Student Performance: Above vs. Below Expectations

1. DTCC Clinical Education Jason A Dougherty PTA, BS Student Performance: Above vs. Below Expectations

2. This Training Module • Thank you for serving as clinical faculty. Thank you also for providing input with regard to what we can do to help you develop as a clinical instructor • This has been compiled in response to feedback from your Effective CI Self Assessment form • Some of these suggestions are constructive with either student experience (students who perform above vs. below expectations)

3. Students’ Expectations of CI Performance • According to Healey, students will enter their clinical affiliation with these expectations. • Patient Interaction • Complex and contextual learning focused on patient care • Supportive Learning Environment • Strong relationship with a clinical instructor who models appropriate behaviors such as a commitment to the teaching and advanced communication skills • Environment allows for student self assessment and constructive feedback during diverse clinical experience

4. CI Expectations of Student Performance • Some students will consistently exhibit the behaviors listed below, requiring less intervention from their clinical instructor • Above Expectations • Safe practitioner/maintains confidentiality • minimal cues required • Strong behaviors/empathy • appropriate communication throughout clinical environment • More autonomous/takes responsibility • quickly progresses to greater independence with patient treatment & clinic procedures • Requires higher level of challenge • Fear student may become bored

5. CI Expectations of Student Performance • Some students may also consistently exhibit the behaviors listed here, requiring greater intervention from their clinical instructor • Below Expectations • Patient Safety/Confidentiality • Requires significant cues with little carryover • Behaviors • Maintains inappropriate relationship and/or inappropriate communication with staff and patients with minimal response to cues. Will not take responsibility for change • Treatment • Unable to apply prior teachings while offering no explanation for decision making • Requires a greater amount of input from CI, possibly taking away from patient care

6. Examples of Behaviors of Concern • These are just some behaviors that we would find inappropriate • Abrasive (disrespect) • Inappropriate language (vulgar/jokes, racially or sexually inappropriate) • Over confident (affiliation is a waste of time) • Distracted or unmotivated (requires cues to do everything, “I don’t know”) • Argumentative • Inappropriate dress • Lateness or unexcused absence • Unprofessional (doesn’t follow plan of care, doesn’t complete full treatment, procedural issues) • Lack of preparation (fails to complete assignment/request)

7. Sample Behavior

8. Student exhibits behavior Algorithm for Student Intervention Meet with CI for constructive input + Carryover – no longer exhibits *No need for follow up Continue behavior Meet with CCCE & document weekly progress + Carryover – no longer exhibits *continue to document weekly Continue behavior Meet with ACCE Develop learning Contract + Carryover – no longer exhibits *begin daily log *continue to document weekly Continue behavior Affiliation Terminated

9. Intervention • Both student populations (above and below expectations), require some form of additional intervention. The following slides contain some suggestions for designing the student's experience in response to their level of performance.

10. Above Expectations • No matter what the theme of your discussion, it is vital to maintain a positive attitude • (+) “ You have been doing really well, let’s try to change your goals to include…. • (-) “ You have met all of your goals, I don’t know what else to do with you”

11. Above Expectations • Don’t assume a high level of performance in every aspect of their clinical affiliation • Example • Great with patient care and maintains a strong, professional relationship with professional staff for 5 weeks. BUT, experiences difficulty with in-service on their last day because of a poor research review or difficulty with public speaking

12. Above Expectations • Maintain Communication • Hourly, Daily, Weekly, Midterm and Final • Even a strong student will need guidance • They may confuse the CI’s confidence in their skills' as avoidance • Example • “My CI was never available after the first couple days” • “My CI was always in their office”

13. Above Expectations • Make sure student participates in goal setting (self directed learning). They should not believe they are a passive participant. • Examples • They didn’t give me enough to do • They didn’t offer me anything else.

14. Above Expectations • Utilize your facility to it’s full potential as an educational site. • Example • Surgical Observation • Observation of other disciplines (OT, Speech) • Care Conferences • Community Programs • Research Opportunities • Libraries • Shadow Physicians

15. Above Expectations • Research topics of interest • Examples • Use this time to… • Look up articles about a previous question • Research topics for in-service • Develop a case study

16. Above Expectations • Do not shelter student from difficult patient interactions. These interactions will contribute to your student’s growth • Examples • Combative patient • Non communicating patient • Patient with challenging pathology

17. Below Expectations • The remaining slides offer suggestions for coping with students whose performance may be below your expectations as a clinical instructor. Please remember that you can always contact me should you have any concerns re: student issues. • Jason Dougherty • 302-657-5131 office / 302-884-9431 pager • jadougherty@christianacare.org / jdoughe7@dtcc.edu

18. Below Expectations • Remind student that their learning should be self directed • Discuss goals together • Are student and CI goals similar (expectations)? • Clinical setting has shifted from learner based to knowledge based • Example/Suggestion • Avoid hearing, “you didn’t show me…”. Instead ask the student, “what do you expect” or “what would you like to accomplish”

