Rozprawy doktorskie na temat „Clinical teaching”

The purpose of this exploratory case study was to describe the culture of clinical teaching through a symbolic interactionist framework, by identifying the rituals, faculty behaviors, and student behaviors and characteristics valued by faculty instructing in clinical settings, using content analysis, interviews and observation. Five faculty, one from each clinical specialty, were chosen using specific criteria. College of Nursing archives were content analyzed to ascertain written valued student behaviors and characteristics and faculty were interviewed to learn their stated beliefs. Faculty/student clinical interactions were observed to assess if faculty written and verbalized beliefs were enacted, and twelve students were interviewed for verification of transmission of the values. Peer debriefing, member checking and an audit trail ensured trustworthiness of the data. Faculty used eight rituals: Preparation, Tracking, Discourse, Closet, Repast, Selection, Maneuver, and Documentation, and three types of actions: Teaching, Role Modeling, and Caretaking to transmit their values. Teaching was utilized 55 percent of the time and involved questioning, instructing, guiding, correcting and observing. Role Modeling, used 22 percent, embodied promoting independence, helping, intervening, kidding and admitting fallibility. Caretaking was evidenced 23 percent of the instructor's time and included caring, praising, diffusing anger, allowing mistakes and sharing self. Over one hundred student behaviors and characteristics that faculty valued were identified and collapsed into six descriptors, listed in descending order: assertive, therapeutic, compliant, knowledgeable, disciplined, and skillful. Faculty placed emphasis on human, interactive skills versus knowledge and psychomotor skills, and responded to students with very caring behaviors. They utilized compassion as a way of effecting conformity, and their use of caring behaviors for the exercise of their power was evident.

An urgent need exists for balance between students learning the theory of clinical practice and becoming an expert. While theory is taught in the didactic setting, it is the experiential setting where the mastery of the clinical teacher is demonstrated. What does the master clinical teacher do that makes the studentâ s learning experience so significant? One must recognize the moment, capture the learning opportunity, and draw the student in so that learning can occur. Effective clinical teaching is paramount in creating empowered students and practitioners. This qualitative case study of a doctoral pharmacy program identified two master clinical preceptors and shadowed one in a hospital and the other in a retail pharmacy. Interactions between clinical preceptors and students were captured through direct observation, audio-tape, and complemented with in-depth interviews. Content analysis identified emerging themes yielding an emerging model of master clinical teaching, illuminating teachable moments between student and clinical preceptor, and the manner in which they interacted with each other and the clinical environment. The model highlights an approach for making the critical time on clinical rotations as effective as possible and offers a practical means to study interactions between students and preceptors, discerning those that lead to teachable moments. Features of the teachable moments are identified. Although expertise cannot be taught, current and future clinical teachers can use this study to improve their teaching and effectiveness in clinical teaching practice. The methodology of this study can be applied to future studies in the same discipline, other rotations, or other disciplines. This study augmented the literature in qualitative research in pharmacy education for clinical practice by 1) utilizing a methodology that could be used in future studies 2) identifying features of teachable moments in the interactions of clinical preceptors and students 3) exploring how the clinical preceptors dealt with the changing environment of their clinical teaching 4) offering an emerging model to guide clinical preceptors for making the critical clinical teaching time as effective as possible. Future studies could utilize this emerging model to gain further insight on clinical teaching practices thus increasing the expertise of clinical teaching.
Ph. D.

Thesis (Ph.D.)--Indiana University, 2009.
Title from screen (viewed on August 28, 2009). School of Nursing, Indiana University-Purdue University Indianapolis (IUPUI). Advisor(s): Pamela Jeffries, Daniel Pesut, Judith Halstead, Tamilyn Bakas. Includes vita. Includes bibliographical references (leaves 169-179).

This study examined the perceived importance of the 22 characteristic of effective clinical instructors as identified by- Katz in 1982. The effect of various demographic variables on these perceived values of importance was also investigated. Data were collected by means of a questionnaire survey instrument. A random sample of 354 nurse anesthesia program directors, CRNA clinical instructors and nurse anesthesia students from across the United States participated in this study. A 73 percent return rate was achieved. Characteristic mean scores of importance demonstrate that respondents perceived all 22 characteristics as either "very important" or "highly important." When all 22 characteristic mean scores for each group were arranged in descending order by the researcher, no significant difference was found between groups. Chi-square tests were significant between the professional groups and the perceived values of importance for four of the characteristics: Evaluation / Counseling, Positive Role Model, Flexibility, and Timely Feedback. No significant relationships were found among the demographic variables and the perceived importance of the 22 characteristics. Multiple regression analysis indicated that the demographic variables accounted for only an extremely small percent of the variance. In conclusion, since many of the mean scores were relatively close to each other, it seems reasonable to conclude that all four professional groups highly valued these characteristics and perceived them as critically important to clinical instruction. There was no significant difference in the way each professional group rank ordered the 22 characteristics. No previously reviewed study exhibited this same level of homogeneity among respondents. The researcher suggests that this homogeneity may be the result of previous clinical nursing experience and/or the nature of the anesthesia clinical environment itself. Findings in this study have implications for the continuing education and evaluation of nurse anesthesia faculty along with possible impacts on employment decisions.

Doctor of Philosophy (PhD)
Abstract Clinical teachers’ experiences of nursing and teaching Clinical nurse teachers’ experiences of nursing and teaching undergraduate nursing students on clinical placement are explored in this thesis because of concerns about the quality of nursing students’ learning outcomes. The aim was to identify variation in clinical teachers’ conceptions of nursing and their conceptions of, and approaches to teaching undergraduate nursing students. The study was significant because clinical teachers’ conceptions of nursing and approaches to clinical teaching have not been researched previously. Underpinning the study was a phenomenographic perspective on learning and teaching. This perspective views learning and teaching in terms of how they were experienced. Experience of nursing and clinical teaching, for example, can be understood in terms of related ‘what’ and ‘how’ aspects. The ‘what’ aspect concerns how nursing and clinical teaching were understood. The ‘how’ aspect is concerned the ways nursing and clinical teaching were approached. Experience of nursing and clinical teaching were described and analysed in terms of the separate ‘what’ and ‘how’ aspects and are understood in terms of the relationship between each of the aspects. Data from semi-structured interviews with twenty clinical teachers were analysed using phenomenographic research techniques (Marton & Booth, 1997) in order to identify variation in how nursing and clinical teaching were experienced. To extend the description, the research also sought to identify the empirical relationships between each of the aspects investigated. Key aspects of variation in clinical teacher experiences of nursing and clinical teaching and associated relationships have been identified. The results suggest that clinical teachers who adopted a student-centred approach to teaching conceived of nursing and clinical teaching in complex ways. The phenomenographic approach provides for an experiential and holistic account of clinical teaching: a perspective absent in nursing education research literature. The research findings extend knowledge that will assist with preparation and support of clinical teachers.

Thesis (Ph. D.)--University of Sydney, 2007.
Title from title screen (viewed 22 November 2007). Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the Faculty of Education and Social Work. Degree awarded 2007 ; thesis submitted 2006. Includes bibliographical references. Also issued in print.

Effective and efficient clinical teaching is essential with dwindling training hours and growing numbers of trainees and students, however, standards are variable across the UK and USA. Formative evaluation of clinical teaching performance can lead to standardisation and improvement. Current evaluation tools were assessed and found wanting in their development of appropriate formative criteria to evaluate. I employed a grounded theory exploration of ward round teaching to identify factors associated with effective or ineffective learning outcomes to inform the development of a new formative evaluation tool. The thesis was in two phases.

