Applied clinical research Evaluation of a Quality Improvement Project in clinical education

1. Applied clinical researchEvaluation of a Quality Improvement Projectin clinical education Lynsey Parrott M.Hlth.Sci. (Sp.-Lang. Path). RegMRCSLT.MSPA. & Esther Pettit MSc.RegMRCSLT.

2. QI model

3. Context & Problem • The format of clinical exams at Marjon. • 8 of 46 (21%) failed to demonstrate their clinical reasoning & professional skills at more than a satisfactory level in clinical exams (CE). • Considered “at-risk” of failing in final year.

4. Research question Does tutorial support during year 3 enable student speech and language therapists to develop their clinical reasoning & professional skills, rated as satisfactory after year 2 clinical exams?

5. Project progression

9. Focus group comments • “Heightened anxiety affected word finding skills”. • Challenged by “thinking on-line”. • “Difficulty understanding the questions.” • “Nervous & lacking in confidence.” • “No idea what questions would be asked”. • Lack of feedback from CE was “unsettling”. • “One-sided interrogation”.

10. Agreed learning objectives

11. Tutorial content • 8 x 90 min sessions adhering to a set format. • On-going practice of presentation skills. • On-going practise in professional discussion. • On-line discussion on diagnosis and appraisal. • Focuses on giving & receiving feedback. • Case based discussion.

12. Theoretical components of tutorial structure. • Underpinning successful learning is the…. “wanting (or needing), doing, feedback & digesting” (Race 2002). • Peer Assisted Learning (PAL) (Cross et al. 2006) and feedback. • Role of Facilitator rather than a Teacher. • Learning theory - “conscious-unconscious competence-incompetence” framework. 5. “thinking out aloud” (Scott 2004) skills in the development of their clinical reasoning skills.

14. 4 stages of learning skills

15. Thinking aloud strategies • Use plain words to tell yourself what you did & why. • “Director’s commentary” • It’s okay to make mistakes. • Tell your client’s story. • Mind map your information. • Talk at your own speed. • Talk about how you felt, the jargon you knew….

16. Evaluation • Completion of evaluation questionnaire • Qualitative feedback • Outcomes from year 3 placement • Outcomes from year 3 clinical exam

17. Example of evaluation form How confident do you feel now in recognising symptoms of communication disorders? 1 2 3 4 5 6 How confident do you feel now in discussing the process of differential diagnosis? 1 2 3 4 5 6 How confident are you that weekly tutorials will provide you with frequent and regular learning opportunities to improve your competency at establishing a diagnosis of communication disorders? 1 2 3 4 5 6

19. Qualitative comments Format of tutorials • Liked the structure and predictability Content • Worked well; change nothing Facilitation • Very supportive; good atmosphere; positive vibe. • Input from specific clinical examiners needed.

20. Student outcome

22. References • Cleland, Arnold, R., & Chesser, A. (2005).Failing finals is often a surprise for the student but not the teacher: identifying difficulties and supporting students with academic difficulties. Medical Teacher. Vol. 27, no. 6, pp. 504 - 508. • Cross, V., Moore, A., Morris, J., Caladine, L., Hilton, R. & Bristow, H. (2006). The practice-based educator. London: Wiley. • McAllister, L. & Lincoln, M. (2004). Clinical Education in Speech-Language Pathology. London, Whurr. • Murdoch-Eaton, D. & Levene, M. (2004). Formal appraisal of undergraduate medical students: is it worth the effort? Medical Teacher. Vol.26, no.1, pp. 28 – 32. • Race, P. (2002). The lecturer’s toolkit. A Practical Guide to Learning, Teaching and Assessment. U.K. Kogan Page Limited. • Rose M. & Best D. (2005). Transforming practice through Clinical Education, Professional Supervision and Mentoring. China, Elsevier. • Scott, I. (2004). ‘Teaching clinical reasoning: a case based approach’ In Higgs, J. & Jones, M. (2004). Clinical Reasoning in the Health Professions. U.K., Butterworth-Heinemann.