19. Sample Behavior

20. Below Expectations • Don’t hesitate to provide constructive input • Don’t forget the positive/affirming • The sooner the better • Discuss with student when they prefer to discuss performance – greater self directed learning • Example/Suggestion • Provide input re: behaviors at the end of the day allows student to improve tomorrow vs. • Wait until Friday, don’t expect change until next week

21. Below Expectations • Maintain positive approach during constructive input • Focus on behaviors not personal judgment • Use cool off period if necessary • Take time to collect thoughts and compile succinct input to provide to student • If not succinct, impact of input can be lost • Example/Suggestion • “Here is what you did wrong…” vs. • “Here are some areas that could be improved…”

22. Below Expectations • Use Diagnostic Education • Discuss thought process to figure out where “wrong turn” occurred • Cover all domains of learning. Explain, exhibit & discuss, then ask student to repeat • Discuss patient prior to treatment time and suggest scenarios as well • Example/Suggestion • Patient scenario • What are symptoms? • What is causing symptoms? • What can be done to quiet symptoms? • What can be dome to alleviate future issues? • Ask student to perform intervention on CI/staff • Ask student to do necessary research prior to treatment

23. Below Expectations • Use Diagnostic Education (cont) • Clarifies early misconceptions • Ask for student input (self directed) • Ask student to use a daily reflective journal – another opportunity to understand their perspective and though process • Example/Suggestion • Avoid hearing, “I thought we were supposed to…” or “ This wasn’t what I wanted to do…”

24. Below Expectations • Document, document, document • Every time you document constructive input is another opportunity for the student to improve • Example/Suggestion • Weekly log • Midterm and Final Student Performance Evaluation • Learning Contract • Meeting Minutes (with student) • Ask student to compile: • Journal • Proficiency Checklist

25. Below Expectations • Consider Environment • Student may hesitate to communicate in front of others • Student may not be comfortable directing input directly to CI • Provide every opportunity for them to talk • Student may need space for paperwork • Easily distracted • Example/Suggestion • Change environment for meeting • Cafeteria, coffee shop, outside • Use third party for communication if needed • Student may fear lower grade if they give CI constructive input • Provide desk, locker, shared office

26. Below Expectations • Consider CI is always the model for ideal practitioner • “Do as I say, not as I do…”? • Maintain continuity if more than one CI • Don’t take for granted the “small stuff” – give student every opportunity to be comfortable in your clinic • Example/Suggestion • CI must exhibit positive attitude about PT & teaching • A 2nd CI may not display same attitude toward PT and teaching • CI must be a willing CI, not forced to take a student • “Small stuff” • Orient student to clinic, equipment, paperwork and introduce to staff

27. Below Expectations • Remind student that we must follow legal and ethical codes • Example/Suggestion • APTA • Delaware State • Pennsylvania State

28. References • Physical therapy clinical instructor educator credentialing manual. (1997). Alexandria, Va: American Physical Therapy Association. • Bransford, J.D., Brown, A.L. & Cocking, R. R. (2000). How people learn: Brain, mind, body and school. Washington D.C.: National academy press. • Cole, B. & Wessel, J. (2006). How clinical instructors can enhance the learning experience of physical therapy students in an introductory clinical placement. Advances in health sciences education, 13, 163- 179. • Hanson, K.J. & Stenvig, T.E. (2008). The good clinical nursing educator and the baccalaureate nursing clinical experience: attributes and praxis. Journal of nursing education, 47:1, 38. • Healey, W. (2008). Physical therapist student approaches to learning during clinical education experiences: a qualitative study. Journal of physical therapy education, 22:1, 49-57. • Hirsh, D. A., Ogur, B., Thibault, G. E., & Cox, M. (2007). Continuity as an organizing principle for clinical education reform medical education. The New England journal of medicine, 356:8, 858.

29. References (cont) • Kelly, S. (2007). The exemplary clinical instructor: a qualitative case study. Journal of physical therapy education, 21:1, 63-69. • Kraft, M. & Neitzke, G. (2000). Communication in medical education: student’s demands. Medicine, healthcare & philosophy, 3, 185-190. • Lasater, K. & Nielsen, A. (2009). Reflective journaling for clinical judgment development and evaluation. Journal of nursing education, 48:1, 40-44. • Sliwinski, M., Schultze, K., Hansen, R., Malta, S. & Babyar, S. (2004). Clinical performance expectations: a preliminary study comparing physical therapy students, clinical instructors & academic faculty. Journal of physical therapy education, 8:1, 50-57. • Wolfe-Burke, M. (2005). Clinical instructors descriptions of physical therapist student professional behaviors. Journal of physical therapy education, 19:1, 67-75. • Wolfe-Burke, M., Ingram, D., Lewis, K., Odom, C. & Shoaf, L. (2007). Generic inabilities and the use of a decision making rubric for addressing deficits in professional behavior. Journal of physical therapy education, 21:3, 13-22.