Implementing Change in Clinicians and Clinical Educators Thur April 16 th 4-5pm By: Linda Spencer and Tenecia Yeboah New Mexico State University Edgar R. Garrett Speech and Hearing Center
Implementing Change in Clinicians
and Clinical EducatorsThur April 16th 4-5pm
By: Linda Spencer and Tenecia Yeboah
New Mexico State University
Edgar R. Garrett Speech and Hearing
Center
Learning Objectives--
Participants will learn to:
• Set a foundation for a positive clinical experience for
the Clinical Educator and the Student Clinician
• Choose and employ an effective diagnostic for
spotting student clinician conflicts
• Utilize proactive strategies to evoke growth in the
student clinician throughout the graduate student
experience
Did you Ever….
• Dread meeting with a student after a clinical
session that that was unsuccessful?
• Dread meeting with a clinical educator who
has either ‘crossed the line’ with feedback or
suggestions?
Some Reasons for ‘Dread’
• Clinician is ill-prepared
• Clinician has a sparse tool-kit
• Clinical Educator is averse to
change
• Clinical Educator is ‘burnt out’
YET—We are agents of change!
"Coping with our common problems can be an adventure
in creativeness.” Wendell Johnson
Model for Success
Pre-emptive training
Monitoring-Checking in and
Checking up
Remediation-a plan for those who struggle
CE TRAINING
• Training that is Face-to-Face
– ONLINE MODULE IS IN PREPARATION
• Face-to-face format is three CEUs
• Saturday AM
• Conference is light-hearted, with humor, yet
informative
Pre-emptive training
Example Content
• Models of Clinical Education Practices
– Traditional
• Transform behavior of clinician
• Focus on clinical struggles
• Early stages, supervisees believe the educator is ‘right’
or has the answer and is with-holding it
• CEs described as active, directive, didactic, dominant,
controlling, infomrative
Example Content
• Models of Clinical Education Practices
– Relational/Reflective CE emphasizes
• Analytical
• Technical
• Theroetical
• Intrapersonal
• Subjective
• Affective principles of being a clinician
Thinking about ‘Ports of Entry’
• Working from outside in - the goal is to
change, or modify, the overt patterns of
behavior, knowledge, and skills of the
supervisee.
• Working from inside out - the goal is to
understand the covert, internal processes
and affective states of the supervisee
Scenarios are used• Examples of Clinical Educator/Clinician dyad
communication vignettes
• Target traditional vs Relational/Reflective
practices
– Use of self
• 1st develop mindsight
• 2nd distinguish between background and foreground
questions or comments
• 3rd notice and attend to physiological sensations during
interactions
Facilitating Healthy Student and
Clinical Educator Relationships
• Clinical Educator (CE) vs Clinical Supervisor
– CE is more descriptive of what is taking place
– Term is more active
– CE has a role to facilitate a student’s development
and skills set
• MENTORING
Why we need mentors• Guidance and support
• To structure working environment
• To provide constructive, honest feedback
• Role model
• Encouragement
• To build confidence
• To assess competenceGopee, N. (2011) Mentoring and Supervision in Healthcare Sage
Publications, Coventry, UK.
Tasks and Skills that Facilitate an Effective
Relationship between CE and Students (from
ASHA)
• Be sensitive to the power differential between you and the
student
• Create an atmosphere that supports learning
– The student should feel comfortable presenting thoughts and ideas about
their clinical challenges
• Be cautious and balance “support” with “friendship”
• You are an “Educator” and you have to balance your ability to
evaluate the student with your relationship valence
Tasks and Skills that Facilitate an Effective
Relationship between CE and Students (from
ASHA)• Try to teach the student that your “evaluation” of
their performance is independent of your clinical
relationship with them
• Strive for a balance of a “friendly” relationship that is
based in mutual respect
– Let the student know you respect their efforts
• Maintain an open and ongoing communication stream
with the student
Four Processes of Learning
1• Observation of skill
2• Mental retention
3• Reproduction of the skill
4• Reinforcement and adoption
Four Processes of Learning• Observation of skilled
performance– Modeling stimulus
– Observed behavior is useful
– Observer becomes aware of
the skill needed
– Observer becomes eager to
learn the skill
– Observer recalls positive
reinforcement for previous
learning
• Retention of the skill– Step-by step performance of
the skill becomes assimilated
– Mental rehearsal of modeled
behavior
Gopee, N. (2011) Mentoring and
Supervision in Healthcare Sage
Publications, Coventry, UK.
