Clinical Teaching is More Than Telling
Purpose
This course is designed for Clinical Instructors (CIs) who wish to advance their clinical teaching strategies. In today’s healthcare delivery systems, CIs are challenged with meeting many responsibilities of patient care management on top of student management. This course will provide “take-home” tools to employ whether the CI is teaching the novice PT/PTA student, the internship DPT student, or the resident who is a novice PT. Learning theories and current evidence will serve as a basis for how to effectively and efficiently engage the learner to achieve the desired objectives.
Methods and/or Description of Project
The topic of clinical teaching will be discussed from three avenues: qualities of the successful clinical instructor, enriching teaching by exploring the biology of learning, and clinical reasoning. A case scenario is threaded through the presentation. Participants will be asked to share their perspectives in small and large group interaction.
In the first portion of the course, Qualities of the Successful Clinical Instructor, participants will reflect on their professional growth as a CI and what it means to be a clinical “teacher”. Reflective practice is discussed based on Schon’s original work. Attributes of the less successful CI are also discussed and a student/CI case scenario is introduced at this point. Participants will hypothesize what issues both the student and CI are having. The presentation then leads into describing the expert CI and strategies to promote the transition from novice to expert CI based on current literature. Active engagement will include CIs developing their personal philosophy of clinical teaching, assessment strategies for various stages of clinical readiness, and reflecting on their own teaching styles.
The second portion, Enriching Your Teaching By Exploring the Biology of Learning, delves into the current literature on the neurobiology and neurophysiology of learning. The case is discussed to determine if there are “connection” problems between the learner’s front and back cortex. The presentation then progresses to teaching how to facilitate those connections. Concepts of errorless learning, emotion and learning, and other learning strategies are explored through the use of the case scenario. Discussion also occurs on the most effective questions to ask the learner to facilitate the connections. Dual process theory (fast brain/slow brain biology) and the frames of reference are discussed as potential differences between student and CI decision-making. Videos are used to demonstrate debriefing or formative feedback sessions and the best methods for providing this feedback are discussed.
The third portion, Clinical Reasoning, presents strategies to progress students’ clinical reasoning skills. Clinical reasoning concepts are explored and current literature is presented that explores critical thinking and clinical reasoning development. The case is brought back to discuss the student’s ability to problem solve and critically think as part of the student’s overall clinical reasoning skills. The phases of clinical reasoning are explored and the case is discussed to determine where the student is in his clinical reasoning development. The fast brain/slow brain biology is revisited from a slow vs fast thinking ability. Clinical reasoning and facilitation of learning are summarized. Student supervision is discussed from the novice student, internship student, and resident perspective.
Results/Outcomes
Participants will reflect on their own experience as learners and teachers. They will practice applying theory and principles from this session to a case scenario. They will recognize barriers and opportunities to incorporate teaching strategies to be effective clinical teachers. They will have a better understanding of where their students are in their clinical reasoning development. And in turn, employ new strategies for teaching and assessment of readiness to progress learning in their students in the clinical setting.
Conclusions/Relevance to the conference theme: The Pursuit of Excellence in Physical Therapy Education
“Clinical Teaching Is More Than Telling” will address two themes relevant to the pursuit of excellence in physical therapy education:
- Fostering Clinical Reasoning: Classroom to Clinic to Residency
- Instructional Strategies for the Classroom and Clinic
Since the intended audience is CIs and CCCEs, the clinical reasoning and instructional strategies are directed to the clinical setting.
References
Agency for Healthcare Research and Quality. TeamSTEPPS®. Team Strategies & Tools to Enhance Performance and Patient Safety. Available at: http://teamstepps.ahrq.gov/. Accessed June 15, 2015.
Brudvig T, Dirkes A, Dutta P, et al. Critical thinking skills in health care professional students: a systematic review. J Phys Ther Educ. 2013;27:12-20.
Christensen N, Nordstrom T. Facilitating the teaching and learning of clinical reasoning. In: Jensen G, Mostrom E, eds. Handbook of Teaching and Learning for Physical Therapists. St. Louis, Missouri: Butterworth-Heinemann; 2013:184-199.
Furze J, Black L, Hoffman J, et al. Exploration of students’ clinical reasoning development in professional physical therapy education. J Phys Ther Educ. 2015;29:22-32.
Furze J, Gale J, Black L, et al. Clinical reasoning: development of a grading rubric for student assessment. J Phys Ther Educ. 2015;29:34-40.
Gilliland, A. Clinical reasoning in first- and third-year physical therapist students. J Phys Ther Educ. 2014;28:64-77.
Huhn K, Black L, Jensen G, et al. Tracking change in critical-thinking skills. J Phys Ther Educ. 2013;27:26-31.
Mostrom E. What makes a good clinical teacher? In: Jensen G, Mostrom E, eds. Handbook of Teaching and Learning for Physical Therapists. 3rd ed. St. Louis, MO: Elsevier; 2013:159-175.
Patton N, Higgs J, Smith M. Using theories of learning in workplaces to enhance physiotherapy clinical education. Physiotherapy Theory and Practice, Early Online:1-11, 2012.
Rudolph J, Simon R, Rivard P, et al. Debriefing with good judgment: Combining rigorous feedback with genuine inquiry. Anesthesiol Clin. 2007;25:361–376.
Schon, D. The Reflective Practitioner. How Professionals Think in Action. USA: Basic Books, Inc; 1983.
Zull JE. The Art of Changing the Brain. Sterling, VA: Stylus; 2002.
Course Objectives
1. Describe skills and qualifications of a successful CI.
2. Define various learning problems that students may experience.
3. Apply principles of best practice for assessing student learning and performance.
4. Describe teaching principles that apply to the clinical setting.
5. Distinguish between various supervisory approaches that are site and student dependent.
6. Apply concepts of teaching clinical reasoning.
Instructional Methods
Lecture, discussion, reflection, application using a case scenario
Tentative Outline/Schedule
Two 90 minute educational sessions are requested to present this material:
60 minutes: Qualities of the successful clinical instructor
60 minutes: Enriching your teaching by exploring the biology of learning
50 minutes: Clinical reasoning
10 minutes: Questions and answers