Teacher development
Remember how it feels to be a student? Sue Murphy, Clinical Education, Faculty of Medicine, Department of Physical Therapy, University of British Columbia, Vancouver, Canada
Lack of educational experience can lead to clinical educators having difficulty relating to the student experience
SUMMARY Background: Students’ education in their clinical placements is often supervised by practising clinicians. Most health care professional programmes provide workshops and short courses to train clinicians for supervising student learning. Context: Although clinical educators are often expert clinicians with extensive years of clinical experience, they are not necessarily expert educators. The lack of educational experience can lead to clinical educators having difficulty relating to the student experience, and subsequent
difficulty in planning a meaningful and effective learning experience. Innovation: We incorporated Kolb’s model of experiential learning into the curriculum of a workshop that is regularly offered by the local university for training physical therapy educators. Using this model, participants had to feel and think like a student by putting themselves in a student’s role. Over 3 years (2009–2011), 302 participants attended the workshop. Participants were asked to fill out a survey after the workshop to evaluate the incorporation of Kolb’s model into the curriculum.
After the workshop, participants reported a high level of satisfaction with the workshop (9.2/10), as well as a 50 per cent increase in their readiness and comfort in planning and supervising student learning. Implications: Kolb’s model is a highly adaptable model that can be used effectively in the training of clinical educators. The experiential approach of this model enables educators to understand ‘how it feels to be a student’ and carry that understanding forward into planning learning experiences for their own students.
336 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 336–339
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6/27/2014 10:51:40 AM
INTRODUCTION
Clinical educators are not necessarily expert educators
S
upervision of student education in the clinical setting by practising professionals is common practice in many health care professional programmes.1–3 In the many physical therapy (PT) programme, students are placed for periods of 4–6 weeks in clinical settings ranging from acute care hospitals to rehabilitation centres, child development centres, community settings, private clinics and residential care. In order to prepare clinicians to supervise student learning, many programmes offer workshops to familiarise practising professionals with the expectations of both students and educational institutions. In British Columbia, Canada, a 1–day workshop is offered by the university to clinicians who plan to supervise PT students during their placements. This workshop is at no cost to participants, and is offered in locations around the province with a mixed format of lecture and experiential learning.
CONTEXT Clinical educators are frequently expert clinicians who have spent many years honing their skills in a particular field of practice.4,5 These same clinical educators are not necessarily expert educators, and it may be many years since they themselves were a student, or since they have had any contact with students or an academic institution.4–6 This can lead to difficulty in planning a meaningful and effective learning experience for students. Our experience indicates that problems arise around unrealistic expectations of student performance, inappropriate objective setting for the level of student, and lack of insight into the student’s perspective on both performance and clinical scenarios.
INNOVATION In order to bridge the gap in understanding between clinical educators and students, we sought a model that could be incorporated into the workshop curriculum and provide an experiential component, enabling clinicians to more closely relate to the student experience. Kolb’s cycle of experiential learning was selected as our model for its practical and constructivist nature.7 Kolb’s cycle consists of four elements: concrete experience; reflective observation; active experimentation; and abstract conceptualisation. Each stage is an integral part of the experiential learning process; however, the elements are cyclic in nature and learners can enter the process at any point in the cycle. Clinical educators are often encouraged to incorporate these elements into student learning experiences in order to maximise learning in the clinical setting. We propose that these elements can also be incorporated into training workshops for the clinical educators. This allows the educators to experience the impact of these elements for themselves and gain insight into how to translate that experience into planning the learning experience for their own students. Each of the four elements of Kolb’s cycle was incorporated into the workshop. The workshop was
run over 3 years (2009–2011) and was attended by 302 participants. Participants included both novice and experienced clinicians, with between 1 and 20 years of clinical experience. Participants were asked to fill out a survey after the workshop to provide feedback on the workshop effectiveness. Participants’ narrative comments were also collected during and immediately following the workshop. Concrete experience A feeling often cited by students is that of ‘not knowing enough’ and of being judged on this perceived lack of knowledge. To enable participants to experience this feeling, they were placed in pairs with someone from a completely different area of practice about which they knew very little (e.g. an educator from an intensive care unit was paired up with an educator from a child development centre). The only information each participant had about their partner was their area of work: they had no information as to the size or scope of the facility they worked at, their clinical role or their caseload. They were then asked (without discussion with their partner) to write three objectives for themselves as if they were going to start work in their partner’s area, focusing on what they needed to learn in the first week. This exercise mimics what happens when students are asked for their learning objectives before or on arrival at the facility.
