Basics of Clinical Education

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Introduction

Clinical education is one of the most valuable opportunities for student learning in a programme. Experiential learning provides an opportunity for students to practise knowledge, skills, and attitudes in the workplace where they are ultimately expected to perform.[2]

Clinical education is also valuable for programmatic improvement. Student performance in the clinical setting provides useful feedback to the programme regarding student preparation to serve individuals in the community.

Definitions

Clinical Education

According to the American Physical Therapy Association, clinical education is "a formal supervised experiential learning, focused on development and application of patient/client-centered skills and professional behaviors. It is designed so that students gain substantial, relevant clinical experience and skills, engage in contemporary practice, and demonstrate competence before beginning entry level practice."[1]

Clinical Educator

The clinical instructors can also be called a clinical mentor, educator, or preceptor or clinical faculty. [3]

The rehabilitation professional responsible for the therapy student and for directly instructing, guiding, supervising, and formally assessing the student during the clinical education experience.

Clinical education faculty

The individuals engaged in providing the clinical education components of the curriculum.[1]

General Guidelines for Clinical Education Programme

• One of the most essential features of a successful clinical education programme is the quality of the clinical instructors or clinical faculty. [3]
• Clinical instructors must have a professional license in the relevant profession.[4]

"The clinical education director/coordinator and clinical education site instructors involved in the physical therapist professional entry level education programme should be licensed/registered physical therapists if such a process exists in the country/state or if no licensure/registration exists, then clinical faculty must be a member of the professional organisation."--WCPT (2011)

• Some programmes require at least one year of clinical experience before clinical mentorship occurs. Creating a requirement to participate in a clinical mentorship training programme improves the quality of clinical education programmes. Programmes have been developed to improve mentorship, and these have resulted in improvements in student experiences.[5]

Characteristics of Successful Clinical Instructors

The clinical instructor's supervisory style has been identified as an important element to evaluate.[6]

Characteristics of successful clinical instructors and environments have been described by Recker-Hughes et al. in 2014.[3] The authors describe successful characteristics of instructors to include mentors who have

1. strong interpersonal and communication skills, (2)
2. professional behaviours, (3)
3. instructional and teaching skills, and (4)
4. evaluation and performance skills.[3]

Notably, these characteristics are largely similar to characteristics of successful academic instructors.

interpersonal and communication skills

Interpersonal and communication skills that promote student learning include: [3]

• demonstrating a motivation to mentor students,
• creating a positive learning environment
• effective communication.An example behaviour that suggests a preceptor is interested in mentoring includes simply making

time to discuss, answer questions, and provide feedback to the student.

Creating an individualised communication plan is helpful because it helps align the instructor and student expectations for appropriate opportunities to discuss a clinical case, as well as the timing and approach to providing constructive feedback.

professional behaviours

Skills in the domain of professionalism that promote success in the clinical environment include

modelling principled behaviour, demonstrating evidence-based care, and collaborating with the team.[3]

Modelling patient-centered care, evidence-based practice, and collaboration are essential behaviours

in a mentor. [6]

In the clinical setting, teaching must shift from student-centred to patient-centred care. Both

discussing the shift and modelling the behaviour can help the student shift towards patient-centred

care.

Modelling evidence-based practice includes asking clinical questions, providing interventions that

are based on evidence, and comparing patient outcomes to the literature. Students often struggle

with predicting outcomes and integrating prognostic indicators. Clinical instructors can guide this

process by collecting patient outcomes and helping a student compare patient outcomes to published

outcomes. This comparison can spark conversations on reasons for delayed recovery or faster

recovery. The discussion itself can help students learn how to anticipate prognosis in patients.

Modelling collaborative practice provides an opportunity for a novice practitioner to observe

leadership skills in terms of offering expertise, understanding the perspectives of colleagues, and

coming to a consensus when opposing ideas collide. Simply making time for meetings and

discussions helps students observe behaviours around the value of interprofessional collaboration.

instructional and teaching skills

3. Skills in teaching that promote student learning include (1) modifying the level of expectations based

on student performance, (2) use of multiple types of instructional strategies, and an (3) emphasis on

reflection.[3][6]

Mentors who have a variety of teaching strategies may be able to adjust their instruction based on

the needs of the student.[6]

Instructional strategies that have the best evidence include (1) mastery

learning, (2) goal setting and (3) small group learning.[7]

Mastery learning is a form of deliberate practice of a specific task with an expected level of

proficiency defined.[8]

Important elements of this type of instruction include goal setting,

which can be defined in terms of levels of competence, practice opportunities, and the

timeframe may be individually defined rather than set for all students. This type of strategy

can be modified based on the level of the student’s initial performance, which can vary from

beginning, intermediate or entry level skilled performance. Huang et al.[7]

suggests that skill

based components of practice may be best suited for mastery learning.

Small group learning is another instructional strategy that demonstrated a large effect size on

student performance. Small group learning in this context included flipped classroom design

where students prepared for the learning activities with a reading assignment, then

participated in discussion on clinical cases with their peers and a content expert.[9]

Important

elements of this type of instructional strategy include the active elements by the

student. Rather than direct instruction, students have an opportunity to discuss and justify

their decisions with their peers. Peer discussions are useful because the pace of the discussion

can be slower, allowing students the opportunity to think methodically and slowly. Clinical

experts often think quickly and come to the answer much faster than the novice. Small group

discussions provide an opportunity to discuss clinical decisions at a slower pace.

6/9/23, 9:25 AM Clinical Education Components - Physiopedia

https://www.physio-pedia.com/Clinical_Education_Components 5/12

Other examples of effective teaching in clinical education include (1) providing worked examples,

(2) concept mapping, and (3) meta-cognitive strategies.[7]

evaluation and performance skills

Skills in assessment of student performance include providing feedback that is timely, objective and

specific; and applying the feedback to identify opportunities for success.[3]

Feedback that is provided in a manner that both promotes student learning and evaluates student

performance is essential.

When feedback is given frequently, it provides the opportunity for the student to modify and

improve.

Feedback that is too frequent does not provide the student with the opportunity to reflect on

their own performance and modify before the instructor redirects.

Providing vague comments is less effective than describing both specific behavioural

observations and comparing it to expected behaviours.

Student performance can be evaluated with clinical performance measures or rubrics. This helps

both the student and the instructor anticipate expectations in clinical performance.

Examples of clinical assessment tools in physical therapy include Clinical Performance

Instrument, Canadian Physiotherapy Assessment of Clinical Performance, Assessment of

Physical Therapy Practice.

Occupational therapy programmes often use Fieldwork Performance Evaluation.

Speech language pathology programmes use a variety of tools, two of which are the

COMPASS: Competency Assessment in Speech Pathology Assessment Resource Manual

and the Clinical Performance Evaluation Criteria.

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