implementing change in clinicians and clinical...

Implementing Change in Clinicians

and Clinical EducatorsThur April 16th 4-5pm

By: Linda Spencer and Tenecia Yeboah

New Mexico State University

Edgar R. Garrett Speech and Hearing

Center

Learning Objectives--

Participants will learn to:

• Set a foundation for a positive clinical experience for

the Clinical Educator and the Student Clinician

• Choose and employ an effective diagnostic for

spotting student clinician conflicts

• Utilize proactive strategies to evoke growth in the

student clinician throughout the graduate student

experience

Did you Ever….

• Dread meeting with a student after a clinical

session that that was unsuccessful?

• Dread meeting with a clinical educator who

has either ‘crossed the line’ with feedback or

suggestions?

Some Reasons for ‘Dread’

• Clinician is ill-prepared

• Clinician has a sparse tool-kit

• Clinical Educator is averse to

change

• Clinical Educator is ‘burnt out’

YET—We are agents of change!

"Coping with our common problems can be an adventure

in creativeness.” Wendell Johnson

Model for Success

Pre-emptive training

Monitoring-Checking in and

Checking up

Remediation-a plan for those who struggle

CE TRAINING

• Training that is Face-to-Face

– ONLINE MODULE IS IN PREPARATION

• Face-to-face format is three CEUs

• Saturday AM

• Conference is light-hearted, with humor, yet

informative


Example Content

• Models of Clinical Education Practices

– Traditional

• Transform behavior of clinician

• Focus on clinical struggles

• Early stages, supervisees believe the educator is ‘right’

or has the answer and is with-holding it

• CEs described as active, directive, didactic, dominant,

controlling, infomrative

SOAP Quiz

Example Content

• Models of Clinical Education Practices

– Relational/Reflective CE emphasizes

• Analytical

• Technical

• Theroetical

• Intrapersonal

• Subjective

• Affective principles of being a clinician

Thinking about ‘Ports of Entry’

• Working from outside in - the goal is to

change, or modify, the overt patterns of

behavior, knowledge, and skills of the

supervisee.

• Working from inside out - the goal is to

understand the covert, internal processes

and affective states of the supervisee

Scenarios are used• Examples of Clinical Educator/Clinician dyad

communication vignettes

• Target traditional vs Relational/Reflective

practices

– Use of self

• 1st develop mindsight

• 2nd distinguish between background and foreground

questions or comments

• 3rd notice and attend to physiological sensations during

interactions

Facilitating Healthy Student and

Clinical Educator Relationships

• Clinical Educator (CE) vs Clinical Supervisor

– CE is more descriptive of what is taking place

– Term is more active

– CE has a role to facilitate a student’s development

and skills set

• MENTORING

Why we need mentors• Guidance and support

• To structure working environment

• To provide constructive, honest feedback

• Role model

• Encouragement

• To build confidence

• To assess competenceGopee, N. (2011) Mentoring and Supervision in Healthcare Sage

Publications, Coventry, UK.

Tasks and Skills that Facilitate an Effective

Relationship between CE and Students (from

ASHA)

• Be sensitive to the power differential between you and the

student

• Create an atmosphere that supports learning

– The student should feel comfortable presenting thoughts and ideas about

their clinical challenges

• Be cautious and balance “support” with “friendship”

• You are an “Educator” and you have to balance your ability to

evaluate the student with your relationship valence

Tasks and Skills that Facilitate an Effective

Relationship between CE and Students (from

ASHA)• Try to teach the student that your “evaluation” of

their performance is independent of your clinical

relationship with them

• Strive for a balance of a “friendly” relationship that is

based in mutual respect

– Let the student know you respect their efforts

• Maintain an open and ongoing communication stream

with the student

Four Processes of Learning

1• Observation of skill

2• Mental retention

3• Reproduction of the skill

4• Reinforcement and adoption

Four Processes of Learning• Observation of skilled

performance– Modeling stimulus

– Observed behavior is useful

– Observer becomes aware of

the skill needed

– Observer becomes eager to

learn the skill

– Observer recalls positive

reinforcement for previous

learning

• Retention of the skill– Step-by step performance of

the skill becomes assimilated

– Mental rehearsal of modeled

behavior

Gopee, N. (2011) Mentoring and

Supervision in Healthcare Sage


Four Processes of Learning

• Motor reproduction of

the skill

– Observer carries out

observed behavior or

skill

– Self –evaluates

performance

– Reinforcement and

adoption

• Behavior is reinforced by

external reward (praise,

self affirmation)

