Earl Clarence V. Coniconde, RN Queen Q.

Alimbubuyog, RN

Clinical Teaching Dr. A.K. Yngente

TEACHING STRATEGIES/METHODOLOGIES FOR RELATED LEARNING EXPERIENCES (RLE)

Models of Clinical Teaching

Traditional Model

The teacher both serve as the Classroom instructor and clinical instructor of a group of students. The benefit of this setting is that the students are given the opportunity to directly apply in the clinical setting what has been taught inside the classroom. Since the educator provides both the instruction and evaluation, the facilitator can select activities that will meet the students needs in consideration with the course goals and objectives. However, if the facilitator is handling a large group of students, he may not be accessible to students when needed because of the demand of other student. The facilitator, since he is not really part of the health care team in the clinical setting, he may lack expertise in clinical skills, teaching procedure and use of technologies. Another disadvantage of the traditional model is that since the facilitator is an outsider to the clinical setting, he may not fully grasp the system of care and its culture. Therefore, strong, trusting and supportive relationship must exist between the facilitator and the staff of the clinical setting, a task which depends widely on the interpersonal skill of the facilitator and the cooperation of his students.

Preceptor model

The preceptor model is usually used in upper level nursing students and in distance courses, wherein each student is partnered with an expert nurse and learns from him/her on a one-on-one basis. The preceptor is a staff of the health facility that renders direct nursing care to the patient while at the same time manages the clinical learning experience of the student assigned to him/her. The preceptor helps the student in bridging the juncture between classroom and clinical setting, immerse into the professional practice and socialize in the professional circle. The faculty member on the other hand acts as the course coordinator, liaison between the nursing education program and clinical setting, and resource person for the preceptor.

This model allows the student to develop and learn confidence at work, critical thinking and decision making skills while following a role model. However, the disadvantage in this model is the lack of integration of theory, research and practice, lack of flexibility in reassigning students to other preceptors when needed and time and other demands made on the preceptor. The disintegration of theory, research and practice is grounded on different educator in the classroom and clinical setting. The preceptor may have already been practicing her own way of carrying nursing care and techniques which may be different from, but still acceptable to nursing community, the classroom setting. Lack of flexibility in reassignment may be due to time constraint, financial and human resource problems. Since the preceptor works as a staff nurse and nurse educator, demands from nursing role may affect her time with her student. The biggest advantage for this model is the individualized approach in addressing the students specific learning needs.

Paired Model

Paired model is a variation of preceptor model wherein a student is paired with a staff nurse for a clinical day. Nurse manager determines the number of students that can be paired depending on the available staff on duty among other circumstances. The remainder of the students time is spent by traditional method. The advantage for this model is that the students feel more comfortable in the area because a sense lot belongingness is bestowed upon them. They feel less anxious in the clinical environment thus they experience enhance learning. However, this type of model involves more human resources to be facilitate the students learning that might demand more budget allocation.

Partnership model

In the partnership model, the nurse education program partner up with a health agency in a symbiotic relationship. The nurse education program benefits from partnering with the health care agency in order to address their budgetary constraints, nursing faculty shortage, and lack of clinical sites. On the other hand, health care agency benefits from nursing education program in increasing nursing workforce in their institution. Expertise and services are shared between the partners. The advance practice nurse from the health care agency teaches the nursing students in the clinical area, while the course coordinator and faculty member acts as consultant or or researcher for the institution. The facilitator in the clinical setting may handle students individually as the preceptor model or as a group as the traditional model. Partnerships may also

be community based like several heath department, community health center and other community based organizations.

FOUR TYPES OF CLINICAL STRATEGIES

Learning Objectives: At the end of the presentation, we should be able to: Enumerate the models of clinicalteaching used by nurse instructors in their area. Identify different teaching strategies/methods commonly utilized in the clinical setting. Explain the purposes as well as the advantages and disadvantages of such teaching methodologies Discuss examples and situations where these teaching techniques may be applied.

