Transcript Workshop 1 - Clinical education through a leadership lens

Leadership and Clinical Education (LaCE)
Workshop 1
‘Clinical education through a leadership lens’
Robyn Nash and Pauline Calleja, QUT
Leading clinical learning
Session Objectives
Provide a forum which explores:

Connections between leadership and clinical
education

A clinical education leadership framework

Opportunities for personal/professional development
as a leader of clinical learning
Leading clinical learning
What is leadership?

Buzz session 1
What is your concept of ‘leadership’?
Leading clinical learning
What is leadership?
…. any behaviour that influence the actions and
attitudes of others to achieve certain results
Australian Leadership Development Centre, 2007
Leading clinical learning
Characteristics of effective leadership?









Inspire aspiration
Strive for excellence, know own strengths
Set direction
Communicate on both information and interpersonal levels
Bring out the best in people, help them develop capabilities and skills
Guide people to the right destination in a smooth and efficient way
Persist in the face of unexpected setbacks
Be the change, role model by example
Reward success .............
(Burns 1978; Bass 1985; Bennis & Nanus 1985; Kouzes & Posner 2003)
Leading clinical learning
What is clinical education?

Buzz session 2
What is your concept of ‘clinical
education’?
Leading clinical learning
What is clinical education?

... commonly described as the component of health practitioner
education that allows students to put theoretical knowledge into
practice within the patient/client care environment (Clare et al. 2003)
‘… the translation of theory into clinical knowledge and
professional skills ....’ McAllister et al. (1997, p.3)
‘… the co-creation of new knowledge through critical reflection and dialogue
between learner and facilitator ‘ Harvey et al. (2002, p. 578)
.. a process of contextual and experiential learning which involves clinical
educators and students working in partnership to achieve professional
development outcomes ...
Leading clinical learning
Experiential learning
“.. learning is the process whereby knowledge is created
through the transformation of experience. Knowledge
results from the combination of grasping experience and
transforming it“
(Kolb 1984, p. 41)
Leading clinical learning
Experiential learning
Feeling
Watching
Doing
Thinking
Kolb’s Cycle of Experiential Learning (1984)
Leading clinical learning
Kolb’s ‘principles’:





learning is a process which combines experience, reflection, thinking
and doing
different people prefer different style/s of learning, and learn more
effectively if they can utilize their preferred learning style
learning results from constructive interactions between the person and
his/her environment
learning is a holistic process of adaptation. It is not just the result of thinking,
but involves the integration of thinking, feeling, perceiving and behaving
time is needed for learners to process their experiences in order to derive
new meanings that can be applied to future situations.
Leading clinical learning
Learning styles

Active learners


Reflective learners


need time to plan, prepare and have time to reflect on their learning before being
confronted with a new challenge.
Theoretical learners


like to be constantly challenged, can think on their feet and enjoy the challenge of
being thrown in the deep end, learning best 'on the job' through practical exposure,
trial and error and direct experience.
stimulated by abstract ideas and concepts. They like to consider viewpoints and
theories and to analyse situations before selecting options and approaches to a task.
They learn through observation, discussion, analysis, and enjoy logical and
sophisticated reasoning.
Pragmatic learners

enjoy learning from qualified demonstration, and need to see the practical advantage
of all that they are doing. They need to know that what they are doing works and is
realistic
Honey & Mumford (2000)
Leading clinical learning
Four stages of professional development: a
‘competency’ model
Unconscious
incompetence
Conscious
incompetence
Conscious
competence
Unconscious
competence
Learner
Low level of
competence; unaware
of failings.
Low level of
competence; aware
of failings but
having full skills to
correct them.
Demonstrates
competence but
skills not fully
internalized or
integrated.
Carries out tasks
without conscious
thought; skills
internalized and
routine.
Clinical
supervisor
Helps learners to
recognize
weaknesses, identify
areas for development
and become aware of
learning needs
Uses range of skills
and techniques to
assess learners’
development in
relation to defined
expectations
Helps learner to
develop and refine
skills, reinforces
good practices
Raise awareness
of detail and
unpack processes
for more advanced
learning
McKimm & Swanwick (2009)
Teaching
styles
Teacher directed
Assertive
Suggestive
Learner directed
Collaborative
Facilitative
All styles are important. The key = choosing the style that is appropriate to the situation (UMDNJ 2006)
Leading clinical learning
Leadership and clinical education: A good fit
Clinical education .. a process of contextual and experiential learning
which involves clinical educators and students working in partnership
to achieve professional development outcomes ...
• Inspiring shared vision
Clinical
education
• Knowing the stakeholders
• Inspiring quality learning
• Working with people
• Knowing the stakeholders
• Interacting supportively
• Developing competence
• Sustaining commitment
• Enabling desired outcomes
• Sustaining commitment
Ramsden 1998; Kouzes & Posner
1997-2007; Bennis & Nanus 1987
Leadership
Lee et al. 2002; Tang et al. 2005;
Lambert 2007; Robinson 2009
• Establishing direction
• Enhancing commitment
• Executing the role
• Enacting to achieve
LaCE
framework
Leadership ...’any behaviour that influence the actions and
attitudes of others to achieve certain results’ (ALDC 2007)
Leading clinical learning
Leadership and Clinical Education Framework – E4
Dimensions of practice
Enhancing
commitment
Executing
the role
Enacting self
development
Attributes
Sharing vision and
values
Communicating
effectively
Clinical teaching &
learning
Knowing self
Setting clear goals
Interacting in a range
of contexts
Assessing students’
performance
Obtaining feedback
on performance
Promoting a culture
of learning
Empowering others to
achieve
Managing day-to-day
business
Engaging in personal
and/or professional
development
Professional learning
Enhanced student outcomes
ACTION LEARNING
REFLECTION ON PRACTICE
Establishing
direction
Personal development
Achievement of personal /
professional goals
Leading clinical learning
Clinical teachers: what do students value?

