Hello and welcome to my presentation about clinical post-conferencing in nursing education. My name is Jennifer Black, and I will guide you through the exploration of this particular teaching strategy. This presentation is the result of a structured literature review that I conducted to investigate the value and effectiveness of clinical post-conferencing in nursing education. The purpose of this guide is to increase your awareness about this teaching strategy, help generate ideas about how to conduct an effective post-conference, and perhaps even inspire you to participate in future research to further support its use in nursing education.
The purpose of my review was three-fold: 1) to understand the purpose of the post-conference as a clinical teaching strategy; 2) to examine the role of the educator in the clinical post-conference; and 3) to assess the effectiveness and applicability of the clinical post-conference in nursing education today. In sharing these results with you, I hope to help new instructors gain an appreciation for the importance of the post-conference as a clinical teaching strategy, understanding your role as a learning facilitator, and to increase the awareness about the need for more empirical evidence to provide support for its continued use in nursing education.
This quote is representative of the potential power of all nursing students and clinical instructors. Small groups can be very dynamic!! Throughout this presentation, I will explain how the use of post-conferencing can unleash the potential in students and instructors alike.
This presentation has been structured around the results of the literature review I conducted. During our time together, we will take a closer look at: the theoretical foundation of the post-conference and its overall value, modern applications in today’s technology-driven world, the role of clinical faculty as a facilitator and promoter of higher order thinking, the paucity of empirical evidence, and the future of post-conferencing as a teaching strategy.
In this section of the presentation we will look at the underlying theories that influence the utility of the clinical post-conference as a teaching strategy, the importance of debriefing and reflective learning as it pertains to post-conferencing, and the development of critical thinking skills as a desired outcome.
TRANSFORMATIVE LEARNING THEORYMezirow’s transformative learning theory is based on the supposition that learners have perspectives derived from learning experiences, thoughts, values and insights (Sokol & Crantonas cited in Hsu, 2007). The process of critical reflection is integral to a transformative learning experience.Nurse educators seek to assist students in exploring the meaning in their experiences, enabling them to critically appraise previously held values, beliefs and assumptions in relation to their clinical learning (Hsu, 2007).BEHAVIOURAL-ENVIRONMENTAL THEORYLewin’s behavioural-environmental theory posits that human behaviour is a function of the state of the person and the state of the environment in which the person exists (Letizia & Jennrich, 1998). Behaviour must be examined inside the context of the environment in which it occurs (Letizia & Jennrich, 1998).BLOOM’S TAXONOMY OF LEARNING DOMAINSThe taxonomy of the cognitive domains – knowledge, comprehension, application, analysis, synthesis and evaluation – was first developed by Bloom and is utilized today for developing test items and leveling questions (Gaberson & Oermann, 2010a).Clinical instructors often ask questions at the first two levels (knowledge, comprehension), but in order to help students develop critical thinking and clinical judgment skills, educators ought to pose higher level questions (Gaberson & Oermann, 2010a; Hsu, 2007; Oermann, 2008).
Please take a moment to think back to when you were a student in the clinical setting and consider a time when you experienced something that made you feel happy, sad, angry, apprehensive, frightened, or anxious. How did you manage these feelings?Did you have an opportunity to share your feelings with your peers? How did this affect your learning?
The process of reflection enables students to explore their feelings, thoughts, attitudes and previous learning (Hermann, 2006).It is important for instructors to be aware that learning will not effectively take place until students have had an opportunity to express any strongemotions that they have encountered during their clinical experience (Matheney, 1969). This is the primary reason why it’s important to include the debriefing process at the beginning of every post-conference.
Critical thinking is defined as “a process used to determine a course of action involving collecting appropriate data, analyzing the validity and utility of the information, evaluating multiple lines of reasoning, and coming to valid conclusions”(Gaberson & Oermann, 2010, p. 23).Critical thinking involves habits of the mind such as reflective thinking, clinical reasoning, and clinical judgment (Alfaro-LeFevre as cited in Gaberson & Oermann, 2010b).It is interesting to note, however, that there is no empirical evidence presented in any of the articles I reviewed that explains to what end clinical conferencing is responsible for the development of these skills. Further research is required to establish this relationship.
