patient Encounter.
Share quantitative and qualitative data on student and CI perspectives on simulation activities.
Provide information on student performance on upcoming full-time clinical experiences.
Expected and unanticipated outcomes of CI involvement.
Question and answer period.