Traditional Teaching Strategies

Lecturing Purposes of Lecturing An efficient means to introducing learners to new topics Can be used to stimulate students interest in a subject. Can also be used to inspire people. Another purpose of the lecture is to integrate and synthesize a large body of knowledge from several fields or sources. (Parker, 1993) Difficult concepts can be clarified. Valuable where knowledge is advancing rapidly and up-to-date textbooks are available (Jones, 1990)

Advantages of the Lecture Method Economical Supplements a textbook by enhancing a topic and making it come to life. During a lecture, the teacher serves as a role model for students. Helps students develop their listening abilities. (Stunkel, 1998)

Disadvantages of the Lecture Method By nature it lends to the teaching of facts while placing little emphasis on problem solving, decision making, analytical thinking, or transfer of learning (Black, 1993 et al).

Surface learning students memorizing information and failing to truly comprehend or tie new information to existing cognitive schemata Not conducive to meeting students individual learning needs. Limited attention span on the part of learners

Organizing the Lecture Planning the lecture well ahead of the time of delivery is time well spent because a lecture thrown together at the last minute appears to be just that. Objectives of the lecture Gauge how much time it will take to cover the content The difficulty of the material and the ability level of the audience

Forms of Lecture Outline Hierarachical or classical Problem-centered format Comparative structure Thesis format (Bligh, 2000)

Delivering the Lecture The planning and organizing of content are finished. Now its time to deliver the lecture. We need to plan your delivery, rehearse, and consciously think about your techniques of delivery if you are to maximize your effectiveness Controlling anxiety Spontaneity Voice quality Body language Speed of delivery Getting off on the right foot Clarifying during the lecture Facilitating retrieval from memory

Types of Lectures Traditional oral essay Participatory lecture Lecture with uncompleted handouts Feedback lecture Mediated lecture

Discussion Formal discussion the topic is announced in advance and the class is asked to prepare to take part in the discussion by reading certain materials or watching a videotape and so on. Informal discussion take place spontaneously at any point during the class including at the end of a lecture when the teacher asks, Are there any questions? Purposes and Advantages of Discussion Give learners an opportunity to apply principles, concepts, and theories and, in that process, to transfer their learning to new and different situations. Clarification of information and concepts Students can learn the process of group problem solving Discussion with nurses or nursing students about professional, societal, or ethical issues can help participants develop and evaluate their beliefs and positions. Attitudes can be changed through discussion. (Bligh, 2000) Many students like it and may even prefer it to other methods. (Beishline & Holmes 1997)

Disadvantages of Discussion They take a lot of time. One person or a few people monopolized the discussion Discussions are valuable only if the participants come prepared with the necessary background information.

Discussion Techniques Make your expectations clear Set ground rules Arrange the physical space Plan a discussion starter Facilitate, dont discuss Encourage quiet group members Dont allow monopolies Direct the discussion among group members Keep the discussion on track Clarify when confusion reigns Tolerate some silence Summarize when appropriate

Questioning Functions of Questioning Places learners in active role. Questions can be used to assess a baseline of knowledge Can also be used to review content

Levels of Questions Convergent or Divergent (Wink, 1993) o Convergent require the learner to recall or integrate information they have learned. They have specific, usually short and expected answers. o Divergent ask the learner to generate new ideas, draw implications, or formulate a new perspective on a topic. There is no single correct answer. Lower-order or Higher-order (Barden, 1995) o Lower-order questions those that require the learner to recall information that they have read or memorized. o Higher-order questions require more than recall. To answer a higher-order question, the learner would have to be able to comprehend or think critically about the information. Blooms taxonomy o Knowledge o Comprehension o Application o Analysis o Synthesis o Evaluation

Types of Questions Factual questions Probing questions o Extension probes o Clarification probes o Justification probes o Prompting probes o Redirection probes Multiple-choice questions Open-ended questions

Discussion-stimulating questions Questions that guide problem-solving Rhetorical questions

Questioning Techniques Prepare some questions ahead of time State questions clearly and specifically Tolerate some silence Listen carefully Use the beam, focus, build technique Provide feedback Handle wrong answers carefully

Stimulating Learners to Ask Questions Thanking or praising the person for asking the question and, After answering it, asking the questioner if you have answered the question. When responding to a question, talk to the whole class, not just the questioner.

Using Audiovisuals Selecting Media How does an educator begin to select the appropriate media, and how and when should they be used? These decisions are based on a number of factors. The chief determinants are the learning objectives. Another factor to consider in deciding on media use is availability of both materials and technical assistance. The level, ability and number of learners are also important considerations, especially if you want to assign audiovisuals for individual use.