© 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 336–339 337
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6/27/2014 10:51:43 AM
Role-play scenarios were designed to develop communication and conflict resolution skills
Particularly in their junior rotations, students often have very limited knowledge about the type of facility, their assigned caseload and the clinical role of the PT in that setting, and hence the objectives developed may be overly general or inappropriate. This exercise proved very evocative for participants, many of whom claimed to feel ‘totally lost’ when forced to develop learning objectives for a situation out of their comfort zone. When asked to share their objectives with their partner and receive feedback, many participants found that their objectives were not feasible, relevant or meaningful in their partner’s context. Reflective observation and active experimentation A triad role-play was designed to incorporate both reflective observation and active experimentation. Participants formed triads, with one person taking the student role, one the educator and one the observer. Roles were rotated so that each participant had an opportunity to play each role. Role-play scenarios were designed to develop communication and conflict-resolution skills: for example, miscommunication and misunderstanding between the educator and student regarding the student’s performance. The educator and the student each had different versions of the scenario to reflect the different viewpoints of the educator and the student. The observer was able to see both scripts, and therefore understand ‘both sides of the story’. As well as observing, the observer provided feedback following the role-play and facilitated discussion amongst the triad. Despite knowing that the ‘educator’ was a fellow participant, the ‘students’ described feelings of intimidation, insecurity, difficulty articulating their point of view and significant discomfort with the interaction. These feelings were particularly marked when their role as a student indicated they had significant performance
issues: one ‘student’ actually became tearful during the interaction. The ‘educators’ also expressed significant discomfort with parts of the interactions, particularly when they had to ‘break bad news’, such as impending student failure, or when they had to address serious professional issues. Although initially reluctant to role-play, survey data indicated that participants found this experience one of the most valuable parts of the workshop, particularly when in the student role. One participant commented that, ‘The most valuable thing I learned today was being in the role of a student’. Likewise, another participant stated that they were ‘Very glad to be reminded how stressful and scary a placement is for the student’. Abstract conceptualisation Educational theories were used at the workshop to facilitate the understanding of the concepts presented above, and to allow the educators to develop practical strategies based on theory rather than ‘gut feeling’. For example, Benner’s model was presented to highlight the evolution of clinical
excellence from novice to expert.8 This model was then used in an exercise where educators had to write sample learning objectives for junior, intermediate and senior students in a specific clinical area.
DISCUSSION Our data show that the incorporation of Kolb’s elements into the workshop was very successful, indicated by a high level of satisfaction reported by the 302 participants who filled out the survey. The workshop had a mean evaluation of 9.2 out of 10 (where 1 was ‘unhelpful’ and 10 was ‘excellent’). The participants’ perception of their readiness and comfort to provide student learning experience improved by an average of 50 per cent after the workshop (from 5.4 to 8.1 out of 10), indicating that the workshop is probably effective in building confidence in clinical educators. Participants mentioned that setting objectives and doing the role-play were the most valuable things learned in the workshop (17.7 and 9.7%, respectively; Table 1). For example, a participant stated that, ‘The most
Table 1. Summary of quantitative findings from the post-workshop survey Year 2009 Year 2010 Year 2011 Overall (n = 107) (n = 112) (n = 83) (n = 302) Workshop evaluation*
9.3%
9.2%
9.1%
9.2%
5.5% Participant’s comfort level with planning student learning before the workshop**
5.4%
5.4%
5.4%
8.1%
8.2%
8.1%
8.1%
Setting objectives was 16% the most valuable thing learned
20%
17%
17.7%
Role-play was the most valuable thing learned
11%
6%
9.7%
Participant’s comfort level with planning student learning after the workshop**
12%
*1, unhelpful; 10, excellent. **1, uncomfortable; 10, comfortable.