The Medical School of the University of Liverpool is at a critical phase in its development. Through the 1990’s and 2000’s it improved from being at the bottom of the league tables, with graduates who were imperfectly prepared for their pre-registration house officer posts, to being at the top of the league tables with the best prepared graduates. In more recent years it has performed badly in the National Student Survey, and has, consequently fallen down towards the bottom of the league tables. The graduates are still well prepared, but the sense of cohesion and common endeavor within the medical school has been lost. This is manifest in several ways, but the trigger for this study was a difficulty in recruiting senior clinicians to teach our medical students. A series of semi-structured interviews was held with a purposive and convenience sample of fourteen senior clinicians. Nine of the participants were members of full time University staff with honorary National Health Service (NHS) contracts, and five were full time NHS clinicians with honorary University contracts. The gender balance was equivalent to that of the senior clinicians in our region (60M:40F). The approach taken in this study is a critical realist approach, whereby it is recognized that individual participants experience and interpret reality in their own particular ways. The factors that individuals consider to facilitate or frustrate their involvement in teaching undergraduate medical students are, at best, a proxy measure for the actual constraints and enablers. The themes extracted from the interviews were studied using a constructivist grounded theory method. The major enablers for being involved with teaching undergraduate medical students were the students themselves, and a desire to give them the best possible experience. The major constraints were a lack of clarity about expectations, a lack of recognition for those involved in teaching, and the difficulty of balancing competing imperatives. The two new elements uncovered in this study are the influence of colleagues (for good or ill) and the relative unimportance of “time” itself. A series of recommendations are made which involve leadership, communication, recognition, and, crucially, ensuring the agency of those who wish to be involved in educating undergraduate medical students. Awareness of these issues should strengthen the medical school in its resolve to improve the student experience, and rebuild our community of practice.

Thesis (Ph.D.)--Indiana University, 2009.
Title from screen (viewed on August 28, 2009). School of Nursing, Indiana University-Purdue University Indianapolis (IUPUI). Advisor(s): Pamela Ironside, Anna McDaniel. Includes vita. Includes bibliographical references (leaves 177-197).

College of Education faculty members at the University of Central Missouri found that public school teachers and administrators from surrounding schools were reluctant to hand over classrooms of students to novice teachers for student teaching. With high stakes accountability for test scores, teachers voiced their need to be present in the classroom, particularly during spring semester of statewide testing (Diana, 2014). The university adopted a co-teaching model of student teaching to prepare its teaching candidates for the first year of teaching while allowing the cooperating teacher to stay in the classroom throughout the student teaching term. The problem-of-practice addressed in this study focuses on the need to determine if a co-teaching student teacher model provides university students an adequate amount of clinical experience and preparation to support a successful first year of teaching.

The purpose of this study is two-fold: (1) analyze the perceptions of former and current student teachers, cooperating teachers, and university supervisors on the coteaching model of student teaching and (2) assess the model’s effectiveness in preparing student teachers for their first year of teaching. To this end, the research questions are as follows:

Research Question 1. What are the perceptions of University of Central Missouri current and former student teachers on the co-teaching student-teaching model’s ability to prepare student teachers for their first year of teaching?

Research Question 2. What are the perceptions of University of Central Missouri university supervisors on the co-teaching student-teaching model’s ability to prepare student teachers for their first year of teaching?

Research Question 3. What are the perceptions of cooperating teachers on the co-teaching student- teaching model’s ability to prepare student teachers for their first year of teaching?

The research questions were answered through an analysis of the data collected via a quantitative survey followed by a qualitative interview. The quantitative survey asked respondents to rate items on a Likert-type scale (Fink, 2013) as to how well they perceived the co-teaching model of student teaching prepares student teachers to meet Missouri Teaching Standards. The qualitative survey asked respondents to discuss their perceptions of how well the co-teaching model of student teaching prepares student teachers for their first year of teaching based on their personal experience.

The responses indicated that the co-teaching model scored higher in first year teacher preparation by elementary teachers and elementary supervisors than by secondary teachers and supervisors. Responses also indicated that student teachers and cooperating teachers perceived the co-teaching model as more positively preparing student teachers for their first year of teaching than do university supervisors. Additionally, responses indicated that the co-teaching model of student teaching closely aligns to the Gradual Release of Responsibility theory of learning (Pearson & Gallagher, 1983) with the co-teaching model of student teaching strengths as follows: extensive modeling by a More Knowledgeable Other (Vygotsky, 1978), extensive professional reflection and immediate feedback, a narrowing of focus, professional collaboration, and building of confidence in the student teacher. Due to the student teacher never solely taking over the classroom responsibilities in a co-teaching model of student teaching, the model’s barrier for preparing student teachers for their first year of teaching centers on the student teacher not receiving a fully realistic teaching experience in a classroom without a co-teacher.

On this basis, it is recommended that universities and school districts adopt the co-teaching model of student teaching to provide a strong base of teaching background for the student teacher through the Gradual Release of Responsibility. The student teacher should also receive two to three weeks of sole classroom responsibility and all the duties in that role as to provide a realistic experience of teaching without a co-teacher present. Further research could synthesize the perceptions of the same group of participants in this study regarding a model similar to the one recommended.

The need to prepare and support clinical teaching faculty is identified as a priority by nurse educators. However, there is no framework for understanding the practice of clinical teaching (Benner, Tanner & Chelsa, 1996; Davis, Dearman, Schwab & Kitchens, 1992; Scanlan, 2001; Siler & Kleiner, 2001; Vollman, 1989). There is little nursing research directed to understanding the practice of clinical teaching. It is widely assumed that nurses who are experts in practice are able to make an easy transition to the role of clinical teacher (Scanlan, 2001; Silar & Kleiner, 2001).
The clinical practicum is the time when students are in the clinical setting as novice nurses under the supervision of both experienced nurses and clinical teachers. The clinical setting may be hospital or community-based and students may be working directly with patients and their families or may be a member of a community-based project team. The purpose of this study was, by asking clinical teachers to describe their practice, to determine whether clinical teaching was a boundary practice bridging nursing and teaching's communities of practice (CoP). The goal of the boundary practice is to sustain a connection between the two communities of practice by dealing with conflicts, seeking common ground and resolving problems. The following research questions were asked: (1) To what extent do clinical teachers describe the characteristics of a boundary practice? (2) What are the participative connections that clinical teachers use in their professional activities? and (3) What boundary objects are transferred from one community of practice to another?
Using a qualitative research design, nine clinical teachers from diverse practice settings and with a range of years in the profession participated in a focus group interview. The focus group interview was followed by individual interviews with four clinical teachers. The conceptual framework that guided this study combined Wenger's (1998, 2002) community of practice model, and Shulman's (1987) teacher knowledge model. Additional theoretical constructs included reflective practitioner, cognitive apprenticeship and situated cognition (Brown, Collins & Duguid, 1989; Lave & Wenger, 1991; Schon, 1987).
The results suggest that clinical teaching is a boundary practice and that clinical teachers create participative connections between nursing and teaching practices through the building of relationships with fellow nurses, students and classroom teachers using strategies that involve reconciling different practice perspectives with the objective of creating supportive clinical learning environments. Clinical teachers described negotiation strategies to move students from the periphery of nursing into the community of nursing practice and using boundary objects to negotiate meaning from practice.
The results suggest that the practice of clinical teaching includes understanding how to balance relationships and reconcile competing demands. The findings also suggest that connection to the classroom teacher and understanding of the course of study are important to the practice of clinical teaching. Two key outcomes of this study are the development of a model of clinical teaching and a working vocabulary to describe the practice of clinical teaching.

