University of Kentucky Doctor of Physical Therapy Program.

Successfully Teaching Students Who Exhibit Challenging Professional Behaviors During Clinical Education

Lynn English, PT, MSEd, DPTKara Lee, PT, DPT, NCS

University of Kentucky Doctor of Physical Therapy Program

ObjectivesAt the conclusion of this session, the learner will be able to:

1. Identify some typical “challenging professional behaviors”.

2. Propose options for documenting these behaviors objectively.

Objectives (2)3. Give examples of specific and well-

considered communication and conflict management skills to work effectively with these students.

4. Plan for a solution to meet the needs of the instructor and learner as possible.

5. Sustain unconditional positive regard for the individual (keeping emotions and biases at bay).

And a Final and Difficult Objective

1. Inability to accurately self-assess abilities.

2. Lack of commitment to learning/responsibility… especially in certain clinical settings.

3. Lack of ability to communicate effectively...congruent with situational needs.

Challenging Professional Behaviors I Have Known

Resistance to feedback from the clinical instructors.

Lack of critical thinking/problem solving skills.

Challenging Professional Behaviors (2)

Proposed Teaching Strategies

1. Use careful and early observation of the student's performance.

2. Prepare to use an organized approach to documenting behaviors of students who are exhibiting challenging behaviors.

Teaching Strategies (2)

3. Consider early contact with the DCE/ACCE regarding the student’s level of performance in the clinical setting- either to seek help or make recommendations.

Teaching Strategies (3)

4. Carefully select learning experiences

5. Plan for/adapt clinical situations to enhance teaching

6. Communicate clearly and often - with ample listening.

Observe and note the student’slevel of learning

(Hayes, Huber, Rogers, Sanders)

First Steps with Any Student

Exposure: Student is a novice

Acquisition: Student can participate in planning and evaluating learning experiences.

Integration: Student can take most of the responsibility for planning, implementing and evaluating learning experiences.

Stages of Learning

What is the problem???Not meeting expectations for

i. safe and effective practiceii. a level of independence appropriate for

your facilityiii. a level of competence consistent with the

student’s educational preparation

Identifying Challenges

Alteration of your teaching plan may be necessary:

The student may require smaller steps in the progression of learning experiences to meet the behavioral objectives.

Performance different than expected?

Study: Diagnosis of Student Professional Behaviors

(Hayes, Huber, Rogers, Sanders; Jette, Bertoni, Coots, et al))

Behaviors deemed as questionable by supervising CIs

were either: 1. Cognitive:

a. Inadequate knowledge and skills 2. Noncognitive

a. Poor communication b. Unprofessional behaviors

Accurate Identification of Student Behaviors

1. Most unacceptable student behaviors were noncognitive, but cognitive behaviors were addressed more often.

2. Students who did not receive feedback were unlikely to change.

3. If behaviors changed, the experience was more successful.

4. CIs used cognitive behaviors more often to recommend a negative outcome.

This Study Concluded

Is it a cognitive issue? (Underlying knowledge)

Is it a psychomotor issue? (Manual skills awkward or lacking)

Is it affective? (Communication, interpersonal)Example: A student could perform well in the cognitive domain and lower than expected in the affective domain.

Teaching Strategies: Looking carefully at

where the problem lies

Develop a portfolio of examples to help the student:

Formative Evaluation Instrumentsi. Weekly Planning Form- sets goals

and documents achievement or residual needs

ii. Anecdotal Recordiii. Professional Behaviors Assessment

(Kontney, May, Iglarsh; May, Morgan, Lemke et al)

iv. Clinical Performance Instrument

Tools to Help Document

Important to determine how perceptions match--- or not.

Same tools may be completed by the student:◦ Weekly Planning form with self- assessment

component◦ Professional Behaviors self-assessment◦ Clinical Habits Inventory Test

Student Self-Assessment

Compare student performance with facilityexpectations/objectives.

Compare student performance with academic objectives.

Look at student previous clinical experience

Comparing Reality to Expectation

Again…you may choose to communicate with the academic program and contact the ACCE/DCE.

With your formative evaluation you can provide a more detailed picture of the student's performance.