338 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 336–339
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6/27/2014 10:51:46 AM
valuable thing I learned was collaborative objective setting. I probably would have been more authoritative’. Another participant mentioned that, ‘I actually found the examples used for roleplaying really useful, even though I usually hate role-playing’. In addition to incorporating each element individually, the cyclic nature of the process was emphasised by sequencing the workshop according to Kolb’s cycle. Concrete experiences were followed by reflection, where ideas and concepts were developed individually, and were then shared with the large group for further ‘testing’ (i.e. discussion, refinement and conclusions). Implementing the conclusions drawn from this process into practice can lead to creating another concrete experience and repeating the cycle again. Implications The results of this study show that clinicians who have taken the workshop have a better understanding of the learning experience of students, and have more confidence and comfort in providing a more relevant and meaningful learning experience.
Kolb’s model is a highly adaptable model that can be easily incorporated into an educator’s training workshop, to provide an experiential component and enable clinicians to better understand the frame of reference of their students. Our results indicate that despite the challenges of taking time away from busy clinical caseloads, encouraging participation in the workshop was not a significant challenge, as 302 participants attended the workshop over a 3–year period. Participants deemed their participation valuable and suggested that, ‘This course should be mandatory’ for clinical educators. Although this workshop was designed for PT educators, it can be easily adapted for other health care professional groups and potentially for an interprofessional audience, as the learning issues are common among these groups.9 The use of Kolb’s model in preparatory workshops for students who are about to embark on clinical education is currently being explored. REFERENCES 1. Rosenwax L, Gribble N, Margaria H. GRACE: an innovative program of
clinical education in allied health. J Allied Health 2010;39:e11–e16. 2. Baltimore JJ. The hospital clinical preceptor: essential preparation for success. J Contin Educ Nurs 2004;35:133–140. 3. Mills JE, Francis KL, Bonner A. Mentoring, clinical supervision and preceptoring: clarifying the conceptual definitions for Australian rural nurses. A review of the literature. Rural Remote Health 2005;5:410. 4. Halcomb EJ, Andrew S, Peters K, Salamonson Y, Jackson D. Casualisation of the teaching workforce: implications for nursing education. Nurse Educ Today 2010;30:528–532.
Clinicians who have taken the workshop have more confidence in providing a more relevant and meaningful learning experience
5. Sedgwick M, Harris S. A critique of the undergraduate nursing preceptorship model. Nurs Res Pract 2012;248356. 6. Rose M, Best D. Transforming Practice Through Clinical Education, Professional Supervision and Mentoring. London, UK: Elsevier; 2005. 7. Kolb DA. Experiential learning. Englewood Cliffs: Prentice Hall; 1984. 8. Benner P. From novice to expert. Am J Nurs 1982;82:402–407. 9. Delany C, Watkin D. A study of critical reflection in health professional education: ‘learning where others are coming from’. Adv Health Sci Educ Theory Pract 2009;14:411–429.
