Manage Clinical Practice

1
Manage Clinical Practice
2
Introduction

• What challenges do you face when students are
  working in the clinical area to practice their
  skills?
• Is the facility appropriate?
• Do the staff welcome your students?

3
Objectives

• Select and prepare clinical instructors and staff
• Coordinate clinical practice
• Conduct clinical practice sessions
• Monitor students progress

4
Clinical Practice Team

• Students
• Teacher
• Clinical instructor
• Staff members working in the clinic

5
Selecting Clinical Instructors

• Time available and a desire to work with students
• Proficient healthcare delivery skills that are
  consistent with what is being taught
• Excellent interpersonal communication skills
• Organizational skills
• Teaching skills

6
Strengthening Clinical Instructors

• Clinical knowledge and skills are up-to-date and
  consistent with what is being taught
• Teaching skills, such as demonstrating with
  models, coaching, providing feedback, and
  performing assessments, that they will need in
  working with students

7
Preparing Clinical Instructors and Staff 1

• Meet to communicate objectives and requirements
  for the clinical rotation and discuss any
  questions
• Inform the clinical instructors of the students
  abilities and learning needs

8
Preparing Clinical Instructors and Staff 2

• Inform the clinical instructors and staff about
  to give feedback on student performance (provide
  them with the checklists, forms, feedback
  reports)
• Clinical practice carried out in communities and
  homes requires making sure students and any staff
  are fully aware of expectations

9
Coordinate Teaching 1

• Work closely with all members of the team
• Meet with clinical instructors in advance to
  discuss student placement, preparation of the
  staff and communications with students
• Share copies of the syllabus with the clinical
  instructors and staff

10
Coordinate Teaching 2

• Give the clinical instructors or staff copies of
  the student performance report
• Discuss plans for student assessment including
  sharing copies of the checklists and a summary of
  the skills they will be responsible for observing

11
Student Responsibilities 1

• Review any assigned readings or checklists
• Attend and actively participate in all clinical
  practice visits
• Take an active role in learning and communicate
  questions and concerns to the clinical instructor
  or teacher
• Obtain comprehensive and targeted health
  histories
• Conduct physical examinations

12
Student Responsibilities 2

• Present findings clearly and concisely
• Observe demonstrations of skills and perform
  skills
• Select and interpret screening and diagnostic
  laboratory tests in collaboration with the
  clinical instructor
• Co-manage patients with complex health problems

13
Student Responsibilities 3

• Educate and counsel patients and families
• Coordinate and communicate patient management
  with the clinical instructor
• Document findings and experiences in an
  organized, thorough manner
• Evaluate clinical practice experience

14
Responsibilities of Teachers, Clinical
Instructors and Staff 1

• Maintain up-to-date healthcare delivery skills
• Review teaching materials or tools
• Review learning objectives for clinical practice
• Ensure that the necessary logistics have been
  arranged
• Orient clinical staff and any others involved in
  teaching to the learning objectives and the
  expected tasks

15
Responsibilities of Teachers, Clinical
Instructors and Staff 2

• Communicate with other teachers or clinical
  instructors
• Orient students to each new clinical site, with
  the assistance of a staff member
• Ensure that students and clinical instructors or
  staff members have the tools (checklists,
  logbooks)
• Review learning objectives with the students and
  clinical staff

16
Responsibilities of Teachers, Clinical
Instructors and Staff 3

• Select appropriate patients based on the learning
  objectives for the session or rotation
• Demonstrate skills for students
• Observe students as they practice, and provide
  frequent feedback on performance
• Assist students, clinical staff, and other
  teaching assistants with any difficulties

17
Responsibilities of Teachers, Clinical
Instructors and Staff 4

• Sign and review the logbook
• Plan with the students for additional experiences
• Assess and report on students performance
• Monitor students progress throughout the
  clinical practice experience, and report results
  to other teachers or clinical instructors
  responsible for the session or rotation

18
Use Objectives to Plan

• Review the learning objectives to assist in
  planning appropriate clinical practice
  activities
• Determine which objectives can be met in the
  outpatient department and which in the inpatient
  ward.
• External clinics, communities, and home visits
  are other sites used in clinical practice
  activities.

19
The Outpatient Department 1

• First point of contact for most patients, so most
  appropriate place to practice interviewing and
  interpersonal and counseling skills as well as
  clinical skills
• Best place to develop an initial care plan and to
  teach patients how to implement the plan at home

20
The Outpatient Department 2

• The outpatient department also is an excellent
  interim step between simulated practice and
  working with very sick patients in the inpatient
  ward.
• The manual lists some objectives that can be met
  in the outpatient setting. Can you think of
  others?

21
The Inpatient Ward

• In inpatient settings, patients are usually
  seriously ill, and have already started a care
  plan and specific treatments.
• Inpatient wards are a good place to teach patient
  management, practice healthcare delivery skills,
  and demonstrate management of rarely seen
  conditions.

22
Examples of Inpatient Ward Skills 1

• Assess clinical status
• Perform specific clinical interventions such as
  administering an intravenous solution
• Document information on the patients plan of
  care, treatment, and changes in condition

23
Examples of Inpatient Ward Skills 2

• Communicate clearly with clinical staff and
  family (as appropriate) the findings about a
  patient
• Review diagnostic test results and apply them to
  the patients condition

24
Examples of External Clinics and Home Visit Skills

• Assessment of environmental hazards
• Group and individual education skills
• Communication skills
• History-taking skills
• Infant and postpartum visit assessment skills

25
Structure Clinical Practice Sessions 1

• Move from basic to more complex skills.
• Move students from observation to direct work
  with patients.
• Structure activities to allow for the most
  interaction with patients.

