Student Learningin the Clinical Setting

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Objectives Describe learning experiences that effectively engage

students in developing clinical expertise. Assess your own learning style using Kolb's theory of

experiential learning. Discuss effective clinical teaching strategies for your

learning style. Develop strategies to effectively address the three

remaining learning styles to foster learning in clinical settings.

Describe current research findings about how people learn and apply them to clinical teaching situations.

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Shifting Paradigms in Nursing Education - McBride, 1999

Traditional view• Nursing at bedside

• Process oriented

• Emphasis largely on mortality and some on morbidity

• Emphasis on teaching

• Scholarship narrowly defined and focused on personal interests

Expanded view• Nursing at patient’s side

• Outcome oriented

• Emphasis on mortality, limiting morbidity,and maximizing quality of life

• Emphasis on learning

• Scholarship broadly defined—consistent with institutional mission

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The Most Predictive Indicators of Learning Outcomes: Two environmental factors

• Interaction among students

• Interaction between students and faculty

- Astin, 1991

The Three Roles of the Baccalaureate Generalist Nurse (AACN, 2008)

Provider of direct and indirect care Designer, manager, coordinator of care Member of a profession

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Interactive Learning...

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Clinical Learning: An Exemplar of Interactive Learning

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Adapted from Kolb. D. A. and Fry, R. (1975) 'Toward an applied theory of experiential learning;, in C. Cooper (ed.) Theories of Group Process, London: John Wiley.

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Accommodators

Concrete experience/Active experimenter "What would happen if I did this?"

Look for significance in the learning experience and consider what they can do

Consider what others have done

Good with complexity and see relationships among aspects of a system

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Specific clinical learning techniques

Encourage independent discovery

Facilitate active participation

Expect accommodators to ask devil's advocate type questions, such as "what if?" and "why not?"

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Assimilators

Abstract conceptualization/Reflective observer "What is there to know?"

They like accurate, organized delivery of information and they tend to respect the knowledge of the expert.

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Specific clinical learning techniques

Lecture method by a guest speaker in pre- or post-conference (or video/audio presentation) followed by a demonstration.

Exploration of a subject in a lab, following a prepared tutorial

Less "instructor intensive" than some other learning styles.

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Convergers

Abstract conceptualization/Active experimenter The relevancy or "how" of a situation

Application and usefulness of information is increased by understanding detailed information about the system's operation.

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Specific clinical learning techniques

Interactive, not passive

Computer-assisted instruction is a possibility

Problem sets or workbooks can be provided for students to explore

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Divergers

Concrete/Reflexive learners motivated to discover the relevancy or "why" of a situation.

They like to reason from concrete specific information and to explore what a system has to offer and they prefer to have information presented to them in a detailed, systematic, reasoned manner.

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Specific clinical learning techniques

Lectures by guest speaker at pre and post-conferences--focusing on specifics such as the strengths, weaknesses and uses of a system.

Hands-on exploration of a system.

The instructor would be best to mingle with the students, answering questions and making suggestions.

How do YOU learn best?

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Learning Strategies

Think, pair, and share

Communication, communication, communication

Writing vs. speaking

'Building' exercise

Contributing something of substance

When and How People Learn BEST:A Research Perspective

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How Do People Really Learn?

Four primary processes:

• Wanting to learn (motivation)

• Learning by doing (trial and error)

• Learning from feedback (others’ comments; seeing the results)

• Digesting (making sense of what has been learned)

- Race, 1994

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Encourage contacts between students and faculty

Develop reciprocity and cooperation among students

Encourage active learning Give prompt feedback

Seven Principles of Good Practice in Undergraduate Education: Chickering and Gamson (1991)

Seven Principles of Good Practice in Undergraduate Education: Chickering and Gamson (1991) (con’t)

Emphasize time on task Communicate high expectations Respect diverse talents and ways of learning

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How people learn:— Bransford, Brown and Cocking (2004)

Students come to the classroom with preconceptions about how the world works

Students need a deep knowledge base and conceptual frameworks

Students respond to a ‘metacognitive’ approach to learning

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From the Research: How Do People Learn? - Bransford, et al., 2000

The role of prior knowledge in learning Plasticity and issues of early experience Learning as an active process Learning for understanding Adaptive expertise Learning is a time-consuming behavior

Best Practices in Teaching and Learning in Nursing Education - NLN

Critical thinking and clinical thinking are two different things.

Research does not support significant improvement in critical thinking as an outcome of nursing education.

Need to emphasize the narrative nature of clinical judgment, coaching students in the consideration of the general rule in relation to the particular case.

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Barriers to Learning in the Clinical Setting High student to faculty ratios Increasing patient acuity Student anxiety Faculty concerns about patient safety Limited number of clinical sites Lack of variety of patients

- Becker & Neuwirth, 2002; Tanner, 2006

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Anxiety and Learning

As anxiety increases, learning decreases- Audet,1995

Three major causes of anxiety in the clinical setting

• Fear of making mistakes

• Initial clinical experiences on a unit

• Performing clinical procedures- Kleehammer, et.

al., 1990

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Research Shows

Experts' abilities to think and solve problems depend strongly on a rich body of knowledge about subject matter.

- Bransford, et al., 2000

Best practices for clinical faculty: NLN, 2010

Provide feedback Facilitate reflection

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Strengths and Weaknesses of Faculty Teaching Performance - Wolf, et al., 2004

Strengths• Being a knowledgeable

and strategic teacher• Creating a positive

learning environment• Demonstrating

professionalism• Demonstrating positive

personal traits • Displaying scholarly

traits• Being supportive

Weaknesses• Providing poor delivery

of content• Acting disorganized• Being inaccessible• Displaying weak

teaching skill• Being dishonorable• Exhibiting unprofessional

behavior• Displaying negative

personal traits

Summary: What did you learn?

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