TEACHING

IN

THE

CLINICAL

AREA

the teaching of students in the hospitals or clinical settings is designed to provide then with the opportunities to have an actual contact and interaction with the patients or clients and to apply what they have learned in the classroom, community and laboratory with its simulated environment to reallife settings What is being learned in the other concurrent courses should be reinforced and practiced in the clinical setting There may be times when situations may happen in which the student has no prior knowledge of or training for and in this instance, the instructor is expected to provide support and guidance Purposes: 1. The clinical setting offers the students the opportunity to apply the theoretical concepts, rationales, procedures and propositions they have learned in the classroom 2. Skills learned in the laboratory are perfected in the clinical area which offers a live, true-to-life situation instead of a simulated environment in the laboratory 3. The skills of observation, problem-solving and decision-making are refined and honed in the clinical setting which is applied as students interact with their patients in varying situations and conditions o Learners need to practice using these cognitive skills under the guidance of the clinical instructor and other members of the professional staff in real-life settings

4. In the real clinical setting, the student is aided by the clinical instructor on how to organize all data that they are able to compile as well as the intellectual and psychomotor skills they must perform o They also learn priority- setting as to what task need urgent or first priority action and those that can be performed on a second/third priority Their skills in time management and priority setting are developed and applied It is also in this area where the skill of delegation is practiced and truly learned

5. Cultural competence is the ability to interact meaningfully, properly, comfortably and effectively with culturally diverse patients, is a skill that must be developed. 6. Student learn the skills of socialization, which behaviors and values are acceptable or unacceptable and where responsibility and accountability of ones action is demanded and expected o The professional/CI serve as their role models who help them to relate professionally with clients and develop more caring behaviors

Context of Clinical Education Clinical learning is situated in the context of occupational therapy practice: It occurs in real practice settings, with real patients, and with real physical therapists as clinical teachers. Clinical education has occurred in settings in which administrators, directors, and, most importantly, occupational therapy clinical teachers have been willing to provide it. As the treatment of patients with impairments and functional limitations related to human movement and movement dysfunction has moved from inpatient to outpatient settings, occupational therapy clinical education has moved from hospitals to a variety of community-based centers, including outpatient health care facilities, schools, retirement centers, health promotion and wellness centers, and preschools. Academic and Clinical Teaching: Two Different Realities The greatest fundamental difference between academic education and clinical education lies in their service orientations. Occupational therapy academic education, situated within higher education, exists for the primary purpose of educating students to attain core knowledge, skills, and behaviors. In contrast, clinical education, situated within the practice environment, exists first and foremost to provide cost-effective quality care and education for patients, clients, and their families and caregivers. Academic faculties are remunerated for their teaching, scholarship, and community and professional services. Clinical educators are compensated for their services as practitioners by rendering patient care and related activities. Occupational therapy clinical educators are placed in the precarious position of trying to effectively balance and respond to two masters." The first master, the practice setting, requires that the practitioner deliver costeffective and quality patient services. The second master, higher education, wants the clinical educator to respond to the needs of the student learner and the educational outcomes of the academic program.

Other differences between occupational therapy clinical education and academic education relate to the design of the learning experience. Educating students in higher education most often occurs in a predictable classroom environment that is characterized by a beginning and end of the learning session and a method (written, oral, practical) of assessing the student's readiness for clinical practice. Student instruction can be provided in numerous formats with varying degrees of structure, including lecture augmented by the use of audiovisuals, laboratory practice, discussion seminars, collaborative and cooperative peer activities, tutorials, problem -based case discussions, computer-based instruction, and independent or group work practicum. With the emergence of technology, such as distance learning, hypermedia, and virtual reality, the traditional archetype is being challenged by some educators and may eventually lead to an alternative paradigm for classroom learning. Higher education has evolved in its design to provide more active adult learning that stresses the learner, not the teacher. Fundamental concepts and theories and their application to occupational therapy practice must be fully developed in the academic program to ensure that students are capable of progressing through each phase of the curriculum into the real world of practice. Students, however, have found it difficult to divest themselves of the conventional role of the professor as the expert or on the stage who transmits all the knowledge needed to move successfully through the curriculum and accept responsibility and accountability for their own learning. In contrast, the clinical classroom by its very nature is dynamic and flexible. It is a more unpredictable learning laboratory that is constrained by time only as it relates to the length of the patient's visit or the work day schedule. Sometimes to an observer, delivery of patient care and educating students in the practice environment may seem analogous in that they appear unstructured and at times even chaotic. Remarkably, student-learning in the clinical setting occurs with or without patients and is not constrained by walls or by location (e.g., community-based services, walking or driving to patients). Student learning is not measured by written examination, but rather is assessed based on the quality, efficiency, and outcomes of a student's care when measured against a standard of clinical performance. Resources available to the clinical teacher may include many of those used by academic faculty, such as instruction using audiovisuals, practice on a fellow student or the clinical educator, or review and discussion of a journal article. Additional resources readily available to the educator in practice include collaborative and cooperative student learning among and between