Corresponding author’s contact details: Sue Murphy, Clinical Education, Faculty of Medicine, Department of Physical Therapy, University of British Columbia, 212–2177 Wesbrook Mall, Vancouver, British Colombia, V6T 1Z3, Canada. E-mail: [email protected]
Funding: None. Conflict of interest: None. Ethical approval: The evaluation data provided in the article were collected as part of a regular quality assurance programme designed to ensure participant satisfaction with the workshop. Ethics approval is not required at our local university (University of British Columbia) for the analysis and publication of data collected as part of a routine quality assurance programme. As the data were not collected as part of a study, but as part of a quality assurance initiative, we were advised by our local university’s ethics board that ethical approval was not required. doi: 10.1111/tct.12163
© 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 336–339 339
tct_12163.indd 339
6/27/2014 10:51:46 AM
Remember how it feels to be a student? Sue Murphy, Clinical Education, Faculty of Medicine, Department of Physical Therapy, University of British Columbia, Vancouver, Canada
Lack of educational experience can lead to clinical educators having difficulty relating to the student experience
SUMMARY Background: Students’ education in their clinical placements is often supervised by practising clinicians. Most health care professional programmes provide workshops and short courses to train clinicians for supervising student learning. Context: Although clinical educators are often expert clinicians with extensive years of clinical experience, they are not necessarily expert educators. The lack of educational experience can lead to clinical educators having difficulty relating to the student experience, and subsequent
difficulty in planning a meaningful and effective learning experience. Innovation: We incorporated Kolb’s model of experiential learning into the curriculum of a workshop that is regularly offered by the local university for training physical therapy educators. Using this model, participants had to feel and think like a student by putting themselves in a student’s role. Over 3 years (2009–2011), 302 participants attended the workshop. Participants were asked to fill out a survey after the workshop to evaluate the incorporation of Kolb’s model into the curriculum.
After the workshop, participants reported a high level of satisfaction with the workshop (9.2/10), as well as a 50 per cent increase in their readiness and comfort in planning and supervising student learning. Implications: Kolb’s model is a highly adaptable model that can be used effectively in the training of clinical educators. The experiential approach of this model enables educators to understand ‘how it feels to be a student’ and carry that understanding forward into planning learning experiences for their own students.
336 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 336–339
tct_12163.indd 336
6/27/2014 10:51:40 AM
INTRODUCTION
Clinical educators are not necessarily expert educators
S
upervision of student education in the clinical setting by practising professionals is common practice in many health care professional programmes.1–3 In the many physical therapy (PT) programme, students are placed for periods of 4–6 weeks in clinical settings ranging from acute care hospitals to rehabilitation centres, child development centres, community settings, private clinics and residential care. In order to prepare clinicians to supervise student learning, many programmes offer workshops to familiarise practising professionals with the expectations of both students and educational institutions. In British Columbia, Canada, a 1–day workshop is offered by the university to clinicians who plan to supervise PT students during their placements. This workshop is at no cost to participants, and is offered in locations around the province with a mixed format of lecture and experiential learning.
CONTEXT Clinical educators are frequently expert clinicians who have spent many years honing their skills in a particular field of practice.4,5 These same clinical educators are not necessarily expert educators, and it may be many years since they themselves were a student, or since they have had any contact with students or an academic institution.4–6 This can lead to difficulty in planning a meaningful and effective learning experience for students. Our experience indicates that problems arise around unrealistic expectations of student performance, inappropriate objective setting for the level of student, and lack of insight into the student’s perspective on both performance and clinical scenarios.
INNOVATION In order to bridge the gap in understanding between clinical educators and students, we sought a model that could be incorporated into the workshop curriculum and provide an experiential component, enabling clinicians to more closely relate to the student experience. Kolb’s cycle of experiential learning was selected as our model for its practical and constructivist nature.7 Kolb’s cycle consists of four elements: concrete experience; reflective observation; active experimentation; and abstract conceptualisation. Each stage is an integral part of the experiential learning process; however, the elements are cyclic in nature and learners can enter the process at any point in the cycle. Clinical educators are often encouraged to incorporate these elements into student learning experiences in order to maximise learning in the clinical setting. We propose that these elements can also be incorporated into training workshops for the clinical educators. This allows the educators to experience the impact of these elements for themselves and gain insight into how to translate that experience into planning the learning experience for their own students. Each of the four elements of Kolb’s cycle was incorporated into the workshop. The workshop was
run over 3 years (2009–2011) and was attended by 302 participants. Participants included both novice and experienced clinicians, with between 1 and 20 years of clinical experience. Participants were asked to fill out a survey after the workshop to provide feedback on the workshop effectiveness. Participants’ narrative comments were also collected during and immediately following the workshop. Concrete experience A feeling often cited by students is that of ‘not knowing enough’ and of being judged on this perceived lack of knowledge. To enable participants to experience this feeling, they were placed in pairs with someone from a completely different area of practice about which they knew very little (e.g. an educator from an intensive care unit was paired up with an educator from a child development centre). The only information each participant had about their partner was their area of work: they had no information as to the size or scope of the facility they worked at, their clinical role or their caseload. They were then asked (without discussion with their partner) to write three objectives for themselves as if they were going to start work in their partner’s area, focusing on what they needed to learn in the first week. This exercise mimics what happens when students are asked for their learning objectives before or on arrival at the facility.