Types of Traditional Audiovisuals Handouts Used to communicate facts, figures and concepts. Some highly detailed explanations can be followed along by the audience. Saves a lot of time to give information in handout form rather than spend class time lecturing on it.

If handouts are distributed before class, learners can review them in preparation for class discussion. Ensures that all learners have access to the same information and can review that information whenever necessary. Useful for reinforcing patient teaching. Drawbacks o Costly o Nursing students may get so engrossed by what you have on a hard copy that they don't hear anything else you say. o Some learners read slower than others.

Chalkboards/Whiteboards Universally used in education. Allow for spontaneity in the classroom. New ideas or solutions to problems can be jotted down as they are mentioned. If learners are suddenly confused about something, the point can be illustrated on the board. If learners cannot visualize an object, it can be quickly sketched. Useful for working out mathematical problems, for spelling new words, for outlining material to be covered in class, and for having several students placing their ideas on the board at the same time Drawbacks o Mess made by chalk o The fact that material on the board usually cannot be saved until the next class o The fact that the board may not be visible to very large groups o While writing on the chalk/whiteboard, your back is to the class, which may cause you to lose flow of contact with the learners and interfere with their ability to hear you. o Not good for instructor who has poor handwriting, since the information may be lost to students who cannot decipher it. Overhead Transparencies Easy to make, use, store, and transport and can be an asset to any teacher. Can be used similarly to a chalk/whiteboard for writing down spontaneous ideas, outlining class content, or doing math problems, but their use surpasses that of a chlk/whiteboard. Can be prepared beforehand to save class time and to help organize and illustrate content.

 Slides

Diagrams and drawings can be drawn or copied onto transparencies. Concepts can be illustrated and lectures can be outlined. Charts and graphs can be presented. Cartoons can be projected for humor and illustration. It stands in front of the audience and you can face the class while using it, thus, eye contact can be maintained. It is easy to use, requiring only manipulation of the on-off switch and a focus knob.

Use slides to show pictures or project diagrams, charts, and word concepts. Can be effective promoters of discussions Can help to make abstractions concrete Can lend realism to an otherwise academic discussion. Not too expensive to make or buy They are compact and easy to store They are easy to update and reorganize to fit changing class needs The teacher can control the speed of slide presentation so that each frame can be discussed for the desired length of time It is also easy to back up to previous frames if a question arises pertaining to them. Drawbacks: o Can easily get smudged with fingerprints because they are so small o They can get bent inside a malfunctioning projector. o Projector blubs dont last too long and are expensive to replace. o Reduced room light is necessary to get a clear image on the screen, which makes it difficult for learners to take notes.

Videotapes Showing commercially produced videos as a teaching method in academic settings has been found to produce learning outcomes similar to those resulting from lectures Costeffective method of patient education that is acceptable to the public and results in learning outcomes similar to that achieved by in-person teaching Advantages include a teacher can still maintain eye contact with the class and provide something of a personal touch, even though the performance is not live. Motion enhances the realism of the situation and often increases interest. Can be used at the learners own pace. The learner can replay and freeze frames according to his or her needs. Teacher may choose to freeze the action and discuss what has just been played before proceeding

Drawbacks: o Communication is only one-way and learners cannot interact with the medium; they become passive recipient of information. Can be minimized by instructor involvement before, during and after showing videotapes. o Cost of good videotaping equipment can be high. Demonstration Follows tell, show, then elicit pattern, where the instructor explains the concept or procedure, shows the student how to apply the concept or perform the procedure, and then elicits a comparable performance from the student.

Case Studies Clinical Concept Mapping Teacher-Created Data Collection Forms Daily Nursing Care Plans

Activity-Based Teaching Strategies

Cooperative learning Based on the premise that learners work together and are responsible for not only their own learning but also the learning of other group members.

Types Formal Groups to complete a specific learning task consisting of concepts or skills; one class to many weeks; Informal Groups to enhance understanding of specific unit of information; to make connections to prior learning; no more than one class and perhaps for only a few minutes during a class Base Groups to provide encouragement and to monitor progress throughout the learning experience; length of the learning experience usually long term

Advantages Group members learn to function as part of a team Working in a group for any length of time can teach or enhance social skills Can help address individual learning needs and learning styles

Critical thinking is promoted

Simulations Controlled representation of reality Exercises that learners engage in to learn about the real world without the risks of the real world.