disciplines, video libraries of patient cases, in-service education, grand rounds, surgery observation, special clinics and screenings (e.g., seating clinic, scoliosis screening, community-based education to prevent common falls in the elderly), pre-surgical evaluations, on-site continuing education course offerings, observation and interactions with other health professionals, and participation in clinical research. Rich learning opportunities are available in practice that complement and clarify much of what is provided in occupational therapy academic education. Because learning occurs within the context of practice and patient care, the clinical teacher is characterized as "a guide by the side" rather than an expert. The clinical teacher teaches primarily through interactions and handling of patients and assumes multiple roles, including facilitator, coach, supervisor, role model, and performance evaluator. The clinical educator provides opportunities for students to experience safe practice. She or he also asks probing questions that encourage the student to reflect by posing questions to herself or himself, reinforces students' thinking and curiosity by fostering scholarly inquiry and by sorting fact from fiction, and, by example, teaches students how to manage ambiguities (e.g., balancing functional and psychosocial need$ of the patient within the constraints

Organizational Structure of Clinical Education The, organizational structure of clinical education is designed to be efficient. It is also designed to provide a way for academic faculty to inform clinical faculty of their respective curricula and of student expectations. In return, clinical faculty inform academic faculty of the relevance of academic curriculum to entry-level practice and the ability of students to translate knowledge and theory into practice as evidenced by their clinical performance. Persons assuming these roles must continually interact to ensure the provision of quality occupational therapy education for students. These three roles are most commonly tided the academic coordinator of clinical education, the center coordinator of clinical education, and the clinical instructor. The academic coordinator of clinical education is situated in the academy, while the center coordinator of clinical education and Cl are based in clinical practice. Clinical education represents approximately 28-30% of the total curriculum and is characterized as that part of the educational experience that allows students to apply theory and didactic knowledge to the real world of clinical practice. As such, all academic faculty contribute to the effectiveness of the clinical learning experience, because a student's performance in the clinic is a direct reflection of the education received during the didactic portion of the curriculum. Faculty must seek

to better understand how their classroom experiences relate to student performance in the clinic, and clinicians should comprehend how and what information presented in the classroom relates to the clinical education process and entry-level performance expectations. This is accomplished when faculty become involved in clinical site visits using established guidelines or when they facilitate continuing education and clinical research in collaboration with clinicians

Decisions about student clinical competence should not rest solely with the academic coordinator of clinical education but should reflect the collective wisdom of academic and clinical faculty assessments, student self-assessments, and the patient's assessment of the student's performance. Furthermore, expectations for student performance during progressive clinical experiences should consider faculty's perspectives, because such experiences represent critical stepping stones that will enable students to attain desired program goals. SUPERVISORY ROLE It is in the hospital or clinical setting that learners are enabled to develop the necessary clinical skills and come to recognize the standards and behaviors of their chosen profession When working with small numbers of learners in the clinical setting, interpersonal skills are a paramount importance o A friendly welcome will put the learner at ease and effort on the part of the therapist to develop an atmosphere of mutual trust and collaboration will facilitate learning process Not only learners feel anxious but it is in the clinical situation that they encounter patients and clients for the first time PREPARATION Before the learners arrived it will help if the therapist has already organized some time to spend with them Often fearful More experienced learner feel some degree of unease = unfamiliarity of the new clinical area

an orientation pack which could include a map of the hospital or community, list of names of doctors or social service staff, details of health and safety policies

a timetable setting out the proposed learning activities specific learning objective the style of teaching adopted by the therapist will be critical to the process of learning Therapist will need to adjust to different learners and to adapt to them as their needs change. Most learners require great deal of direction initially and will want to watch therapist in action and observe The learners will also want to see how the therapist interacts on a professional level with patients, clients and colleagues Therapist provides a role model During discussion with therapist, when the opinion of the learners can be sought concerning clinical problems encountered Learners could be asked to justify both their choice of treatment and any advice they might give and be encourage to offer alternatives IE should be checked by CI

Therapist joins the learner as observers while learners as practitioners o o Therapist can give feedback to learners about their skill Feedback should be given as soon as possible after the observation Learners tend to find it unhelpful when therapist takes over

Success of the supervisory role is dependent upon the interaction which develop between therapist and the learner

THE STUDENT CLINICAL EXPERIENCE 1. Orientation

Student orientation includes an overview of the basic policies and procedures, physical set-up and facilities and administrative staff = guided tour or group orientation Proper decorum, objectives, program of the center, explains the grading system etc.

2. LEARNING FROM PRACTICE learning from experience is a process which links work, education and personal development learning how to learn is an important goal the learners may know about the pathological conditions of the clients as well as the importance of psychological and social factors of treatment, from theory learned in college it is during exposure to practice that they come to recognize the uniqueness of each individual and how they themselves relate to each and the need to develop a variety of treatment and communication strategies what may work for the client may not work effectively to the other client

learners must come to recognize that multidimensional nature of patients and clients problems and develop different strategies to assist with each reflection is the key whereby learners become aware of what was taking place throughout the experience learners may also help each other by spending time together reflecting on and sharing their experiences the therapist should encourage these activities and be instrumental in helping learners progress around learning cycle

3. ASSESSMENT