TITLE: A systematic approach to the development of a learning community for clinical educators

Authors: McAllister and Moyle

Presentation given to the British Educational Research Association Annual Conference, University of Manchester, 16-18 September 2004

This paper discusses an innovative Australian educational research and curriculum strategy designed to improve the quality of clinical teaching and learning provided to higher education students of health science. The focus was on examining and then building skills and capacity in clinical educators.

Little research has been conducted which explores the clinical education role, requirements and conditions for educational advancement from the points of view of the clinical teacher or the education provider. As a result courses develop which may not be sustainable in the long term because stakeholder requirements have not been comprehensively explored or understood.

Our study used a semi-structured interview schedule to provide a snap shot of views from stakeholders and potential students in answer to the following broad research question: What are stakeholders' views about expanding university programs in clinical education?

This paper will discuss the findings and describe the innovative curriculum project that has been developed in response. Termed an "online learning community for clinical educators" the course has been designed to develop a supportive learning community, which enhances relationship amongst students, establishes a distinct sense of place for clinical education, develops a collective body of knowledge and shared memory so that this community begins to grow its own history, tradition and discipline.

BACKGROUND

In 2003, we were successful in gaining a grant through GriffithUniversity’s quality enhancement initiative to explore a strategy to improve the quality of clinical teaching and learning provided to undergraduate students. We set out to do this by focusing on building skills and capacity in our large part time workforce – the clinical educators. We also envisaged that this quality improvement strategy would have the long term added benefits of improving the health care culture so that it became a workplace based on support for learners, supervision for novices and supportive of life long learning.

Little research has been conducted which explores the clinical education role, requirements and conditions for educational advancement from the points of view of the clinical teacher or the education provider. As a result courses develop which may not be sustainable in the long term because stakeholder requirements have not been comprehensively explored or understood.

We designed a semi-structured interview schedule to provide a snap shot of views from stakeholders and potential students in answer to the following broad research question: What are stakeholders’ views about expanding university programs in clinical education?

This paper will discuss the findings and compare those to the literature, as well as describe the innovative curriculum project that has been developed in response. Termed an “online learning community for clinical educators” the course has been designed to meet the following desired outcomes:

  1. The development of a supportive learning community which enhances relationship amongst students, so that they feel they belong and develop a growing and shared identity
  2. A sense of Place is built for clinical education, wherein students, graduates and scholars come to learn and to contribute so that it becomes organic, and vital
  3. A collective Mind is built, that is a place were new knowledge about clinical education is born, developed, researched and disseminated so that we facilitate a growing sense of confidence and competence in clinical education
  4. A shared Memory is grown, that is the community starts to develop a shared history
  5. Clinical Education as a Discipline is advanced

Literature

Skilled clinical educators are crucial to facilitating learning and skills development in students of various health professions. But maintaining educational quality in this area is challenging because of many issues (Clare et al 2002). The role requires specialised education knowledge, skills and attributes, in particular clinical teaching skills and educational research competence. There is lack of consistency in relation to the role of clinical educator. Schools and Universities may have different requirements, as may the various health services that make use of clinical educators. Many clinical teachers lack qualifications perhaps because of role overload, minimal incentives to undertake graduate study, or lack of access to relevant courses. According to some university and health service providers, there are shortages of suitable clinical educators and minimal structures to support or develop their roles. Few clinical educators are engaged in research in the field and as a result, the role is limited to teaching and learning and is, therefore, conservative rather than future-oriented and capacity building. There are also few educational pathways for clinical educators, and many lack professional support, identity and recognition.

Little research has been conducted which explores the clinical education role, requirements and conditions for educational advancement from the points of view of the clinical teacher or the education provider. As a result courses develop which may not be sustainable in the long term because stakeholder requirements have not been comprehensively explored or understood.

The Study

We designed a semi-structured interview schedule to provide a snap shot of views from stakeholders and potential students in answer to the following broad research question:

What are stakeholders’ views about expanding university programs in clinical education?

A series of interview questions included:

  1. What are the requirements of the clinical education role from the points of view of potential students, and providers?
  2. What conditions exist/could exist which would support this role?
  3. What is/could be the role of professional education in supporting this role?
  4. What would you like to see this program contain?
  5. What conditions would need to exist for you to undertake a clinical education program?
  6. What issues exist as barriers and opportunities for your School in relation to clinical education?
  7. Would a multi-disciplinary program in clinical education be useful to your school?
  8. If a scholarship for students was available who do you think should/could fund it?

After gaining ethical approval through Griffith University Human Research Ethics Committee, 10 participants were recruited through a process of snowball sampling. We sent an introductory email to a group email list inviting participation. This recruited academics who teach within the School of Nursing. We also surveyed potential students and potential providers. The research assistant trained in interviewing skills and in education, was not familiar with clinical education and this naivety allowed her to encourage open and critical dialogue. She was seen as impartial.

Data was analysed qualitatively using thematic analysis.

Findings were compared with current clinical education literature.

