Leading clinical learning Leadership and Clinical Education (LaCE) Workshop 1 ‘Clinical education through a leadership lens’ Robyn Nash and Pauline Calleja, QUT

Leading clinical learning Session Objectives Provide a forum which explores: Connections between leadership and clinical education A clinical education leadership framework Opportunities for personal/professional development as a leader of clinical learning

Leading clinical learning What is leadership? Buzz session 1 What is your concept of ‘leadership’?

Leading clinical learning What is leadership? …. any behaviour that influence the actions and attitudes of others to achieve certain results Australian Leadership Development Centre, 2007

Characteristics of effective leadership? Leading clinical learning Inspire aspiration Strive for excellence, know own strengths Set direction Communicate on both information and interpersonal levels Bring out the best in people, help them develop capabilities and skills Guide people to the right destination in a smooth and efficient way Persist in the face of unexpected setbacks Be the change, role model by example Reward success ( Burns 1978; Bass 1985; Bennis & Nanus 1985; Kouzes & Posner 2003)

Leading clinical learning What is clinical education? Buzz session 2 What is your concept of ‘clinical education’?

Leading clinical learning What is clinical education?... commonly described as the component of health practitioner education that allows students to put theoretical knowledge into practice within the patient/client care environment (Clare et al. 2003) ‘… the translation of theory into clinical knowledge and professional skills....’ McAllister et al. (1997, p.3) ‘… the co-creation of new knowledge through critical reflection and dialogue between learner and facilitator ‘ Harvey et al. (2002, p. 578).. a process of contextual and experiential learning which involves clinical educators and students working in partnership to achieve professional development outcomes...

Experiential learning “.. learning is the process whereby knowledge is created through the transformation of experience. Knowledge results from the combination of grasping experience and transforming it“ (Kolb 1984, p. 41) Leading clinical learning

Experiential learning Leading clinical learning Thinking Feeling Doing Watching Kolb’s Cycle of Experiential Learning (1984)

Kolb’s ‘principles’: learning is a process which combines experience, reflection, thinking and doing different people prefer different style/s of learning, and learn more effectively if they can utilize their preferred learning style learning results from constructive interactions between the person and his/her environment learning is a holistic process of adaptation. It is not just the result of thinking, but involves the integration of thinking, feeling, perceiving and behaving time is needed for learners to process their experiences in order to derive new meanings that can be applied to future situations. Leading clinical learning

Learning styles Active learners  like to be constantly challenged, can think on their feet and enjoy the challenge of being thrown in the deep end, learning best 'on the job' through practical exposure, trial and error and direct experience. Reflective learners  need time to plan, prepare and have time to reflect on their learning before being confronted with a new challenge. Theoretical learners  stimulated by abstract ideas and concepts. They like to consider viewpoints and theories and to analyse situations before selecting options and approaches to a task. They learn through observation, discussion, analysis, and enjoy logical and sophisticated reasoning. Pragmatic learners  enjoy learning from qualified demonstration, and need to see the practical advantage of all that they are doing. They need to know that what they are doing works and is realistic Honey & Mumford (2000) Leading clinical learning

Four stages of professional development: a ‘competency’ model Unconscious incompetence Conscious incompetence Conscious competence Unconscious competence Learner Low level of competence; unaware of failings. Low level of competence; aware of failings but having full skills to correct them. Demonstrates competence but skills not fully internalized or integrated. Carries out tasks without conscious thought; skills internalized and routine. Clinical supervisor Helps learners to recognize weaknesses, identify areas for development and become aware of learning needs Uses range of skills and techniques to assess learners’ development in relation to defined expectations Helps learner to develop and refine skills, reinforces good practices Raise awareness of detail and unpack processes for more advanced learning Teaching styles Teacher directed Assertive Suggestive Learner directed Collaborative Facilitative McKimm & Swanwick (2009) All styles are important. The key = choosing the style that is appropriate to the situation (UMDNJ 2006)

Leadership and clinical education: A good fit Inspiring shared vision Knowing the stakeholders Working with people Enabling desired outcomes Sustaining commitment Leadership Clinical education Establishing direction Enhancing commitment Executing the role Enacting to achieve LaCE framework Leadership...’any behaviour that influence the actions and attitudes of others to achieve certain results’ (ALDC 2007) Ramsden 1998; Kouzes & Posner ; Bennis & Nanus 1987 Lee et al. 2002; Tang et al. 2005; Lambert 2007; Robinson 2009 Inspiring quality learning Knowing the stakeholders Interacting supportively Developing competence Sustaining commitment Clinical education.. a process of contextual and experiential learning which involves clinical educators and students working in partnership to achieve professional development outcomes... Leading clinical learning

