Developing Clinical Skills Name of presenter Prevention of Postpartum Hemorrhage Initiative (POPPHI) Project PATH

1. Adapted from PPT developed by Jhpiego corporation. Available at: http://www.reproline.jhu.edu/english/5tools/5presgrp/ctschpt7/cts7pg.htm Developing Clinical SkillsName of presenterPrevention of Postpartum Hemorrhage Initiative (POPPHI) ProjectPATH

2. Objective 7-1 After completing this session, future mentors will be able to demonstrate a clinical skill and coach skill development.

3. Enabling Objectives 7-2 • Identify phases in the skill transfer and assessment process • Coach development of a skill • Use anatomic models for clinical training • Conduct an effective clinical demonstration

4. AMTSL mentor roles 7-3 • Demonstrate skills on anatomic models • Facilitate small group discussions, role plays, and working through case studies • Coach the learners as they practice skills on the model and then in the clinical area • Evaluate the learner when she/he is ready

5. Steps in learning a clinical skill 7-4 • Skill acquisition • Skill competency • Skill proficiency

6. Skill Acquisition 7-5 • Represents the initial phase in learning a new clinical skill or activity • One or more practice sessions are needed for learning how to perform the required steps and the sequence (if necessary) in which they should be performed • Assistance and coaching are necessary to achieve correct performance of the skill or activity

7. Skill Competency 7-6 • Skill competency represents an intermediate phase in learning a new clinical skill or activity • The learner can perform the required steps in the proper sequence (if necessary) but may not progress from step to step efficiently

8. Skill Proficiency 7-7 • Skill proficiency represents the final phase in learning a new clinical skill or activity • The learner efficiently and precisely performs the steps in the proper sequence (if necessary)

9. Developing Clinical Skills 7-8 • The mentor demonstrates the clinical skill using the practice checklist • Practice checklists are used to facilitate learning the steps or tasks (and sequence, if necessary) in performing a particular skill or activity • Learners practice the skill under the supervision of the mentor, first on models and then with clients • The mentor evaluates the learner’s skill competency using the evaluation checklist • Evaluation checklists are used to evaluate performance of the skill or activity objectively

10. Work in pairs 7-9 • What is the difference between the practice and evaluation checklists?

11. Demonstration of the skill 7-10 The skill should be demonstrated: • During interactive classroom presentations, explanation of the skill or activity to be learned • Using slides or a videotape in which the steps and their sequence are demonstrated • Demonstrating the skill or activity using an anatomic model or role play while following steps as described in the practice checklist • Performing a role play in which a learner simulates a client

12. Demonstration: Whole-Part-Whole Approach 7-11 When first demonstrating the procedure, the mentor may follow the steps below: • Demonstrate the whole procedure from beginning to end • Isolate or break down the procedure or activity into parts and allow practice of the individual parts of the procedure or activity • Demonstrate the whole procedure again and then allow learners to practice the procedure from beginning to end

13. Why use practice checklists? 7-12 • Ensures that training is based on a standardized procedure • Standardizes training materials and audiovisual aids • Forms the basis of classroom or clinical demonstrations as well as learner practice sessions • Can be used as a self- or peer-assessment tool

14. Using practice checklists 7-13 • learners follow the steps as the trainer demonstrates a clinical procedure using anatomic models • learners use the practice checklists during classroom practice as trainer observes and coaches • learners assess each other using the practice checklist

15. Guidelines for demonstrating a Skill #1 7-14 • State the objectives of the demonstration and point out what the learners should do • Use the practice checklist – ask someone to read the steps aloud as you demonstrate them • Make sure that everyone can see the steps involved • Never demonstrate the skill or activity incorrectly • Demonstrate the procedure in as realistic a manner as possible

16. Guidelines for demonstrating a Skill #2 7-15 • Include all steps of the procedure in the proper sequence according to the approved performance standards • Explain to learners what is being done—especially any difficult or hard-to-see steps • Ask questions of learners • Take enough time so that each step can be observed and understood • Use equipment and instruments properly