Types Simulation exercise a controlled representation of a piece of reality that learners can manipulate to better understand the corresponding real situation Simulation game a game that represents real-life situations in which learners compete according to a set of rules in order to win or achieve an objective. Role-playing a form of drama in which learners spontaneously act out roles in interaction involving problems or challenges in human relations Case study an analysis of an incident or situation in which characters and relationships are described, factual or hypothetical events transpire, and problems need to be resolved or solved.

Purposes and Uses Simulation are intended to help learners practice decision-making and problem-solving skills Develop human interaction abilities Learn psychomotor skills in a safe and controlled setting Gives chance to learners to apply principles and theories they have heard or read about and to see how and when these principles and theories work. Simulations are usually worked out by groups of learners Can be used to achieve many learning objectives Simulations is also an avenue for attitude for change Decision-making skills can be fostered Simulation strategies can be applied to the teaching of psychomotor skills.

Problem-Based Learning (PBL) It is an approach to learning that involves confronting students with real-life problems that provide a stimulus for critical thinking and self-taught content. PBL is based on the premise that students, working together in small groups, will analyze a case; identify their own needs for information, and then solve problems like those that occur in everyday life.

Problem-based learning is thought by some people to be synonymous with the simulation case method of teaching and learning. In fact, it is not the same but a significant variation from the case method. Students using PBL have little background knowledge of the subject matter in the case, whereas in the case method, students already have mostof the background knowledge that need to apply to the case.

Self-Learning Modules Defined as a self-contained unit or package of study materials for use by an individual. Components of Self-Learning Modules o Introduction and instructions o Behavioral objectives o Pretests o Learning activities o Self-evaluation o Posttest

Computer-Teaching Strategies
Computers are used to communicate information to students and nurses in a time-saving way, to teach critical thinking and problem solving, to provide simulations of reality, and to educate from a distance. In the clinical world, computers are used to communicate with other health care professionals , to access patient records in real-time online, to provide patient teaching , and to provide home-based care and support for the chronically-ill In addition to mastery learning, computers can maximize time on task and can help develop overlearning. Overlearning is achieved when learners practice beyond the point of mastery and responses are automatic. Computer programs provide instant feedback, which is effective in learning. The computer can reply to the students answers with statements like Good job, Ann, or Juan, you have really learned that well, The use of the learners name gives the impression of a human teacher providing the feedback , and many people, even educators, enjoy seeing the computer use their name once in a while. Perhaps the greatest advantage of computer instruction is that it allows a person to interact in the learning situation; he or she can respond to questions, manipulate variables, solve problems, and create plans and strategies

Computer Assisted Instruction

Drill and Practice Tutorials Games Simulations Multimedia Presentations Evaluating Software Computer-Assisted Instruction for Patient Education Computer-Assisted Instruction for Nursing Students and Staff

Computer-Managed Instruction Teachers can use computers to manage, prepare, organize and evaluate educational experiences.

The Internet E-mail News Groups World Wide Web World Wide Web Searches Mobile/Smartphone Applications

Virtual Reality It is a computer-based, simulated three-dimensional environment in which the participant interacts with a virtual world. The learner does not just watch or read a simulation, but participates in it as if this were real world actually experienced.

Distance Learning
It is a method used to connect teachers and learners who are geographically separated. It encompasses correspondence courses and courses delivered by satellite, television broadcasting, or telephone lines. One issue that is common to the various forms of distance learning is the provision of clinical education. If some form of video or computer technology is being used, and learners do not have to come to a campus or central clinical agency, how is clinical learning achieved. The answer is that generally learners are paired up with preceptors in clinical sites near their homes. A clinical site coordinator is usually hired to arrange these placements. o Interactive Television Classes

o Distance Learning Via the Internet

References: De Young, S. (2003) Teaching Strategies for Nurse Educators. Pearson Prentice Hall. Gaberson, K. and Oermann, M. (2009) Clinical Taching Strategies in Nursing. 2nd edition. Springer Publisher Company O Connor, A. (2006) Clinical Instruction & Evaluation: A Teaching Resource. 2nd Ed. Jones & Bartlett Publishers.