Findings

  1. Clinical educators lack formally learned knowledge and skills relevant to teaching students.

Clare, White, Edwards and van Loon, 2002 produced a national report on the curriculum for nursing identified the need for greater linkage between learning that takes place within the university and clinical contexts. The report emphasized that clinical teachers need to have the skills to respond to various learning styles and curriculum models, to encourage learning, provide feedback, develop currency in nursing knowledge and integrate science knowledge and reflective practice.

Currently in Australia there are no specialized education courses for nurses. Even though a key selection criteria for promotion is for nurses to be active in clinical education, that activity is confined to the practice arena, and nurses are not offered opportunities to investigate education formally and no graduate qualifications are available.

  1. Clinical educators have no professional body

Clare et al (2002) also noted that there is no infrastructure to support their role and that this reinforces barriers between universities, students, new graduates, employers and the nursing profession. A professional body could assist in gaining clarity of the role (clinical teachers have important roles in guiding, coaching, motivating, and inspiring, teaching through role modelling, and performance appraisal, liaising, and finally assessing students.

A professional body could also set benchmarks and credential qualified educators, which would offer consistency for the role definition and performance

BENEFITS TO QUEENSLAND

In Queensland, Australia and Internationally, there is a critical shortage of health professionals and in particular nurses. Although tertiary institutions aim to graduate clinicians who are critical practitioners and ready to work within the current health care system and who can adapt to change, there is evidence that new health graduates quickly become disillusioned and burnout by the health system. In particular, Australian National Reviews of nursing (DEST 2002; National Review of Nursing Education 2001) have revealed that a lack of suitable education and cultural support at the workplace may deter many nurses from remaining within the healthcare industry. One imagines that other health professional graduates may have the same concerns that lead to their resignation.

The proposed program would benefit students of health professions as well as the clinical population by more adequately preparing clinical educators in their efforts to educate and support students in the workplace. This would be an important strategy to improve

CURRICULUM DEVELOPMENT

An educational program was then created that aimed to respond to the needs and requirements uncovered in the research.

Termed an “online learning community for clinical educators” the course has been designed to meet the following desired outcomes:

  1. The development of a supportive learning community which enhances relationship amongst students, so that they feel they belong and develop a growing and shared identity
  2. A sense of Place is built for clinical education, wherein students, graduates and scholars come to learn and to contribute so that it becomes organic, and vital
  3. A collective Mind is built, that is a place were new knowledge about clinical education is born, developed, researched and disseminated so that we facilitate a growing sense of confidence and competence in clinical education
  4. A shared Memory is grown, that is the community starts to develop a shared history
  5. Clinical Education as a Discipline is advanced

We worked with a team of IT professionals and educational designers to create an online course. We wanted the learning community to evoke a sense of place and to remind students of close-knit communities. So we constructed a virtual village. The village contains the following features that help to meet our learning outcomes.

  1. We have a community building -- a place for occasional congregation and ritual, be a place for displays, perhaps posters, messages of support or celebrations of birthdays/anniversaries or achievements. It will be a beautiful place that changes with the months/seasons
  2. A café: Paloff & Pratt (1999) suggest this inclusion as a place that is primarily a student space, not directly tied to the curriculum which will contribute to opportunity for relationship and social communication especially informal discourse.
  3. A library:

that contains a reference desk (for clinical policies and forms)

contemporary articles on clinical education

Links to relevant data bases

Links to relevant clinical education websites

  1. A craft shop: a co-op that will begin tiny and grow to collect and then weave together (like a patchwork quilt) the creative strategies that members use to engage students to achieve clinically. It may be that in the future there will be some sort of display of this produce, and then a celebration at its completion.
  2. A classroom:

Where members will need to be present regularly and make a comment of some sort

Instructors will establish guidelines for participation so that it is more likely that students will engage with colleagues

Discussion triggers will be provided (can we make some trigger videos of clinical learning scenarios, do we have some quotes, some issues that are relevant to explore)

The idea for a craft workshop will be raised, and a paper/book will be collaboratively developed (Active learning will take place, emphasis on creating knowledge and meaning communally)

  1. A clinical school: A place where virtual students present with learning issues and are responded to by virtual clinical educators (use of videos, gaming technology…)
  1. A post- office:

Where members can submit completed assessment items, authored works…

Where members can find contact addresses for members

Where members can send/receive messages/resources to each other

  1. Avirtual gallery:

Where images of community, clinical teaching triggers, nursing practices can be posted and discussion initiated

  1. A Health Service:

Where members can go for links to counselling/health

or where members can advise their students to go if they have health problems that interfere with prac?

Advice for strategies for managing ongoing student health problems

References

Clare, J., White, J., Edwards, H., & van Loon, A. (2002). Curriculum, clinical education, recruitment, transition and retention in nursing. AUTC Final Report. FlindersUniversity: Adelaide.

Palloff, R., & Pratt, K. (1999). Building learning communities in cyberspace.San Francisco: Jossey-Bass.

Retallick, J., Cocklin, B., & Coombe, K. (1999). Learning communities in education. Routledge: London.

Sergiovanni, T. (1994a). Building community in schools. San Francisco: Jossey-Bass.

Sergiovanni, T. (1994b) Organisations or communities? Changing the metaphor changes the theory. Educational Administration Quarterly, 30(2), 214-226.