Enhancing learning in clinical placements: self assessment, rubrics and scaffolding (a case study)Ieva StupansUniversity of New England

Geoff March &Susanne OwenUniversity of South Australia

Australian UG pharmacy programs4 years, include clinical placements , at

graduation not competent , require one year intern period and assessments etc in order to be registered.

Therefore program endpoint is not specified.However program must enable student to

commence intern period.Assessments of clinical placements in pharmacy

generally based on assessment of individual activities not assessment of competency as such.

These activities may be based around competencies

Competency Standards for Pharmacists in Australia

Eight domains

Standard 1.5, element 1:importance of life-long learning, self assessment, reflective learning

Learning activity based around counselling

Each student required to undertake counselling throughout the placement Write a reflective piece regarding their

improvements in counselling between the early and late stages of the placement

Learning activity based around counselling

Each student required to undertake counselling throughout the placement Three iterations of the activity

developed A, B,CEvaluation

scoring of various facetsdetermining types of reflection

demonstrated in the writing

How would you scaffold this activity?

Write a reflective piece regarding their improvements in counselling between the early and late stages of the placement

Scoring: Understanding of role and function of Competencies - uses competency developmental criteria language, refers to relevant

performance criteria

Marks

A

C

Scoring: Clear thoughtful analysis – makes connections between experiences, course material and other relevant events (Reflection)

Marks

A

Examples from the qualitative analysis for reflective writing Reflective observation involving explaining

actions:“I became better at identifying a particular

patient’s information needs. I was able to tailor the type and extent of information provided to the patient depending on the number of other medications and also the patient’s cognitive level”

Examples from the qualitative analysis for reflective writing Abstract conceptualisation involving linking to

other experiences:“ the level of support from my preceptor

needed.... the time taken for me to provide..... degree of client focus also improved”

Abstract experimentation/theory confirmation involving discussing future action

“I would look up tertiary references (such as the Australian Medicines Handbook) for important counselling points”

What were the differences between the 3 iterations?A- Write a reflective piece regarding your improvements in

counselling between the early and late stages of the placement

B- Write a reflective piece regarding your improvements in counselling between the early and late stages of the placementPlus description of reflectionPlus graduated descriptors around competencies

C-Write a reflective piece regarding your improvements in counselling between the early and late stages of the placementPlus description of reflectionPlus graduated descriptors around competenciesPlus rubric and specific scaffolding

RO-reflective observation; AC-abstract conceptualisation; AE-active experimentation; CE- concrete experience

1. Setting of professional

goals

5. Developing Supportive Networks

2. Evaluating strengths

& needs

3. Planning Learning Agenda

4. Active change by experimentation

and practice

Reflection-for-action

Reflection-for- action

Reflecting and Goal Setting

Rubric: Explain (1) what the most significant changes are, (2) why changes in competency skill

development are occurring (3) describe the evidence for this change (4) describe the change you have observed in

terms of the links to pre-placement and during placement support/learning materials and

(5) your action for the future in further developing your proficiency in this skill.

Journey to competencyCriteriaLevel of support Time taken for preparing for the

task Time taken for doing the task Clinical problem solvingDegree of client focus

Journey to CompetencyExampleFocussed on selfPartly client focussedMostly client focussedSufficient process skills for client

focus

Reflection- in, on, for action- Placement period B

in

Reflection in, on, for action- Placement period C

SummaryB C

Reflective observation involving explaining actions

53% 37%

Abstract conceptualisation involving linking to other experiences

42% 42%

Abstract experimentation/theory confirmation involving discussing future action

5% 21%

Reflection is an essential element of lifelong learning and professional development

Self assessment in itself is meaningless unless it leads to planning

ConclusionStudents with appropriate scaffolding can

plan for future personal development i.e. Reflection for action

Scaffolding or Assessment ???“from our students’ point of view, assessment

always defines the actual curriculum” (Ramsden)

“Assessment defines what students regard as important [and] how they spend their time… If you want to change student learning then change the methods of assessment” (Brown)

“Assessment systems dominate what students are oriented towards in their learning” (Gibbs)

Learning

Zone of Proximal Development

What ideas could you incorporate into students’

activities?

How do you prepare students to go on placement?