The field of psychology has made large strides in evaluating and disseminating evidence-based treatments (EBTs), as well as refuting harmful pseudoscientific treatments, for various childhood mental health disorders. EBTs that meet the gold standard of a well-established treatment provide supportive evidence of treatment effectiveness. However, there are notable limitations to these criteria, particularly in regards to manualization and feasibility. A solution is to use a common elements approach to service delivery, such that the fundamental skills or practices within treatment programs can be used to effectively target treatment goals. As this approach is evolving in the field, it is imperative that future clinicians and researchers are versed in understanding evidence-based common elements (EBCEs) and unsupported elements. The current study examines the impact of teaching undergraduate students EBCEs and uncommon elements across three randomly assigned conditions. Results indicated that students who learned about EBCEs rated EBCEs more effectively post manipulation and students who learned about uncommon elements rated uncommon elements less effectively post manipulation. The results are consistent with previous findings and underscore the importance of educating students on effective and ineffective treatments (Jones-Soto, 2015, unpublished; Hupp et al., 2013). Implications and future directions are discussed.

This study examined clinical teachers' use of questioning and the variations in their use of questioning as a teaching strategy. By using questioning and other appropriate teaching strategies, clinical teachers can facilitate the development of critical thinking, decision making, and problem solving in students. Effective use of questioning strategies involves asking low level and high level questions to facilitate recall of classroom knowledge and promote application of the knowledge to solve patient problems in varying clinical situations. Using a comparative descriptive design, this study used a convenience sample of 26 clinical teachers from one University School of Nursing to examine questioning during post-clinical conferences, which were audio taped. Questions asked by the clinical teachers at two post-clinical conference were identified and transcribed by the researcher. Using Craig and Page's (1981) framework, these questions were categorised by the researcher and an independent rater. Inter rater reliability for 850 of the questions asked was established at 85.6%. The remaining 143 questions were categorised following deliberation between the researcher and the independent rater. Data analysis was carried out using non parametric tests, which included Wilcoxon Matched-Pairs Signed ranks test, Mann Whitney U test, Kruskal Wallis test, and Spearman's rho. The findings of the study indicate that, although there was variation in the number of questions asked, this group of clinical teachers asked more low level questions. There was a significant difference in the number of low level questions asked between the two post clinical conferences, but no significant difference in the number of high level questions asked. There was no significant difference between the number of low level and high level questions asked at post-clinical conferences held in three different semesters. There was also no significant relationship between clinical teachers' academic qualifications and the types and levels of questions asked (p> .05). There were variations in the relationship between the professional experience of clinical teachers and the levels of questions asked. Based on the findings of the study, it is recommended that clinical teachers are taught how to ask questions, particularly high level questions.

By 2018, STEM occupations are projected to grow twice as fast as all other occupations combined (Olson & Riordan, 2012; Craig Thomas, Hou, & Mathur, 2012). The need to educate and produce more STEM graduates is eminent, and research shows that the pipeline to prepare students for STEM fields begins in elementary school. Research also shows that many elementary teachers lack the pedagogical content knowledge (PCK) and confidence to teach STEM subjects (Dorph, Shields, Tiffany-Morales, Hartry, & McCaffrey, 2011). Meanwhile, opportunities for elementary teachers to develop their STEM PCK and confidence in teacher preparation programs or professional development are limited.

To address this problem, programs like Raising the Bar for STEM Education in California are emerging. A yearlong case study utilizing both qualitative and quantitative methods was employed to examine the program’s effectiveness in preparing future elementary teachers to effectively teach STEM subjects through a STEM-rich, clinical, co-teaching model of student teaching. Data collection methods included qualitative interviews, observations through videotaped lessons, documents, and quantitative pre- and post-surveys. The key findings from this study include that the STEM-rich, clinical, co-teaching model of student teaching was successful in increasing pre-service teachers’ confidence and expanding their pedagogical knowledge of teaching inquiry-based lessons. Pre-service teachers were willing and excited to teach STEM subjects in their future elementary classrooms at the conclusion of the program. However, the growth in content knowledge and confidence was uneven among the four STEM content areas and there was a lack of integration. \

Based on the findings of this study, it is recommended that future STEM professional development programs emphasize the vital importance of STEM fields as the rationale for teaching STEM subjects; build pedagogical content knowledge; integrate STEM subjects through a focus on engineering; explicitly link STEM to Common Core State Standards and Next Generation Science Standards; design the STEM professional development around the characteristics of Adult Learning Theory; and foster reflective, collaborative communities of practice. Further recommendations for policy and research are presented and discussed.

Magister Curationis - MCur
Background: Clinical supervision or clinical accompaniment is considered an integral part of nursing education and is crucial for the development of nursing students’ clinical competence. In order to achieve this, clinical supervision requires skilled human resources which vary from one educational institution to another and may include lecturers, clinical supervisors/facilitators and professional nurses. Clinical supervisors are required to be good educators as well as excellent clinicians. In addition, they often draw on their individual, personal and professional experiences to guide their teaching to meet the demands of both the clinical and academic contexts in which they work. However, the clinical teaching model or framework used by educational institutions is often not aligned to clinical practice activities and vice versa. This poses challenges for students due to the different expectations of educators and professional nurses in practice. Inadequately prepared clinical supervisors can have a detrimental effect on the delivery of the nursing programme that may include poor clinical teaching and inadequate integration of theory and clinical competencies, which ultimately leads to poorly trained nursing students. Aim of the study: The aim of this study was to explore the perceptions of clinical supervisors regarding their preparedness for clinical teaching. Methods: The study adopted a qualitative research approach, utilising an exploratory descriptive design. A non-probability purposive sampling method was used to select 12 clinical supervisors in the undergraduate programme. The researcher collected the data by means of semi-structured interviews with open-ended questions and analysed this data using content data analysis. Analysis of the data using ATLAS, ti 8 research software programme generated four themes and 18 categories. Findings: The findings indicated that clinical supervisors required time to adapt to their role and improve their knowledge and skills despite them having a positive experience during their orientation. Although appreciative of the support and guidance, clinical supervisors stated that not all colleagues were supportive, which in some instances had a negative impact on interpersonal relationships. The findings furthermore indicated that clinical supervisors apply all the steps of the five phases in the skills lab methodology employed by the School of Nursing at the university where the study was conducted. Clinical supervisors are required to be well informed and committed to continuing education in order to incorporate theory into practice with the latest developments and equipment in facilities. Furthermore, the findings indicated that inconsistency and failure to attend to students’ clinical learning needs can have a negative impact on student learning. Ethics: The researcher adhered to all principles of research ethics throughout the study.

What strategies are effective for clinical nurse instructors to use in developing critical thinking in student nurses? Many clinical strategies have been discussed in, literature, but only a few have been verified through research as to their usefulness.This study used the qualitative research methodology of multiple case studies. Participants were six clinical nurse instructors. Nursing experience ranged from 17-27 years, teaching experience involved 2-24 years. Four instructors had doctorates, one nurse had a masters degree, and the sixth nurse lacked two courses before completing a masters degree. The six instructors were from five areas of nursing: medical/surgical (beginning and intermediate level), maternity, mental health, community health and management.Each instructor was interviewed three times during the same semester, approximately two weeks apart. Interviews were audio recorded and transcribed. Spradley's (1979) domain and taxonomic analyses were used to analyze the data.Data analysis showed that some strategies were used by all instructors, with adaptations made for the specialty. The strategies used by all instructors were questioning, nursing care plans and clinical conferences. More than one instructor used student journals, teaching projects, research articles, milieu assessments, and case studies/scenarios.This research strongly supported the use of questioning to help the student progress in critical thinking. Contrary to some research, the present research found that questioning by the instructors was not detached but was situated in the client setting which helped the student synthesize facts into a whole. The research identified many questions used by the clinical nurse instructors.Instructors identified their role in assisting students toward critical thinking as helper, facilitator, coach and guide. Instructors also identified the following characteristics as necessary to help students: caring attitude, creativity, perseverance, knowledgeable, listener, encourager and learning attitude. The instructors motivated students as they progressed in critical thinking through verbal and nonverbal rewards. Students gained self-confidence as they experienced success in their journey towards critical thinking. Implications for nursing practice are provided. The importance of this research lies in the rich depth of discovering how these strategies, roles, characteristics, and motivators assist nursing students in developing critical thinking skills in different clinical settings.2
Department of Educational Leadership