Establishing direction Enacting self development Executing the role Enhancing commitment Dimensions of practice Attributes Sharing vision and values Setting clear goals Promoting a culture of learning Communicating effectively Interacting in a range of contexts Empowering others to achieve Clinical teaching & learning Assessing students’ performance Managing day-to-day business Knowing self Obtaining feedback on performance Engaging in personal and/or professional development Professional learning Personal development Enhanced student outcomesAchievement of personal / professional goals Leadership and Clinical Education Framework – E 4 REFLECTION ON PRACTICE ACTION LEARNING

Leading clinical learning Clinical teachers: what do students value? Nursing students’ perceptions of effective Vs ineffective clinical teachers  Teaching ability eg. encourages thinking and learning  Personality characteristics eg. enthusiastic approach  Professional competence eg. good professional knowledge  Interpersonal relationships eg. good relationships with nursing team Tang et al. (2005 ) Medical residents 3 most important characteristics  Nonjudgemental  Clinical competency  Enthusiasm Buchel & Edwards (2005) 48% 47% 32%

Clinical instruction: what do students value? Open, collegial relationship Adapting the experience to the student Facilitating clinical reasoning Making time for the student Supportive environment Kelly (2007) Leading clinical learning

Importance of clinical supervision Clinical experience is a core element of health professional education, but...  Experience in the real world does not automatically translate to positive student learning experiences, or mean that the development of professional knowledge and skills will occur effectively  Factors that are key to the promotion of optimal learning in the clinical environment include: supportive practice environments effective supervisory relationships a positive learning culture collegial relationships between students and staff  The importance of clinical supervisors in playing a central role within this context cannot be underestimated Leading clinical learning

Some closing thoughts… Leaders are responsible for getting results through others. Leaders should be judged not by what they do, but rather by what those around them are doing and achieving. In this light it is very clear that leadership is people work, with a focus on achieving results. Australian Leadership Development Centre

Leading clinical learning References Allied Health Professions Australia (2006). Clinical Education Discussion Paper, October. Available at: Buchel, T. & Edwards, F. (2005). Characteristics of effective clinical teachers. Family Medicine, 37(1), Clare, J. et al (2003). Evaluating clinical learning environments: Creating education-practice partnerships and benchmarks for nursing. AUTC final report. Adelaide: Flinders University. Clark, D. (1997). In Zilembo, M. & L. Monterosso. (2008)., Nursing students’ perceptions of desirable leadership qualities in nurse preceptors: a descriptive study, Contemporary Nurse, 27(2), Gibson, E. et al (2002). Towards the Development of a Work Integrated Learning Unit. Division of Environmental and Life Sciences and Centre for Professional Development, Macquarie University, Australia. Available at: Harvey, G., Loftus-Hills A., Rycroft-Malone J., et al. (2002). Getting evidence into practice: the role and function of facilitation. Journal of Advanced Nursing, 37, 577–588. Kelly, C. (2007). Students’ perceptions of effective clinical teaching revisited. Nurse Education Today, 27, Kouzes, J. & Posner, B. (2003). The five practices of exemplary leadership. In Kouzes, J. Business Leadership. San Francisco: Jossey-Bass. Lambert, V. & Glacken, M. (2006). Clinical education facilitators’ and post-registration paediatric student nurses’ perceptions of the role of the clinical education facilitator, Nurse Education Today, 26(5), Lee, C., Cholowski, K. & Williams, A. (2002). Nursing students’ and clinical educators’ perceptions of characteristics of effective clinical educators in an Australian university school of nursing, Journal of Advanced Nursing, 39(5), McAllister, L., Lincoln, M., McLeod, S. & Maloney, D. (1997). Facilitating learning in clinical settings. Cheltenham, UK : Stanley Thornes. McKimm, J. & Swanwick, T. (2009). Assessing learner needs. British Journal of Hospital Medicine, 70(6), Pratt, D., Arseneau, R., & Collins, J. (2001). Reconsidering “good teaching” across the continuum of medical education, The Journal of Continuing Education in the Health Professions, 21, 70–81. Robinson, C. (2009). Teaching and clinical education competency: Bringing two worlds together, International Journal of Nursing Education Scholarship, 6(1), Tang, F., Chou, S., Chiang, H. (2007). Students’ perceptions of effective and ineffective clinical instructors, Journal of Nursing Education, 44(4),