This section will examine the use of online conferencing and teleconferencing as alternatives to the traditional post-conference in the clinical setting.
Conferencing immediately after clinical may not be ideal as both students and teachers are likely to be physically and mentally fatigued, increasing the likelihood of passive learning (Cooper et al., 2004; Yehle & Royal, 2010).Other barriers to conferencing in the clinical area include limited availability of physical space, a lack of technological resources, and complex patient care needs that prevent student attendance (Rentmeester, 2006).Conferences should be held on a different day away from the clinical setting and follow a pre-determined agenda to enhance active learning and increased interaction among students (Yehle & Royal, 2010).This new format allows for interactive synthesis and the evaluation of concepts that are introduced in theory courses by using various learning activities such as case studies, games, student-led presentations, and empathy-building exercises (Yehle & Royal, 2010).
Online post-conferencing has been described as more effective than face-to-face as it allows students more time to process clinical experience before discussing them, contributes to students’ sense of control over learning, improves writing skills, and enhances professional socialization (Babenko-Mould et al., 2003; Cooper et al., 2004; Hermann, 2006; Rentmeester, 2006).
Advantages include: facilitating real-time communication and collaborative learning; debriefing occurs in the student’s chosen environment; encourages telephonic dialogue, debate, and engagement strategies, especially from introverted students; eliminates travel or wait times after clinical; and reduces barriers such as unavailable meeting space (Adegbola, 2011).
In this section, we will discuss the role of clinical faculty as learning facilitators and champions of higher-order thinking.
Given the importance of higher level questions in promoting critical thinking, teachers need to be cognizant of the type of questions asked during a clinical post-conference. (Oermann, 2008) The literature reports that faculty consistently ask low-level (or recall) questions. When higher level questions are asked, students are unable to answer using information they have memorized.Instead they may compare their patient’s assessments, plans of care, and nursing interventions to textbook descriptions and what they have learned in clinical. (Oermann, 2008)
Despite its lengthy existence and apparent value as a clinical teaching strategy, there is a significant lack of empirical evidence related to the effectiveness of post-conferences in nursing education (Letizia, 1998). The majority of the authors included in my review suggest that nursing students’ critical thinking skills are developed and enhanced by participating in clinical post-conference, yet the attainment of critical thinking skills is not measured as an outcomein any study pertaining to clinical post-conferencing, nor is there a measurement to ascertain the degree to which critical thinking skills are attained by participating in clinical post-conferences(Adegbola, 2011; Gaberson & Oermann, 2010a; Hermann, 2006; Hsu, 2007; Matheney, 1969; Oermann, 2008; Rentmeester, 2006; Stokes & Kost, 2012; Wink, 1995).
Thank you very much for your attention and participation!! I welcome any questions or comments that you may have.
