Student Learning in the Clinical Setting

1. Student Learningin the Clinical Setting

2. 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.

3. 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 Shifting Paradigms in Nursing Education - McBride, 1999

4. The Most Predictive Indicators of Learning Outcomes: • Two environmental factors • Interaction among students • Interaction between students and faculty - Astin, 1991

5. 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

6. Interactive Learning... 4-6

7. Clinical Learning: An Exemplar of Interactive Learning

9. 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.

10. 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

11. 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?"

12. 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.

13. 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.

14. Convergers • Abstract conceptualization/Active experimenterThe relevancy or "how" of a situation • Application and usefulness of information is increased by understanding detailed information about the system's operation.

15. Specific clinical learning techniques • Interactive, not passive • Computer-assisted instruction is a possibility • Problem sets or workbooks can be provided for students to explore

16. Divergers • Concrete/Reflexive learnersmotivated 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.

17. 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.

18. How do YOU learn best? 4-18

20. Learning Strategies • Think, pair, and share • Communication, communication, communication • Writing vs. speaking • 'Building' exercise • Contributing something of substance

21. When and How People Learn BEST:A Research Perspective 4-21

22. 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

24. Seven Principles of Good Practice in Undergraduate Education: Chickering and Gamson (1991) • Encourage contacts between students and faculty • Develop reciprocity and cooperation among students • Encourage active learning • Give prompt feedback

25. 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

26. 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

27. 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

28. 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.

29. 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

30. 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

31. Research Shows • Experts' abilities to think and solve problems depend strongly on a rich body of knowledge about subject matter. - Bransford, et al., 2000

32. Best practices for clinical faculty: NLN, 2010 • Provide feedback • Facilitate reflection

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

34. Summary: What did you learn? 4-34