Board of Physical Therapy Residency and Fellowship Education, 2013; Sambunjak & Marusic, 2009). Figure 2: Differences Between Clinical Education and Mentorship Teaching and Learning Across the Educational Continuum Clinical Experience Mentorship Focus on Safety. → Focus on effective clinical intervention. Basics of patient management. → Expanded problem solving. Basic skill acquisition. → Intervention progression. Instructor. → Guide, facilitator. Reasoning is rule- governed. → Reasoning become intuitive. Note . From Western Schools, 2020. Reflection is an essential component of learning, regardless of the type of learning (Schön, 1983). The ability to think about a particular situation, determine what worked effectively and what did not, and then to modify actions and behaviors in the future is an important skill of a professional, particularly a healthcare professional, to ultimately improve patient care (Halfer, 2011; Schön, 1983). An effective mentor would reflect upon his or her teaching abilities with a peer, determining what
is working well and what needs improvement to create change in the future. The mentor may very well ask the peer mentee what teaching strategies are helpful in the learning process and what the mentor could do to improve the learning process (Wainwright, Shepard, Harman, & Stephens, 2010). For example, the instructor must ask if providing feedback to the mentee during the patient interaction is a helpful strategy or if the mentee would prefer that feedback occur after the patient has left to avoid damaging the patient’s confidence in the healthcare provider. Lastly, the ability of the mentor to identify and translate evidence into patient management and to role model this for the learner is a foundational component of an effective mentor. Identifying and translating evidence includes determining the most appropriate special tests and measures to perform based upon the literature and the most appropriate interventions with evidence to support their efficacy, and understanding the personal and environmental factors of the International Classification of Functioning, Disability, and Health (ICF) that impact care. For example, environmental and personal factors could modify the plan of care and appropriate interventions (World Health Organization, 2001). A single mother of three children that works two jobs will have difficulty coming to therapy three times per week for manual therapy intervention. In this case, setting this patient up on an effective therapeutic exercise home program may be a better intervention choice given all the demands on her time. In this case, the mentor identifies the personal factors of working two jobs and caring for three children as important components of information that will drive the plan of care to effectively provide treatment for the patient.
TEACHING IN THE CLINICAL SETTING
We’ve already discussed the importance of the clinical setting in providing an optimal learning environment for learners in the health professions including medicine, physical therapy, and occupational therapy. The following section will describe how a clinical instructor or mentor facilitates and allows for learning to occur in the clinical practice setting. This process begins with collaborating in the community of practice (student Diagnosis of student readiness The clinical instructor or mentor may have little knowledge about the learner’s knowledge, skills, and abilities before the start of the clinical or mentorship experience. Thus, the educator must determine an initial baseline status for the learner in order to develop a teaching and learning plan for the experience in the clinical setting. An understanding of the learner’s background including courses in the curriculum they have already completed, competencies in various tests and measures, and experience with various patient types can provide the educator with an emerging understanding of the learner’s competence. However, this information will not provide a complete picture of the learner’s knowledge, skills, and abilities. In order to gain a more holistic understanding, it will be helpful for the educator to provide clear expectations to the learner for the experience and to review the learner’s goals and objectives to determine if they are realistic. This helps the educator to appropriately plan the experience so it is learner-centered and can incorporate specific observations such as surgical procedures, special units to include the intensive care unit, or participation in an orthotic fitting, for example. During the orientation phase of the learning experience, the educator and learner further communicate about expectations and levels of competence and begin the joint planning process of the experience. This time also gives the educator an opportunity to evaluate the student’s self- assessment capabilities with observed demonstrated abilities to determine if the learner can adequately assess his or her own strengths and weaknesses (Paschal, 2013). The educator can use various types of questions when working collaboratively with the learner and a patient to evaluate the correlation between the learner’s self-awareness and actual skills
and teacher or mentee and mentor), planning the educational experience, role-modeling how to practice, asking questions, supervising, and instructing. The clinical educator is responsible for determining the baseline knowledge and skills of the learner, how to assess the learner’s performance, and developing an educational diagnosis for the learner. and abilities. According to classic works, these questions include knowledge, translation, excogitative, and evaluation (Abrams, 1983; Anderson et al., 2001; Bloom, 1956). Knowledge type questions are simply the recall of facts or concepts that can be found in textbooks or journals. For example, the educator may ask the learner if there are any exercise contraindications that should be discussed with the patient 2 weeks following anterior cruciate ligament (ACL) reconstruction surgery. These questions are asked in a way that encourages verbal dialogue so the educator can better understand the learner’s thoughts and knowledge. The next deeper type of question is considered translational where the learner has to demonstrate use of the knowledge. In the preceding example, the educator may ask the learner to explain to the patient why particular exercises are contraindicated post ACL repair. This challenges the learner to not only understand what and why exercises are not indicated but also to explain this in a way the patient can understand. Exocogitative questions require the learner to problem solve and demonstrate clinical reasoning abilities. In the example of the patient with an ACL repair, after performing an initial physical therapy examination, the learner will need to determine a plan of care for the patient. Evaluative questions are the last and potentially most important type of question the educator may ask. These questions encourage the learner to demonstrate metacognitive skills, or reflection upon his or her thinking, important concepts in therapist practice (Croskerry, 2003; Epstein, 2008). For example, the educator might ask the learner to identify what worked well during the session and explain why he or she thinks this was effective. Using the illustration above, the learner identified understanding that returning to playing
EliteLearning.com/Physical-Therapy
Book Code: PTCA2622B
Page 16
Powered by FlippingBook