This thesis explores the relationship between physicians’ clinical and educational roles in the context of UK General Practice (GP) education by investigating the experiences of seven GP trainers through an ethnographic approach employing Activity Theory (AT). The Introduction considers the philosophy and structures of GP education and outlines the author’s professional biography to provide context. The Literature Review focusses on the development of medical education as a discrete field and identity formation in medical educators, concluding that: specialist medical educators are a relatively new group; and there is a paucity of knowledge regarding the impact on physicians of occupying dual clinical and educational roles. The thesis then focusses on three Research Questions (RQs), namely: 1. What is the impact of GP trainers’ clinical practice upon their educational work? 2. How does GP trainers’ educational practice influence their clinical work? 3. What are the social contexts for GP trainers’ clinical and educational practice? These questions are addressed within a pragmatic theoretical framework to build up an ethnographic description of the participants’ experiences. Data collection is through semi-structured interviews and observation of video-recorded teaching. Ethical issues associated with the study are discussed in detail, in particular the challenges of “insider” research. Four approaches are used for data analysis: global impressions; word cloud analysis; thematic analysis; and analysis shaped by AT. In answer to RQs 1 and 2, the study finds that GP trainers experience their dual roles as intimately linked, intuitively transferring their skills between their clinical and educational practice. The study also finds that GP trainers reconstruct their professional identities through teaching. With regard to RQ 3, engaging in teaching can lead to internal conflict for GP trainers and tensions with their colleagues, trainees and regulators. These findings are discussed in relation to medical education research methodology and the impact the study on the researcher is explored. The thesis closes by considering the conflicted position the participants occupy, concluding that teaching offers physicians the opportunity to reconstruct their professional identities so they can approach tensions in their practice with a sense of agency and optimism.

Adjunct faculty members make up a growing proportion of nursing school clinical faculty in the United States due to a nurse educator shortage in higher education. Many of the nurses hired as clinical faculty members have years of experience providing patient care, but they lack experience in clinical instruction and assessment. At a state community college in the southeastern United States, nursing students have expressed dissatisfaction in their course evaluations with inexperienced faculty in clinical programs. The experiences of both nursing students under the guidance of novice clinical instructors and clinical faculty were examined in this case study. The National League for Nursing's (NLN) standards for practice for academic nurse educators served as the conceptual framework for this study and was used to develop research questions related to clinical practice and assessment. Data were collected from 9 students and 6 clinical nursing faculty members who participated in anonymous, open-ended electronic questionnaires regarding use of the standards in instruction and assessment. Student clinical experience collective evaluations from 3nursing programs across the state were also used for data collection and analysis. Data were coded and themes were identified and verified through triangulation. Themes were inconsistent with the NLN standards and included no formal orientation, no preparation for the clinical instructor role, use of subjective instructor evaluations, and lack of instructor feedback. Results were used to develop a professional development program to prepare novice clinical instructors for the clinical environment according to the NLN standards. This study may result in positive social change by improving clinical experiences for nursing students in community colleges, resulting in better patient care as they assume their roles in the larger medical community.

The purpose of the study was to examine students' perceptions of frequency of clinical teacher behaviors and whether those perceptions change by class level. The theoretical framework for the study was Bevis' paradigm of curriculum revolution.In 1993, Marilyn Simons, DNS gathered data from nursing students enrolled in clinical nursing courses at a Midwestern university. The convenience sample totaled 88 (100%). The data was not analyzed or reported. The current study was a retrospective analysis of that data.Findings of the study showed that students perceived faculty as demonstrating professional competence and interpersonal relationship behaviors in the clinical setting. No significant differences were found in these perceptions by class level on either then total scale or on the subscales.The conclusion from the study was that faculty at this particular university are perceived as practicing emancipatory education as proposed by Bevis. It was also concluded that faculty perform at the same level of competency and use similar approaches without regard to class level, and that students perceived that faculty related to them in similar ways across classes.The study was significant because it helps nurse educators understand the student perspective of clinical teacher behavior. The Clinical Teacher Behavior Tool used in the study could be used to help design a cooperative clinical learning model different from the traditional education approach and in accordance with Bevis' paradigm.
School of Nursing

Since the inception of the student supernumerary status, both globally and in South Africa, nursing and midwifery educators have been concerned about the clinical competencies of their students. Student clinical competency levels in South Africa are critical to midwifery practice, especially as most litigation against the Department of Health in South Africa concerns negligence in midwifery practice. In addition, the litigations mostly involve newly qualified midwives, thus suggesting a link with practice competency levels. Several challenges exist in the academic and practice environments regarding student learning, practice and clinical preparedness. Lack of support during clinical placement and a lack of facilities for use during clinical practice modules are among these challenges. Some students, due to the challenges they face with clinical learning and practice, fail to meet the practical competencies for examination entry requirements. Consequently, some of these students have to repeat the year or exit the programme. The current study sought to identify how to assist midwifery educators in their activities to prepare students for clinical placement readiness. The first objective of the study was to explore and describe the perceptions of midwifery educators regarding the need for additional measures to enhance the clinical preparedness of basic midwifery students before they are allocated to the clinical areas. The second objective sought to make recommendations that would further assist the midwifery educators to clinically prepare midwifery students before being allocated and placed in different clinical areas. A qualitative, explorative, descriptive and contextual research design was used for the study and the study was conducted at a nursing college in the Eastern Cape Province from August 2014 to January 2016. The research population consisted of midwifery educators at a nursing college and a purposive sampling technique was used guided by set criteria. Data were collected using focus group interviews. Four focus groups were used making a total of 17 participants. The principles applied for data analysis were those of Tesch’s method of data analysis, which were used to develop the themes and sub-themes. An independent coder assisted with the coding of the data for the purposes of trustworthiness. In addition, Lincoln and Guba’s model of trustworthiness consisting of the criteria of credibility, transferability, dependability and conformability was used to confirm the validity of the study while the ethical principles adopted were informed consent, justice, non-maleficence, privacy and confidentiality. The study found that the participants perceived numerous challenges that hindered the clinical preparedness of their students. These related to increased workload, lack of support from management and a lack of commitment on the part of students towards their studies. The participants also identified inconsistencies in clinical practice between the clinical midwives and the educators, and even among the educators themselves. This lack of consistency in turn causes confusion among the students and thus impacts negatively on their clinical practice preparedness. Based on these findings recommendations for clinical nursing practice, nursing education and research were made.