© 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 336–339 337
tct_12163.indd 337
6/27/2014 10:51:43 AM
Role-play scenarios were designed to develop communication and conflict resolution skills
Particularly in their junior rotations, students often have very limited knowledge about the type of facility, their assigned caseload and the clinical role of the PT in that setting, and hence the objectives developed may be overly general or inappropriate. This exercise proved very evocative for participants, many of whom claimed to feel ‘totally lost’ when forced to develop learning objectives for a situation out of their comfort zone. When asked to share their objectives with their partner and receive feedback, many participants found that their objectives were not feasible, relevant or meaningful in their partner’s context. Reflective observation and active experimentation A triad role-play was designed to incorporate both reflective observation and active experimentation. Participants formed triads, with one person taking the student role, one the educator and one the observer. Roles were rotated so that each participant had an opportunity to play each role. Role-play scenarios were designed to develop communication and conflict-resolution skills: for example, miscommunication and misunderstanding between the educator and student regarding the student’s performance. The educator and the student each had different versions of the scenario to reflect the different viewpoints of the educator and the student. The observer was able to see both scripts, and therefore understand ‘both sides of the story’. As well as observing, the observer provided feedback following the role-play and facilitated discussion amongst the triad. Despite knowing that the ‘educator’ was a fellow participant, the ‘students’ described feelings of intimidation, insecurity, difficulty articulating their point of view and significant discomfort with the interaction. These feelings were particularly marked when their role as a student indicated they had significant performance
issues: one ‘student’ actually became tearful during the interaction. The ‘educators’ also expressed significant discomfort with parts of the interactions, particularly when they had to ‘break bad news’, such as impending student failure, or when they had to address serious professional issues. Although initially reluctant to role-play, survey data indicated that participants found this experience one of the most valuable parts of the workshop, particularly when in the student role. One participant commented that, ‘The most valuable thing I learned today was being in the role of a student’. Likewise, another participant stated that they were ‘Very glad to be reminded how stressful and scary a placement is for the student’. Abstract conceptualisation Educational theories were used at the workshop to facilitate the understanding of the concepts presented above, and to allow the educators to develop practical strategies based on theory rather than ‘gut feeling’. For example, Benner’s model was presented to highlight the evolution of clinical
excellence from novice to expert.8 This model was then used in an exercise where educators had to write sample learning objectives for junior, intermediate and senior students in a specific clinical area.
DISCUSSION Our data show that the incorporation of Kolb’s elements into the workshop was very successful, indicated by a high level of satisfaction reported by the 302 participants who filled out the survey. The workshop had a mean evaluation of 9.2 out of 10 (where 1 was ‘unhelpful’ and 10 was ‘excellent’). The participants’ perception of their readiness and comfort to provide student learning experience improved by an average of 50 per cent after the workshop (from 5.4 to 8.1 out of 10), indicating that the workshop is probably effective in building confidence in clinical educators. Participants mentioned that setting objectives and doing the role-play were the most valuable things learned in the workshop (17.7 and 9.7%, respectively; Table 1). For example, a participant stated that, ‘The most
Table 1. Summary of quantitative findings from the post-workshop survey Year 2009 Year 2010 Year 2011 Overall (n = 107) (n = 112) (n = 83) (n = 302) Workshop evaluation*
9.3%
9.2%
9.1%
9.2%
5.5% Participant’s comfort level with planning student learning before the workshop**
5.4%
5.4%
5.4%
8.1%
8.2%
8.1%
8.1%
Setting objectives was 16% the most valuable thing learned
20%
17%
17.7%
Role-play was the most valuable thing learned
11%
6%
9.7%
Participant’s comfort level with planning student learning after the workshop**
12%
*1, unhelpful; 10, excellent. **1, uncomfortable; 10, comfortable.