Once the comparison is complete…

Confronting the Issues

Earlier is better if you have identified specific issues.

May be before midterm- at the end of a week, or as needed.

Bring documentation to clearly describe…

Meeting to discuss progress

a. Maintain an environment for open discussion

i. Identify the problem to all parties-succinctly

ii. Be open to suggestions, alternatives, ideas, and compromise

iii. Keep the environment non threateningiv. Use "cooling-off periods"

v. PRACTICE…and build in PAUSES

Using Specialized Communication Skills (Patterson, Grenny, et al; Albardiaz; Welch)

Using Specialized Communication Skills (2)

b. Manage defensiveness (yours and students’)Rehearse…Being aware of sensitive areas

i. Separating the facts from your impressions

ii. Considering your own role and contributions

iii. Using a positive approach to work with the individual’s strengths

iv. Conveying clear messages and limits

Using Specialized Communication Skills (3)

vii. Focus on the behavior, not the personviii. Focus on professional requirements

not being metix. Work to establish mutually acceptable

goal(s) to all involved partiesx. Be prepared to have a third party

present, when needed, especially in difficult discussion

c. Promote collegiality through disclosure and shared responsibility

i. Focus on completion of the taskii. Identify the tasks and each person’s

responsibilities/rolesiii. Use collegiality to define roles, not to

place each person on the same level

iv. Work together as colleagues, respecting each other’s roles to complete a task

Communicating a Negotiated Plan

d. Keep communication open to help each person understand perception of roles and responsibilities

i. Problem presentationii. Problem resolutioniii. Interpersonal dimension

iv. PAUSE and LISTEN…critical

Summarize the Discussion

e. Support the discussion with documentation- either previous or current

i. Weekly Planning Form ii. Anecdotal Recordiii. Professional Behaviors Assessment

Using Specialized Communication Skills (6)

Moving forward in the teaching/learning environment:

Once the Discussion is Completed

a. Possibilities after discussion:

i. Alter the pace of teaching/expectationsii. Give repeated similar experiences iii. Refer to the established goals.iv. Clearly maintain expectations of

professional behavior.

Give Special Attention To The Learning Environment

b. Maintain unconditional positive regardi. Keep an open mind for

explanations/motivationsii. Focus on the behavior, not the

personiii. Develop ways to work together

Give Special Attention To The Learning Environment (2)

One possible outcome:

Learning contract 

If there are serious problems:

Learning ContractUniversity of Kentucky Physical Therapy  The clinical learning objectives included in this document reflect the results of midterm CPI comments and a phone conversation with ……, clinical instructor at …….. and ………., University of Kentucky Physical Therapy student Class of …... The course is ……… Clinical Internship , The purpose of defining specific performance statements is to clarify the expectations of performance during the remainder of the clinical experience.  

I understand that I must incorporate these suggestions into my daily activities. Failure to successfully meet these objectives by DATE… may result in a requirement of further clinical internship time. I understand that emphasis on these objectives should in no way be construed to mean that the remainder of the goals and objectives for this experience are less important, or that successful completion of the remaining objectives is not required for successful completion of this experience.  

Stories from the field…

Happy Endings

Anderson LW, Krathwohl Dr, Airasian PW. et al (Ed). A taxonomy for learning, teaching and assessing: a revision of Bloom’s taxonomy of education objectives( Abridged edition). New York, NY: Addison Wesley Longman Inc; 2001.

American Physical Therapy Association. Physical Therapy Clinical Performance Instruments. Alexandria, VA: American Physical Therapy Association 2006.

Hayes KW, Huber G, Rogers J, Banders B. Behaviors that cause clinical instructors to question the clinical competence of physical therapy students. Phys Ther. 1999; 79:653-671.

References

Patterson K, Grenny J, McMillan R, Switzler A. Crucial Conversations: Tools for Talking When the Stakes Are High. New York: McGraw Hill; 2012.

Shea ML, Boyum PG, Spanke MM. Health Occupations Clinical Teacher Education Series for Secondary and Post Secondary Educators. Urbana, IL: Department of Vocational and Technical Education, University of Illinois at Urbana-Champaign, 1985.

References(2)

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