Background Chiropractic programs are expected to provide teaching clinics in order for their graduates to attain the required competencies, so they can practice safely and effectively. Regulators place an expectation that the patients that students encounter in these clinics should be of sufficient variety to prepare them for private practice. So, it is important the chiropractic programs monitor the patient case-mix so they show that they are meeting this requirement. To this end this study sought to review the Murdoch University Chiropractic Clinic (MUCC) patient database and report on the demographic and clinical characteristics. Method Ethic was obtained from Murdoch University (#). In September of 2017 one in five students de-identified complete new patients records who attended MUCC from the preceding 12 months were extracted. The data included was age, gender, employment status, education level, region, duration, severity and disability of complaint along with co-morbidities were recorded onto a spreadsheet. Data was then discussed in relation to previous studies of chiropractic patient case-mix in Australian and international private practice and teaching clinics. Results The most common type of patient seen at MUCC was of younger age, low levels of employment, pain severity and disability and chronicity suggesting this fits the profile of a typical university student. The other commonly occurring profile was suggestive of an age group that could be described as family i.e. somewhat older with mild levels of persistent pain and disability. Under-represented subpopulations included the very young, the elderly and those with acute, severe and / high levels of disability. Conclusion While the case-mix profile of this MUCC sample was broadly similar to that of private practice, some differences were noted that may have implications for the adequate preparation of students for private practice. The results are comparable to teaching clinics internationally which suggests the differences identified in this study are somewhat characteristic of teaching clinic populations in general. It remains unknown if the teaching clinic case-mix is appropriate and adequate to prepare graduates for the under-represented subpopulation groups. A series of recommendations were made in order to address the findings of this study.

Limited research exists on what the general population knows about ASD. Previous research that does exist shows that there is variability in what people believe as symptoms, causes, and treatments of ASD. The purpose of this study was to examine the effect that ASD training has on university students’ general knowledge about ASD. One hundred two college-aged students were randomly assigned to one of three conditions: Myths and Facts condition, Myths condition, or Control condition. Pretest and posttest data were collected to examine the likeliness of participants correctly identifying general knowledge of ASD. A mixed-model ANOVA and independent samples t-tests showed that from pretest to posttest, an ASD Myths and Facts Presentation as well as an ASD Myths Presentation significantly increased the likelihood of participants correctly identifying knowledge about ASD. Qualitative data was also examined regarding the percentage of participants answering in agreement to each question from pretest to posttest.

The experience of the clinical nursing instructor (CNI) in teaching nursing students deemed at risk of failure has not been well explored in nursing literature. It may be difficult for the CNI to support as well as evaluate a student when that student’s performance is judged to be unsatisfactory or unsuccessful. The purpose of this study was to explore CNIs’ experiences in teaching undergraduate nursing students deemed at risk of failure, to discover how CNIs identify potentially unsuccessful students and to describe what supports and resources CNIs utilize to help them manage such students. A pilot study using a qualitative phenomenological approach was used to interview CNIs who had at least one experience teaching an undergraduate nursing student deemed at risk of failure at the University of British Columbia (UBC) and the British Columbia Institute of Technology (BCIT) schools of nursing. The study found that CNIs identified students at risk of failure using “red flags” that included a range of actions, behaviours, and attitudes. These red flags included deficits in the demonstrated thinking, knowledge, and skills; deficits in the social and cultural aspects of nursing practice; disorganization and tardiness; and lack of integrity. CNIs felt that early and clear communication of their concerns with faculty and students deemed at risk of failure was beneficial for both the student and CNI. CNIs made decisions to fail students by considering patient safety and objective evidence while at the same time supporting and nurturing these students by providing opportunities for success.
Applied Science, Faculty of
Nursing, School of
Graduate

Clinical practicum in authentic healthcare settings is an important part of training to become a Medical Laboratory Technologist. Research into this area has shown that the clinical educator plays a significant role in student learning during this phase. To offer a slightly different perspective, the following research sought to examine a separate aspect of clinical training: to what extent does the clinical setting itself contribute to one’s developing technical “competence”? A study was conducted exploring the extent to which clinical educators use their workplace environment (whether intentionally or not) to teach, mentor and socialize new professionals. Five educators, selected on the basis of their TPI score (Pratt & Collins, 2000) each with a different approach to teaching, were used as the basis for case analysis. Further guiding the analysis of educators’ awareness and use of context-as-teacher in the clinical practicum, the works of van Manon, Marton and Booth were used to supplement the case analyses. Examples of the systematic relationship between educator’s teaching perspective and use of context include: Social Reform used the context to encourage participatory democratic engagement; Developmental encouraged working with other members of the healthcare team to move “outside one’s comfort zone” reaching into lifelong and life-wide skill development; Apprenticeship, well represented in this study, focused on work and where work took place; Nurturing encouraged students to use less convenient rooms to adapt and perform at a high level in any surroundings; Transmission clearly separated instructional time from on-task time, allowing sufficient instruction before judging performance. The findings show that educators demonstrate different approaches to teaching; that they use context in teaching (955 documented instances); that the use of context is often related to their teaching perspective; and that there was a lack of awareness for the extent or power of context-as-teacher. They only seldomly designed learning around a healthcare setting resulting in lost opportunities to use the context in teaching. Through ongoing activities and dialogue on teaching, educators can gain an awareness of the role of context and the power of knowingly using context in teaching students in the clinical setting.

Nurses need sharp, clinical reasoning skills to respond to critical situations and to be successful at work in a complex and challenging healthcare system. While past research has focused on using virtual learning environments to teach clinical reasoning, there has been limited research on the experiences of nursing faculty and there is a need for research to include a clearer understanding of potentially significant insights that nurse educators may gain from teaching clinical reasoning skills with virtual learning tools. This qualitative study identified and described nursing faculty experiences with teaching clinical reasoning skills when using virtual learning environments. The researcher interviewed eight nursing faculty and content analyzed the data from those interviews. Findings from this qualitative study supported past research and added to the body of knowledge regarding faculty members’ use of virtual learning environments. For example, faculty experiences indicated that virtual learning environments included patient situations that offered faculty a way to better assess students. It was found that assessing a student in the clinical setting could be very subjective, while the virtual environment is finite. Faculty experiences indicated that one of the challenges to teaching clinical reasoning skills with virtual learning environments was that students found that virtual communication was difficult and faculty claimed that using virtual environments increased faculty workload. The findings of this study provided deeper understanding into experiences reported by nursing faculty on the teaching of clinical reasoning skills when using a virtual learning environment. Recommendations for further research include using a larger sample size, a specified education level population, traditional, face-to-face classes as compared to classes from an online, or blended program, and investigating use of a specific virtual learning environment, in new research.

The current complexity of client care can only benefit from teaching approaches that foster critical reflection and independence of learning in nursing students in actual health care settings. There is value to the nursing profession in understanding the balance between intellectual, strategic and moral acts of teaching within a humanistic, authoritarian or liberal teaching style that stimulates, supports and develops clinical competence and self-direction of learning in students within a nurturing learning environment. In order to further understand the concept of clinical education, a naturalistic, case study inquiry was undertaken in Western Australia. The purposes of the study were first, to construct an understanding of clinical education, the complexities of the clinical educator’s role and responsibilities within the context of the clinical milieu. Second, the researcher aimed to theorise about the context and processes of clinical educators’ teaching and learning interactions with students in the clinical milieu that resulted from the three clinical educator cases. A particular focus in this study was to further understand the ways clinical educators guided aspects of students' learning that required critical thinking and reflective practice. In doing so, this dissertation explains the processes of clinical teaching as described by the participants and observed by the researcher. Clinical educators in pre-registration, undergraduate nursing programmes from two Western Australian universities were identified as major stakeholders in clinical nursing education and were invited to participate. The understanding of clinical education that resulted from the case study is developed and explained in this dissertation. Recent developments within clinical nursing education are marked by increasing complexity within a context of raised client expectations, cultural diversity, technological advances, and fiscal constraint. Within such a learning milieu, clinical educators develop plans for teaching based on knowledge of the curriculum and experience in clinical teaching. They respond to students’ expectations and needs, act as advocates for student initiated client care, and make professional judgements about students’ cognitive, psychomotor and affective competencies. The researcher applied a constructivist approach to create a contextual understanding of clinical educators’ role, responsibilities and processes of clinical teaching. Activities of teaching were identified as being intellectual and strategic (Green, 1971; Hellgren, 1985) and moral (Fenstermacher, 1990; Sirontik, 1990; Stewart, 1993). For the purpose of this dissertation, the intellectual, strategic and moral acts have been adopted for application to the findings on clinical teaching. Those findings were reconstructed in a model developed by the researcher which situates activities of clinical teaching within styles of teaching. The activities of clinical teaching referred to in this dissertation are intellectual, strategic and moral acts of teaching. The styles of teaching referred to in this dissertation are humanistic, authoritarian, liberal and misanthropic and were derived from the literature on Invitational Teaching (Purkey & Novak, 1984; Ripley, 1986). The researcher hypothesises about the regard for student learning that might arise from the various relationships in the model. This thesis adds to the practice of clinical education by suggesting the value of identifying clinical educators’ styles and strategies as a means to nurturing independent life-long learning in students. The benefit of self-direction is a professional who can effectively function regardless of the unpredictable circumstances inherent in the clinical setting and negotiate his/her own learning. Recommendations for further study include the need to validate the constructed model of clinical practice teaching and to determine if the model is predictive of effective clinical learning outcomes that can be validated against various levels of students. Also, there is a need to determine transferability and application of the clinical practice teaching theory to other countries with similar undergraduate academic preparation of Registered Nurses.