338 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 336–339
tct_12163.indd 338
6/27/2014 10:51:46 AM
valuable thing I learned was collaborative objective setting. I probably would have been more authoritative’. Another participant mentioned that, ‘I actually found the examples used for roleplaying really useful, even though I usually hate role-playing’. In addition to incorporating each element individually, the cyclic nature of the process was emphasised by sequencing the workshop according to Kolb’s cycle. Concrete experiences were followed by reflection, where ideas and concepts were developed individually, and were then shared with the large group for further ‘testing’ (i.e. discussion, refinement and conclusions). Implementing the conclusions drawn from this process into practice can lead to creating another concrete experience and repeating the cycle again. Implications The results of this study show that clinicians who have taken the workshop have a better understanding of the learning experience of students, and have more confidence and comfort in providing a more relevant and meaningful learning experience.
Kolb’s model is a highly adaptable model that can be easily incorporated into an educator’s training workshop, to provide an experiential component and enable clinicians to better understand the frame of reference of their students. Our results indicate that despite the challenges of taking time away from busy clinical caseloads, encouraging participation in the workshop was not a significant challenge, as 302 participants attended the workshop over a 3–year period. Participants deemed their participation valuable and suggested that, ‘This course should be mandatory’ for clinical educators. Although this workshop was designed for PT educators, it can be easily adapted for other health care professional groups and potentially for an interprofessional audience, as the learning issues are common among these groups.9 The use of Kolb’s model in preparatory workshops for students who are about to embark on clinical education is currently being explored. REFERENCES 1. Rosenwax L, Gribble N, Margaria H. GRACE: an innovative program of
clinical education in allied health. J Allied Health 2010;39:e11–e16. 2. Baltimore JJ. The hospital clinical preceptor: essential preparation for success. J Contin Educ Nurs 2004;35:133–140. 3. Mills JE, Francis KL, Bonner A. Mentoring, clinical supervision and preceptoring: clarifying the conceptual definitions for Australian rural nurses. A review of the literature. Rural Remote Health 2005;5:410. 4. Halcomb EJ, Andrew S, Peters K, Salamonson Y, Jackson D. Casualisation of the teaching workforce: implications for nursing education. Nurse Educ Today 2010;30:528–532.
Clinicians who have taken the workshop have more confidence in providing a more relevant and meaningful learning experience
5. Sedgwick M, Harris S. A critique of the undergraduate nursing preceptorship model. Nurs Res Pract 2012;248356. 6. Rose M, Best D. Transforming Practice Through Clinical Education, Professional Supervision and Mentoring. London, UK: Elsevier; 2005. 7. Kolb DA. Experiential learning. Englewood Cliffs: Prentice Hall; 1984. 8. Benner P. From novice to expert. Am J Nurs 1982;82:402–407. 9. Delany C, Watkin D. A study of critical reflection in health professional education: ‘learning where others are coming from’. Adv Health Sci Educ Theory Pract 2009;14:411–429.
Corresponding author’s contact details: Sue Murphy, Clinical Education, Faculty of Medicine, Department of Physical Therapy, University of British Columbia, 212–2177 Wesbrook Mall, Vancouver, British Colombia, V6T 1Z3, Canada. E-mail: [email protected]
Funding: None. Conflict of interest: None. Ethical approval: The evaluation data provided in the article were collected as part of a regular quality assurance programme designed to ensure participant satisfaction with the workshop. Ethics approval is not required at our local university (University of British Columbia) for the analysis and publication of data collected as part of a routine quality assurance programme. As the data were not collected as part of a study, but as part of a quality assurance initiative, we were advised by our local university’s ethics board that ethical approval was not required. doi: 10.1111/tct.12163
© 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 336–339 339
tct_12163.indd 339
6/27/2014 10:51:46 AM