Nursing students’ perceptions of
effective Vs ineffective clinical
teachers




Teaching ability

eg. encourages thinking and
learning
Personality characteristics

eg. enthusiastic approach
Professional competence

eg. good professional knowledge
Interpersonal relationships

eg. good relationships with nursing
team

Medical residents 3 most
important characteristics
3

Nonjudgemental
48%
2

Clinical competency
47%

Enthusiasm
32%
4
1
Buchel & Edwards (2005)
Tang et al. (2005)
Leading clinical learning
Clinical instruction: what do students value?





Open, collegial relationship
Adapting the experience to the student
Facilitating clinical reasoning
Making time for the student
Supportive environment
Kelly (2007)
Leading clinical learning
Importance of clinical supervision

Clinical experience is a core element of health professional
education, but...

Experience in the real world does not automatically translate to positive student
learning experiences, or mean that the development of professional knowledge
and skills will occur effectively

Factors that are key to the promotion of optimal learning in the clinical
environment include:

supportive practice environments

effective supervisory relationships

a positive learning culture

collegial relationships between students and staff

The importance of clinical supervisors in playing a central role within this context
cannot be underestimated
Leading clinical learning
Some closing thoughts…
Leaders are responsible for getting results through others.
Leaders should be judged not by what they do, but rather by what those
around them are doing and achieving.
In this light it is very clear that leadership is people work, with a focus on
achieving results.
Australian Leadership Development Centre
Leading clinical learning
References
Allied Health Professions Australia (2006). Clinical Education Discussion Paper, October. Available at: www.ahpa.com.au
Buchel, T. & Edwards, F. (2005). Characteristics of effective clinical teachers. Family Medicine, 37(1), 30-35.
Clare, J. et al (2003). Evaluating clinical learning environments: Creating education-practice partnerships and
benchmarks for nursing. AUTC final report. Adelaide: Flinders University.
Clark, D. (1997). In Zilembo, M. & L. Monterosso. (2008)., Nursing students’ perceptions of desirable leadership qualities in nurse
preceptors: a descriptive study, Contemporary Nurse, 27(2), 194-207.
Gibson, E. et al (2002). Towards the Development of a Work Integrated Learning Unit. Division of Environmental
and Life Sciences and Centre for Professional Development, Macquarie University, Australia. Available at:
www.cfl.mq.edu.au/celebrate/refereed.htm
Harvey, G., Loftus-Hills A., Rycroft-Malone J., et al. (2002). Getting evidence into practice: the role and function of facilitation.
Journal of Advanced Nursing, 37, 577–588.
Kelly, C. (2007). Students’ perceptions of effective clinical teaching revisited. Nurse Education Today, 27, 885-892.
Kouzes, J. & Posner, B. (2003). The five practices of exemplary leadership. In Kouzes, J. Business Leadership. San Francisco:
Jossey-Bass.
Lambert, V. & Glacken, M. (2006). Clinical education facilitators’ and post-registration paediatric student nurses’ perceptions of the
role of the clinical education facilitator, Nurse Education Today, 26(5), 358-366.
Lee, C., Cholowski, K. & Williams, A. (2002). Nursing students’ and clinical educators’ perceptions of characteristics of effective
clinical educators in an Australian university school of nursing, Journal of Advanced Nursing, 39(5), 412-420.
McAllister, L., Lincoln, M., McLeod, S. & Maloney, D. (1997). Facilitating learning in clinical settings. Cheltenham, UK : Stanley
Thornes.
McKimm, J. & Swanwick, T. (2009). Assessing learner needs. British Journal of Hospital Medicine, 70(6), 348-351.
Pratt, D., Arseneau, R., & Collins, J. (2001). Reconsidering “good teaching” across the continuum of medical education, The
Journal of Continuing Education in the Health Professions, 21, 70–81.
Robinson, C. (2009). Teaching and clinical education competency: Bringing two worlds together, International Journal of Nursing
Education Scholarship, 6(1), 1-14.
Tang, F., Chou, S., Chiang, H. (2007). Students’ perceptions of effective and ineffective clinical instructors, Journal of Nursing
Education, 44(4), 187-192.
Leading clinical learning