Studies show nurses experience many barriers to research use in practice. Nursing education needs to prepare nurses to evaluate and apply research as a basis for practice. Clinical teachers have the opportunity to close the gap between research and practice by preparing students to use research in their practice. However, little is known about how clinical teachers use health care research in nursing clinical teaching practice. The purpose of this qualitative research study is to explore the use of health care research in nursing clinical teaching practice. Study objectives are: (a) to explore the use of health care research by clinical teachers (current practices); (b) to examine clinical teachers' concerns about using health care research in their practice; (c) to explore factors that impede or facilitate clinical teachers' use of health care research in their teaching; and (d) to explore strategies used by clinical teachers to promote use of heath care research by students. A grounded theory approach was used. A convenience sample of 15 clinical teachers in a baccalaureate nursing collaborative program were interviewed using a semi-structured questionnaire. Analysis of the data led to the identification of the main theme making the connections. Also identified were the sub categories of valuing the connections, conditions affecting the connections, connections strategies, students seeing the connections and strengthening the connections. The findings were presented to 9 of the original 15 participants and feedback indicated they agreed with the results of analysis and the model developed. Implications for nurses teaching clinical practice, nurses in full-time faculty or administrative roles and research are discussed.

Philosophiae Doctor - PhD (Nursing)
Nursing is the largest healthcare profession in Malawi with more than 11,000 registered Nurses (RNs) and Nurse Technicians and Midwives (NTM) practicing in hospitals and other settings like nursing colleges nationwide. Nursing tutors in all the nursing colleges use numerous types of teaching aids in student preparation. There are numerous teaching strategies that suit pedagogical learning, however not all can yield the desired outcome and are properly applied in both classroom and clinical areas. Therefore, identifying the new teaching strategies for nurse tutors is very critical in nursing education hence this study concentrates on teaching competence, interaction and performance on the use of the strategies. Nurse tutors must encourage teaching and learning discovery through deliberate interactive teaching actions. However, some outcome actions, competences and performance or interactive behaviour of the nurse tutor are much to be desired in most nursing colleges in Malawi. Nurses need to possess classroom and clinical teaching competences to perform the role of a tutor properly.

Introduction Clinical Reasoning is an important competency for medical students to learn. I am a Clinical Lecturer in Medicine and I run a course which has clinical reasoning as a key component. It was identified at curriculum meetings, that Clinical reasoning can be challenging to teach and that there was some evidence that it is an area of the curriculum that could be further developed and improved upon. Study Aim To address the concern about improving the teaching of clinical reasoning skills, my study aimed to; • Develop effective approaches for teaching clinical reasoning to medical students and evaluate them, • Identify educational principles that would help students learn clinical reasoning and share them with curriculum developers, The questions that I identified to support this aim were; • What enhances the students’ ability to learn clinical reasoning? • What makes it harder to learn clinical reasoning? New knowledge was developed by exploring how the theories around clinical reasoning and its teaching could be applied in a practical setting. Methodology An action research approach was used to identify the concerns and issues around teaching clinical reasoning, look for solutions, plan and implement changes and evaluate the changes. The last element of the study was the development of principles when developing a curriculum or teaching sessions for clinical reasoning. Results A new teaching session was designed and delivered to third year medical students. Several key factors important in designing a teaching session around clinical reasoning were identified. Scenarios used in clinical reasoning teaching should be written so that the information in the history is nonspecific and broad enough to allow for thinking across different body systems. They also should be well written to allow actors to play the simulated patient role realistically. The tutors involved need to have the skills to encourage the students to apply knowledge to the scenario through interaction. The tutors need to be able to engender a feeling of safety within the group being taught. There are some indications that the tutors need to have a high level of metacognition themselves. Students need to practice using the clinical reasoning processes and receive feedback on their thought processes. The teaching sessions need to allow time for the students to think and a stop start method was highly rated by the students as a method for doing this. Assessments and teaching materials around clinical reasoning need to avoid the use of “buzz words” or formulaic thinking. Further research into how novices use the clinical reasoning process is needed, as the study suggested that students use inductive reasoning and leave it late to start the reasoning process. They also try and use pattern recognition using “buzz words” very early on in their career.

The purposes of this study were to determine whether associate degree nursing (ADN) programs were implementing innovations in their clinical curricula, to identify recent clinical innovations in these nursing programs, and to identify attributes of innovations that influence innovation adoption. Data were obtained from two questionnaires to all directors of ADN programs in six southwestern states. The first questionnaire asked respondents to identify clinical innovations they had considered recently. The second questionnaire used a Likert Scale to seek respondents' perception of six attributes of innovations--Relative Advantage, Compatibility, Complexity, Observability, Trialability, and Cost--that come from diffusion theory. Analysis of data indicated that 77% of the respondents had implemented changes in their clinical curriculum during the past six years. The most frequently implemented innovations were computer assisted instruction, preceptorship experiences, clinical competency exams, initiating or increasing use of skills labs, and workstudy/externship experiences. Likert Scale values for perceptions of the six attributes, along with a variable created to represent the influence of the Environment, were analyzed by principal component analysis and logistic regression analysis. These analyses led to the conclusion that no one or two variables can be used to predict adoption of an innovation. Instead, a model with each of the attributes should be used in predicting adoption. These findings generally supported the model provided by diffusion theory. However, the influence of Trialability was negligible. Additionally, the Environment variable was found to be an important influence in a favorable adoption decision. Nursing program directors who seek to implement innovations could enhance successful implementation by emphasizing the positive aspects of all attributes of a proposed innovation.

Disciplining children has been a topic of discussion for many years now. One of the most popular methods of discipline is time out. The term time out refers to “a period of time in a less reinforcing environment made contingent on a behavior” (Brantner & Doherty, 1983, p. 87). Time out has been studying for many years and research has supported different procedural components to time out. Using evidence-based components, this study focuses on teaching college students how to facilitate a proper time out procedure. The following procedural components are the chosen main components to examine; time in, verbal warning, immediacy, limited reinforcing location, escape plan, release strategies, and consistency. The current study examines the impact of teaching undergraduate students these procedural components and gains a better idea of this population’s attitudes, opinions, and future likelihood of use for the time out technique. A possible predictor of perceived parenting style was also included in the model. Results indicated that learning the procedural components of time out in depth did increase individuals’ knowledge and attitudes towards this particular discipline strategy. It was also found that future likelihood of using time out was not influenced by the information presented, nor was parenting style a strong predictor for any of the three variables.