Four Processes of Learning
• Motor reproduction of
the skill
– Observer carries out
observed behavior or
skill
– Self –evaluates
performance
– Reinforcement and
adoption
• Behavior is reinforced by
external reward (praise,
self affirmation)
• Behavior is adopted
Gopee, N. (2011) Mentoring and
Supervision in Healthcare Sage
Publications, Coventry, UK.
Student Clinician Training
• Ramp up of clinical services (First semester
one client—Final semester full-time
Externship)
• Thorough Orientation Session is held
– Elements of Training
• Procedures Fire training, HIPPA
Pre-emptive training
CD 589 Class
• Purpose of the class
(Twice a week)
– Extra preparation
• Therapy planning
• Documentation
– ‘Grand rounds’ sharing tough cases
– Overall support
– Practice Evaluations
Clinician Self-Evaluative Process
Open-Ended
• What went well?
• What surprised you?
• What was
disappointing?
• What is my role in the
above?
• How can I change?
Ratings
• Rate your performance on a 1 to
5 scale: 5 = strongly agree; 1 =
strongly disagree;
• Plan was effective
• Used materials creatively
• Cued appropriately
• Modeled appropriately
Monitoring-Checking in
and Checking
up
Clinical Calibration
2.to determine the correct
range for (an artillery gun,
mortar, etc.) by
observing where the fired
projectile hits.
What is my target?
Am I missing the mark?
Clinical Calibration
• Executive Functions
– Metacognitive skills: Self Monitoring/Self
Reflecting
• Predicting
• Shifting
• Repairing breakdowns
Clinical Calibration
• Observational Skills
• How is the client
responding to the
stimuli?
• Recognizing non-verbal
cues
Clinical Calibration
Get feedback from the client
Use guidance from CE
Look at the data; do things match up?
Self Assessment: How did I do today?
Use PDS audio/video recordings
Clinical Calibration-Part 2
• ASHA Ethic II
• Individuals shall honor their responsibility to
achieve and maintain the highest level of
professional competence and performance.
Clinical Calibration
• On Going Self-Reflection-
(Silverman,2008)
• “The better we know
ourselves, the better we can
know and be helpful to
others.”
Clinical Calibration
• Using Self Reflection
• “We do not see things
as they really are. We
see things as we are.”-
• Anais Nin
(Silverman,2008)
Clinical Calibration
• Using reflective practice as a tool to maintain clinical competence
• Continued learning and incorporation of new advancements to expand knowledge base
• Understanding personal characteristics and affects on professional life
• Strube,Hilliard, Gooch , 2012
• Mann, Gordon, McLeod, 2009
Clinical Calibration
• Time Dependent
– In Action: in real time;
are you making/missing
your target?
– On Action: after the fact;
how did my actions affect
the outcome?
• -For Action: Predictive;
what can I change to
affect a different
outcome? • Strube,Hilliard, Gooch , 2012
Clinical Calibration
• Content Dependent• Strube,Hilliard, Gooch , 2012
Critiquing
Values &
Beliefs
Understanding
the
Problem
Exploring
a
Strategy
Asking
Why?
How effective
was the
solution?
How can I
change
this?
Mid-Semester Dispositons
• 5-8 minute ‘check-up’ with faculty and
Clinical Director
• Written documentation of ‘strengths and
weakness’
• A chance for student to voice concerns or
validations
• Signed and placed in file
Remediation of the CE
• Update with the clinical conference
• CE meetings with topical presentations
• Assign a presentation for a CE who is ‘rusty’
in an area
• Offer Continuing ED (online or face-to-face)