17. Advantages of Using Anatomic Models / Simulation #1 7-16 Learners should first practice and be found competent on an anatomic model before attempting the procedure on a client because: • Clients are not harmed or inconvenienced if a mistake is made on the model • The demonstration or practice can be stopped at any time • Several learners can practice simultaneously • Difficult tasks can be practiced repeatedly

18. Advantages of Using Anatomic Models / Simulation #2 7-17 • Practice is not limited to the clinic or operating room, or to the time when clients are scheduled • Practice of a sequence of steps or skill can be repeated at any time and as often as needed • Clinical training is possible even when client caseload is low • Training time is reduced

19. Using Models During Training 7-18 • Ensure that sufficient models are available (usually one model for two or, at most, three learners) • Make sure the model is positioned as if it were a client • As much as possible, duplicate the real situation conditions (e.g., instruments, infection prevention practices) • Always treat the model gently and with the same respect given an actual client

20. Group exercise – Demonstrating AMTSL 7-19 • Review the practice checklist for AMTSL. • Gather all of the equipment you need. • Designate a member in your group to be: • The person who read the steps as the provider practices them • The provider • The woman • The person accompanying the woman • Practice the demonstration and be prepared to demonstrate to the entire group

21. Practicing the skill 7-20 • Learners practice the demonstrated skill or activity on an anatomic model using the practice checklist • Facilitators and fellow learners observe the learner who is practicing while following the practice checklist. • After the learner has completed practicing, the mentor and fellow learner review the practice session and give constructive feedback.

22. Guidelines for giving feedback 7-21 • Be timely—give your feedback soon after the event • Be specific • Be descriptive and not judgmental • Take responsibility for your own feedback

23. Giving feedback: Before practice session 7-22 1. Greet learner. 2. Ask the learner to review her/his performance in previous practice sessions. 3. Ask the learner which steps or tasks s/he would like to work on during the practice session. 4. Review any difficult steps or tasks in the checklist that will be practiced during the session. 5. Work with the learner to set specific goals for the practice session.

24. Giving feedback: During practice session 7-23 1. Observe the learner as s/he practices the procedure. 2. Provide positive reinforcement and suggestions for improvement as the learner practices the procedure. 3. Refer to the checklist during observation. 4. Record notes about learner performance on the checklist during the observation. 5. Be sensitive to the client when providing feedback to the learner during a clinical session with clients. 6. Provide corrective comments only when the comfort or safety of the client is in doubt.

25. Giving feedback: After practice feedback session (1) 7-24 1. Greet the learner. 2. Ask the learner to share feelings about the practice session. 3. Ask the learner to identify those steps performed well. 4. Ask the learner to identify those steps where performance could be improved.

26. Giving feedback: After practice feedback session (2) 7-25 5. Refer to notes on the practice / evaluation checklist. 6. Provide positive reinforcement regarding those steps or tasks the learner performed well. 7. Offer specific suggestions for improvement. 8. Work with the learner to establish goals for the next practice session.

27. Group exercise – Role play 7-26 • Prepare a role play on giving feedback: • Group 1: Before the practice session • Group 2: During the practice session • Group 3: After the practice session • Prepare a role play to present to the whole group

28. Evaluation of skills 7-27 • When learners feel competent on models, the mentor evaluates them using the evaluation checklist. • When learners are competent on models, they begin to practice the skill or activity with clients under a mentor’s guidance. • When learners feel competent in the clinical area, the mentor evaluates them using the evaluation checklist.

29. Summary 7-28 • What are the phases for developing a clinical skill? • What checklist will the learner use while learning the skill? • What are the advantages of using an anatomic model to learn clinical skills? • When will you provide feedback to learners on their performance? • When will you evaluate learners?

30. 7-29 Do you feel able to demonstrate a clinical skill and coach skill development?