The purpose of this study was primarily to explore the conceptualization of critical thinking development in radiologic science students by radiography program directors. Seven research questions framed three overriding themes including 1) perceived definition of and skills associated with critical thinking; 2) effectiveness and utilization of teaching strategies for the development of critical thinking; and 3) appropriateness and utilization of specific assessment measures for documenting critical thinking development. The population for this study included program directors for all JRCERT accredited radiography programs in the United States. Questionnaires were distributed via Survey Monkey©, a commercial on-line survey tool to 620 programs. A forty-seven percent (n = 295) response rate was achieved and included good representation from each of the three recognized program levels (AS, BS and certificate). Statistical analyses performed on the collected data included descriptive analyses (median, mean and standard deviation) to ascertain overall perceptions of the definition of critical thinking; levels of agreement regarding the effectiveness of listed teaching strategies and assessment measures; and the degree of utilization of the same teaching strategies and assessment measures. Chi squared analyses were conducted to identify differences within each of these themes between various program levels and/or between program directors with various levels of educational preparation as defined by the highest degree earned. Results showed that program directors had a broad and somewhat ambiguous perception of the definition of critical thinking, which included many related cognitive processes that were not always classified as attributes of critical thinking according to the literature, but were consistent with definitions and attributes identified as critical thinking by other allied health professions. These common attributes included creative thinking, decision making, problem solving and clinical reasoning as well as other high-order thinking activities such as reflection, judging and reasoning deductively and inductively. Statistically significant differences were identified for some items based on program level and for one item based on program director highest degree. There was general agreement regarding the appropriateness of specific teaching strategies also supported by the literature with the exception of on-line discussions and portfolios. The most highly used teaching strategies reported were not completely congruent with the literature and included traditional lectures with in-class discussions and high-order multiple choice test items. Significant differences between program levels were identified for only two items. The most highly used assessment measures included clinical competency results, employer surveys, image critique performance, specific course assignments, student surveys and ARRT exam results. Only one variable showed significant differences between programs at various academic levels.
Ed.D.
Department of Educational and Human Sciences
Education
Education EdD

This study described the instructional practices of selected clinical medical school faculty. It addressed the following questions: - how do medical and surgical clinical faculty select/design and combine instructional methods and media in teaching clinical content? - what influences clinical faculty use of a particular method or medium for clinical teaching? The primary purpose of this research was to investigate how clinical medical school faculty make pedagogical decisions and carry out their instruction in clinical patient care settings. The research described the clinical faculty members' instructional practices with medical students and how the medical apprenticeship system is used for their clinical instruction. The research involved two medical schools and a sample of four clinical faculty representing surgical and medical practice. A general method of descriptive research was employed including the data-gathering techniques of participant observation, interviewing, and collection of documents. Strategies developed by Spradley (1980) and Erickson (1986) were used for data analysis. Findings indicated that the sample clinical faculty do not use an instructional planning process such as described by Gagne and Briggs (1979) or Wildman and Burton (1981). Instead, they select instructional methods and media intuitively, carefully monitoring the medical students' reactions to their instruction. The data show the instructional techniques that include the human element -- defined here as personcentered methods -- are selected most often.
Ed. D.

The diagnosis and management of patients requires professional know-how or medical craft knowledge. To explain how this knowledge is acquired, this research asked 'How do medical experts pass on their craft?' Other questions arose through successive data collections and progressive focusing on what medical experts did well in their work and teaching. The programme comprised: pilot interviews with three expert physicians; a case study in a hospital medical unit; and paired consultant/SHO interviews. Participant observation, interviews, and expert-novice comparisons explored clinical work, teaching, and learning in apprenticeship. Data analysis of participants' responses and ward round discussions allowed identified categories to cluster within three inter-related constructs instrumental to the acquisition of medical knowledge: gaining experience in the experiential process of clinical practice (1); and the products of experience which manifest as experts' clinical expertise (2) and teaching/learning expertise (3). These constructs can be located within a model of apprenticeship based on Spady's (1973) analysis of authority in effective teaching containing two frames of reference: the social, 'traditional-legal'; and the individual, 'expert-charismatic'. The medical apprenticeship is associated with similar perspectives: the 'traditional-experiential' represents the professional process of learning through patient care with its infrastructure of clinical methods in presentation, discourse, and commentary; and the 'expert-charismatic' represents clinical and teaching expertise coupled with vocational enthusiasm. Experienced experts synthesised two repertoires of knowledge and skills derived from the craft knowledge of medicine and pedagogy, respectively. Both crafts are required for effective clinical education. While apprenticeship accommodates a range of teaching/learning experiences, in postgraduate education experts pass on knowledge through the deliberate engagement of junior doctors in diagnosis and management. The skills involved in this process were largely unrecognised by most senior and junior doctors and were not perceived as 'clinical teaching' although learning was structured through service-based work.

Entry to Practice Competencies and Standards is a document that sets the guidelines of curriculum for all Canadian dental hygiene programs. Within the document, a competency-based curricular aim is emphasized. As contemporary educational literature have been suggesting, student centered learning has become a dominant guiding principle of pedagogical approaches for competency-based education. With shifting curricular aims and pedagogical principles many current educators of dental hygiene programs may be teaching new curricula different to that which they experienced when they were students in dental hygiene programs. Furthermore, many of them may be expected to implement pedagogical approaches that are different from how they were taught due to traditional conceptions of how people learn. This study explores the perspectives on teaching and learning held by clinical dental hygiene instructors at one Canadian institution. The objective is to understand which teaching and learning perspectives dental hygiene instructors hold. Data were collected through semi-structured interviews with fifteen instructors. The results show that instructors tend to think of their teaching as student-centered, yet in a set of 'simulated teaching' questions, the responses were found to be teacher-centered. The research also revealed that the process by which one learns to become a clinical dental hygiene instructor is multifactorial. These factors include but are not limited to the following: instructors' perceptions of their own learning experiences, instructors' experiences of inter- instructor collaboration, and instructors' methods of facilitating student self-efficacy. Given curricular change and the emergence of literature supporting a student-centered approach to teaching and learning, this study shows that it is critical to uncover the teaching/learning beliefs of the instructor's prior to designing faculty development programs. Integrating instructors'preconceptions into the program design may create an environment that is more accommodating of the transition towards the new pedagogical culture.
Dentistry, Faculty of
Graduate