26
Structure Clinical Practice Sessions 2

• Plan a rotation system so that students do not
  overwhelm one area.
• Prepare activities that students can do when
  there are no appropriate patients at the clinical
  practice site.

27
Outpatient Teaching Approaches

• Apprentice
• Team member
• Supervisor
• Lets take a look at each of these approaches

28
Apprentice

• Students function as healthcare providers while
  the clinical instructor or assigned staff member
  closely observes and intervenes when appropriate.
• Slows patient flow but does provide excellent
  practice opportunities.

29
Team Member

• Students function as a member of the team and see
  patients individually or in pairs in a separate
  room and then report their findings and
  recommended plan of care.
• This gives students a more independent experience
  but takes more of the patients time.

30
Supervisor

• Students are assigned to several different rooms,
  and a clinical instructor or other designated
  staff member moves back and forth among the rooms
  providing feedback and supervision.
• This method allows students a great deal of
  independence, but does not allow for much direct
  supervision.

31
Inpatient Teaching Approaches

• Patient-centered teaching
• Ward rounds
• Lets take a look at these approaches

32
Patient-Centered Teaching

• Student is assigned one or more patients to
  follow.
• Student works under supervision of staff and is
  responsible for the patients care.
• Student will present the patient during rounds,
  assist in the care plan, and communicate with
  staff about the patients condition.

33
Ward Rounds

• Ward rounds may be used for either observation or
  interaction.
• Care must be taken during ward rounds to protect
  the patients privacy and to avoid talking as if
  the patient were an object.
• It is better to discuss the patient in a private
  location away from the bedside.

34
Ward Rounds - Observation

• The students join rounds as an observer.
• The healthcare provider managing the patients
  care will report the patients presenting
  complaint, initial findings and treatment,
  laboratory and other diagnostic results and
  interpretation, current condition, and future
  plans.

35
Ward Rounds - Interaction

• During ward rounds, the students are asked
  questions about the patients condition and are
  expected to respond.
• Several of the students may have been asked to
  prepare to present the patient to the group.

36
Positive Feedback

• Positive feedback is often easy to give and can
  be provided in the presence of the patient.
• Keep the feedback simple and relaxed too much
  feedback may alarm the patient.
• At the same time, the absence of feedback of any
  kind can be disturbing to the student.

37
Constructive Feedback

• Constructive feedback is difficult to give, but
  particularly when a patient is present.
• It is important to keep such feedback low-key and
  restrained.
• Avoid embarrassing the student and try and save
  constructive feedback until the students are
  gathered away from the patients.

38
Constructive Feedback Techniques 1

• Often a look or hand gesture (e.g., a touch on
  the shoulder) can be as effective as words and
  less of a concern to the patient.
• In a quiet, direct manner, you can make simple
  suggestions to facilitate the procedure, for
  example, You might find it easier to insert the
  speculum if you use gentle downward pressure.

39
Constructive Feedback Techniques 2

• To help a student avoid making a mistake during a
  procedure, ask a question about the procedure
  itself.
• Sometimes, even though they have had extensive
  practice on models, students make mistakes that
  can potentially harm the patient, so you must be
  prepared to step in and take over the procedure.

40
Cover Before the Clinical Practice Session 1

• The learning objectives for that day or the
  clinical session
• Any necessary scheduling changes
• Students tasks for that day or session,
  including the work assignments and rotation
  schedule if applicable
• Assignments to be completed that day or that
  session

41
Cover Before the Clinical Practice Session 2

• The topic for the post-session meeting, so the
  students can prepare cases or look for
  experiences to share
• Questions related to the session or from previous
  sessions
• Discussion about how feedback will be provided in
  the clinical setting

42
During the Clinical Practice Session 1

• Check in periodically with clinical instructors
  and staff
• Coordinate any planned learning activities
• Observe student-patient interaction
• Continue to facilitate skill development
  (demonstrate, provide feedback)

43
During the Clinical Practice Session 2

• Ask if students have been assessed on any of the
  skills in their logbook
• Assess student skills or ask staff to do this
• Create a positive learning environment by having
  a friendly and helpful manner

44
Protect Patients Rights

• Inform the patient of the role of each person
  involved and make sure that a licensed provider
  is always present
• Obtain the patients permission before having
  students observe, assist with, or perform any
  procedures
• Respect the right to bodily privacy
• Strictly observe the confidentiality

45
After the Clinical Practice Session 1

• Review the learning objectives and assess
  students progress toward meeting them
• Present cases seen that day, particularly those
  that were interesting, unusual, or difficult
• Provide an opportunity for students to ask
  questions

46
After the Clinical Practice Session 2

• Ask students questions about cases or their care
  plans
• Tell students about the logistics of future
  clinical practice sessions

47
Monitor Students Progress

• Logbooks (also called a casebook) as seen in
  Samples 9-1 and 9-2
• Student performance reports
• Field notebooks (often used during community or
  home visits)

48
Summary

• Lets review the information contained in the job
  aid on Page 9-19.
• What questions do you have about managing
  clinical practice?
• How will you plan and manage clinical practice
  for your students?