• Behavior is adopted

Gopee, N. (2011) Mentoring and

Supervision in Healthcare Sage


Student Clinician Training

• Ramp up of clinical services (First semester

one client—Final semester full-time

Externship)

• Thorough Orientation Session is held

– Elements of Training

• Procedures Fire training, HIPPA


CD 589 Class

• Purpose of the class

(Twice a week)

– Extra preparation

• Therapy planning

• Documentation

– ‘Grand rounds’ sharing tough cases

– Overall support

– Practice Evaluations

Weekly Conference with Clinical

Educator

MONITORING

Clinician Self-Evaluative Process

Open-Ended

• What went well?

• What surprised you?

• What was

disappointing?

• What is my role in the

above?

• How can I change?

Ratings

• Rate your performance on a 1 to

5 scale: 5 = strongly agree; 1 =

strongly disagree;

• Plan was effective

• Used materials creatively

• Cued appropriately

• Modeled appropriately

Monitoring-Checking in

and Checking

up

Clinical Calibration

2.to determine the correct

range for (an artillery gun,

mortar, etc.) by

observing where the fired

projectile hits.

What is my target?

Am I missing the mark?


• Executive Functions

– Metacognitive skills: Self Monitoring/Self

Reflecting

• Predicting

• Shifting

• Repairing breakdowns


• Observational Skills

• How is the client

responding to the

stimuli?

• Recognizing non-verbal

cues


• Making adjustments

online

• Changing the game plan

for later


Get feedback from the client

Use guidance from CE

Look at the data; do things match up?

Self Assessment: How did I do today?

Use PDS audio/video recordings

Clinical Calibration-Part 2

• ASHA Ethic II

• Individuals shall honor their responsibility to

achieve and maintain the highest level of

professional competence and performance.


• On Going Self-Reflection-

(Silverman,2008)

• “The better we know

ourselves, the better we can

know and be helpful to

others.”


• Using Self Reflection

• “We do not see things

as they really are. We

see things as we are.”-

• Anais Nin

(Silverman,2008)


• Using reflective practice as a tool to maintain clinical competence

• Continued learning and incorporation of new advancements to expand knowledge base

• Understanding personal characteristics and affects on professional life

• Strube,Hilliard, Gooch , 2012

• Mann, Gordon, McLeod, 2009


• Time Dependent

– In Action: in real time;

are you making/missing

your target?

– On Action: after the fact;

how did my actions affect

the outcome?

• -For Action: Predictive;

what can I change to

affect a different

outcome? • Strube,Hilliard, Gooch , 2012


• Content Dependent• Strube,Hilliard, Gooch , 2012

Critiquing

Values &

Beliefs

Understanding

the

Problem

Exploring

a

Strategy

Asking

Why?

How effective

was the

solution?

How can I

change

this?

Mid-Semester Conference with CE

Mid-Semester Dispositons

• 5-8 minute ‘check-up’ with faculty and

Clinical Director

• Written documentation of ‘strengths and

weakness’

• A chance for student to voice concerns or

validations

• Signed and placed in file

Remediation

Remediation of the CE

• Update with the clinical conference

• CE meetings with topical presentations

• Assign a presentation for a CE who is ‘rusty’

in an area

• Offer Continuing ED (online or face-to-face)

Examples from our files

Student Remediation Plan

• The document elements

• The meeting

• Assorted tips for documenting

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