Problem: While the educational preparation of students in a tertiary nursing programme was the general focus of the study, the specific concern was with the degree to which students in the first and third year of the programme implemented all aspects of the nursing process in their delivery of patient care. The study developed out of a need to evaluate the effectiveness of theoretical teaching in regard to the students' ability to implement theoretical principles in clinical practice. The desired outcome of the study is that the data will be useful in developing more appropriate and effective teaching approaches that will result in improved clinical nursing practice. Methodology A survey of patients receiving nursing care from students in the first and third year of their programme was conducted on completion of a one week block of clinical experience for both groups of students. A questionnaire was the instrument of data collection. Factors included in the study were the patients' perceptions of the students' attention to four of the five phases of the nursing process: assessment, diagnosis, planning and evaluation. Questions addressing the degree of patient involvement in all of these phases were included throughout the questionnaire. Questionnaires were returned from twenty nine of the thirty one patients surveyed in the first year student group and from thirty of the thirty one patients surveyed in the third year student group; constituting a 93.5 percent and a 96.7 percent response respectively. Results The scores achieved by each group of students were compared against scores determined by the researcher to indicate realistic educational and professional standards of practice in each specified section and comparisons were also made between the two students groups to identify development of practice over the education programme. Scores indicated that: 1. Within each section of the study both student groups scored below the expected level on certain items, the most notable deficiencies being related to the aspects of patient empowerment through informing and involving. 2. The third year student group scored overall higher than the first year students in regard to attention to the more 'technical' aspects of the nursing process, but did not give the same degree of attention to the 'human' aspects, scoring equal to, or lower than their less experienced colleagues. Conclusions: 1. There are apparent philosophical differences between the graduates of the 'old style' training system and those involved in the tertiary nursing programme in regard to the individualization of patient care and the allocation of priorities within a time frame. 2. Clinical application of theoretical principles relies heavily on the reinforcement of these principles by the clinical teacher/supervisor. There is a need for these clinical supervisors to have: (a) a better understanding of the educational objectives for students in the clinical settings, and (b) assistance towards developing teaching/organizational strategies that will guide the student towards objective attainment when such abilities are not developed. Recommendations: Among the recommendations presented were: 1. that the nursing discipline within the university make formal and informal opportunities to inform all clinicians of the changes in nursing education and the implications these changes have on the overall approach to the delivery of patient care. 2. that there is an increased emphasis on the educational preparation of the clinical supervisors and that their commitment to the students' achievement of the clinical objectives is enhanced through involvement in programme planning and evaluation.

Background: Consultation skills are the core competencies required at graduation of the doctor as a practitioner. Every medical school has its own system of teaching and assessing consultation skills. These are generally amalgams of previous curricula and not rigorously developed. We took the opportunity presented by a new undergraduate medical curriculum to systematically develop the consultation skills curriculum from classroom teaching to OSCE assessment and formative workplace-based assessment and feedback. Methods: The consultation skills curriculum and assessment system were developed by action research. Data were collected using mixed methods involving questionnaires, focus groups, participant interviews, student reflective summaries and routine monitoring of usage of an app which we developed for generating feedback summaries in the clinical workplace. Participants were teachers and students at Keele University school of medicine. In addition, clinical tutors from seven other UK medical schools participated in a Delphi study of undergraduate medical consultation skills competencies. Results: A case study of curriculum development by action research is presented in nine published papers. Conclusion: This work has contributed to medical education knowledge as follows: an instrument for assessment of consultation skills has been developed and validated; and a set of strategies for improvement of these consultation skills have been developed and validated. It has added to understanding about transfer of learning from the classroom to the workplace; the impact of assessment grades on medical students’ learning and self-perception; and the value of a system of formal workplace-based assessment. Additionally this work was one of the first applications of realist methods in medical education research, and it has developed guidance on feedback in the workplace for individual tutors and educational institutions.

Background The Australian nurse practitioner (NP) role is represented by over 1,400 endorsed NPs practising in over 50 different specialty areas. Generic standards have broadly supported the role’s behavioural, professional and expanded practice expectations since 2006, and have been used for the accreditation of NP Masters programmes nationally. The need for consistent and flexible specialty clinical education for NP students has been described in the Australian literature. The clinical learning and teaching of Australian NP specialty roles has traditionally occurred in the student’s workplace, within a specified area of practice. Jurisdictional differences at state/territory and local levels have influenced how NP students develop and enact their roles once endorsed. Factors such as the student’s clinical supervisor, local legislation and policy, role ambiguity, restrictive local clinical guidelines and protocols influence what NP students learn in their clinical learning environments. These factors contribute to a highly differentiated NP workforce, with differing clinical skills, knowledge and abilities noted within the same specialty area. Similar difficulties have led to the development of broad specialty areas in the United States of America. To better complement the generic learning and teaching students receive through their academic programmes, this research aims to validate a specialist clinical learning and teaching framework for Australian nurse practitioners. This framework will not only enhance consistency in their specialty clinical learning and teaching, but create greater workforce flexibility. A consensus-based research methodology was needed to validate the specialty clinical learning and teaching framework. Delphi Technique is a consensus-based research methodology commonly employed in nursing research to explore solutions to questions that have unclear or indeterminate answers. It aims to achieve a pre-determined level of consensus on a research question, using content experts through an anonymous and iterative process. Critical to the method’s validity is the participation of a heterogeneous group of experts with advanced knowledge of the content area, and whose feedback to other panelists is controlled to minimise social influence. Individual participant characteristics, such as experience level and confidence in decision-making, and the influence of these upon consensus are poorly described in the Delphi literature. There was little previous empirical research to inform how to best describe heterogeneity of opinion informing the specialty clinical learning and teaching framework using nurse practitioners. Aims - To validate a specialty clinical learning and teaching framework for Australian NP students. Specific objectives that addressed this aim were: - To validate a previously developed Australian NP metaspecialty taxonomy. - To validate supporting clinical practice standards used for the metaspecialty taxonomy. - To contribute knowledge of how consensus is achieved when using Reactive Delphi methodology. Specific questions that addressed this aim were: - Does Reactive Delphi methodology potentiate the negative influence of the bandwagon effect in Delphi panelists? - What effect does panelist confidence have on decision-making in Delphi panelists? - How can experience level be objectively demonstrated in individual Delphi panelists? - What effect does experience level have on decision-making in Delphi panelists? - Does confidence relate to opinion change in individual Delphi panelists? - What effect does panel composition have on consensus outcomes? - To demonstrate the application of web-based methods in Delphi research. Specific objectives that addressed this aim were: - Describe the advantages of using a web-based Delphi method. - Describe the risks of using a web-based Delphi method. - Describe how panelist feedback was managed during six concurrent Delphi studies. Methodology and Methods This mixed-methods research used Delphi Technique to achieve consensus on, and therefore validate, a NP specialty clinical learning and teaching framework. Two sequential 3-round Reactive Delphi surveys were used to achieve the research aims. The first Delphi survey was designed to validate a proposed broad Australian NP specialty taxonomy previously established by the 2014 CLLEVER (CLinical LEarning goVERnance) study. The second Delphi survey was designed to validate clinical practice standards, which would support and provide definition to the specialty taxonomy. Together, the taxonomy and standards informed the proposed specialty clinical learning and teaching framework. Consensus Development Conference methodology was used to refine the proposed specialty clinical learning and teaching framework. Data collected during the conduct of the first Delphi survey achieved the second research aim. The third research aim was achieved by using metadata, paradata and embedded data in an advanced web-based survey design for both Delphi surveys. Purposive sampling and snowballing techniques were used to recruit from an eligible population of NPs, endorsed by the Nursing and Midwifery Board of Australia, with at least 12 months’ post-endorsement experience (N=966). Web-based survey technology was used to collect data. Data were analysed using content analysis, descriptive and inferential statistics. The Content Validity Index and non-parametric testing using McNemar’s Test for Change were used to determine consensus that informed the proposed framework. Results Approximately 20% of the eligible Australian NP population contributed to both Delphi surveys. Six broad specialty areas, termed metaspecialties, were validated for the proposed specialty taxonomy. A Consensus Development Conference refined the names of two metaspecialties. The metaspecialties served as a foundation for validated clinical practice standards, which provided substance and definition to the final specialty clinical learning and framework. Heterogeneity of expert NP opinion informing the framework was demonstrated using professional activities representative of advanced practice nursing. There was no indication of negative social influence determining the manner by which panelists achieved consensus on the proposed framework. A novel method of using metadata, paradata and embedded data in web-based surveys was applied, which supported high survey response rates and identified non-response bias. A novel application of web-based surveys allowed the researcher to concurrently conduct six Delphi surveys nested within a larger research project. Conclusion This research demonstrates a rigorous approach in validating a proposed specialty clinical learning and teaching framework for Australian NP students. It contributes new knowledge on the internal and external validity of Reactive Delphi methodology.