Clinical post conference - lay audience presentation - vo
Jennifer Black, RN, BScN
ObjectivesThis presentation is designed to:1. Help clinical instructors gain an appreciation for the importance of post-conferencing as a teaching strategy, and understand their role as a learning facilitator; and2. Increase awareness about the need for empirical evidence to help sustain post-conferencing as an integral part of nursing education. 2
"Never doubt that a small group ofthoughtful, committed people can change the world. Indeed. It is the only thing that ever has." ~ Margaret Mead 3
Presentation Outlineo Overview of the Clinical Post-Conference • Theoretical Influences • Debriefing and reflective learning • Development of critical thinking skillso Modern Applications • Different time, different venue • Online conferencing • Teleconferencingo Role of Faculty • Facilitator • Promoting higher-order thinkingo Lack of Empirical Evidenceo Future Directions 4
Theoretical Influenceso Transformative Learning Theory o Learners have perspectives based on learning experiences, thoughts, values and insights o Critical reflection is essential (Hsu, 2007)o Behavioural-Environmental Theory o Human behaviour is a function of the state of the person AND the environment in which the person exists (Letizia & Jennrich, 1998)o Bloom’s Taxonomy of Learning Domains o Knowledge, comprehension, application, analysis, synthesis, and evaluation o Most instructors ask questions at the first two levels – higher level questioning is needed to develop critical thinking skills (Gaberson & Oermann, 2010a; Hsu, 2007; Oermann, 2008) 6
Reflectiono Think back to when you were a student in the clinical setting and consider a time when you experienced something that made you feel happy, sad, angry, apprehensive, frightened, or anxious.o How did you manage these feelings? 7
Debriefing & Reflective Learningo Debriefing and reflective learning are well known functions of the clinical post-conference. o Discuss the clinical experience; o Share information; o Analyze clinical situations; o Clarify relationships; o Identify problems; o Utilize group process; and o Cultivate support systems to foster the development of reflective learning. (Adegbola, 2011; Hermann, 2006; Hsu, 2007; Matheney, 1969; Oermann, 2008; Stokes & Kost, 2012) 8
Critical Thinkingo The development of criticalthinking skills and problem-solvingabilities are among the primarygoals of clinical post-conferencingand there is plenty of literature tosupport this notion. 9
Modern Applications Different Time, Different Venue Barriers Advantages• Fatigue • Enhance active• Limited availability of learning physical space • Increase interaction• Lack of technological • Interactive synthesis resources• Complex patient care needs 11
Modern ApplicationsOnline Conferencing o Online forums are excellent environments for supporting peer and collaborative learning (Cooper et al., 2004; Hermann, 2006; Rentmeester, 2006). 12
Modern ApplicationsTeleconferencing • An appropriate alternative to post-clinical conferencing when face-to-face communication is impractical (Adegbola, 2011). 13
Role of Facultyo Facilitation • Faculty serve as conference facilitators by utilizing these facilitating behaviours: 1) supporting, encouraging, and sharing information; 2) being flexible yet focused; 3) encouraging and enhancing active participation of all students; 4) posing ideas and questions; 5) providing feedback in a non-threatening way; 6) creating an environment that is conducive to discussion and sharing; 7) assisting students in identifying relationships, patterns and trends; 8) being alert to teaching and learning moments; and 9) facilitating the group process. (Stokes & Kost, 2012) 15
Reflectiono Think about the type of questions you ask your students during post-conference.o Which cognitive domain of Bloom’s taxonomy do they belong to? • Knowledge • Comprehension • Application • Analysis • Synthesis • Evaluation 16
Promoting Higher-Order Thinkingo Faculty consistently ask low-level (recall) questions.o There is a need to ask higher-level questions to promote higher-order thinking. 17
Conclusionso Overall, the purpose and value of post- conferencing as a clinical teaching strategy is well articulated and well supported in the literature, although there is a quantifiable lack of empirical evidence and contemporary research.o The development of critical thinking and clinical reasoning skills continue to be the driving force behind the endurance of this clinical teaching strategy despite the absence of objective measurements.o 19
Future Directionso Recommendations for further study include: o Comparing the impact of post-conference learning environments (online vs. face-to-face) on the educational process and learning outcomes; o Exploring faculty perceptions of higher-order questioning; o Measuring critical thinking and clinical reasoning as outcomes of post-conference learning; and o Examining the post-conference with a constructivist lens. 20
ReferencesAdegbola, M. (2011). Taking learning to the learner: using audio teleconferencing for postclinical conferences and more. Creative Nursing, 17(3),120-125. doi:10.1891/1078-4518.104.22.168Cooper, C., Taft, L., & Thelen, M. (2004). Examining the role of technology in learning: An evaluation of online clinical conferencing. Journal ofProfessional Nursing, 20(3), 160-166. doi: 10.1016/j.profnurs.2004.04.003Gaberson, K.B., & Oermann, M.H. (2010a). Discussion and clinical conference. In K.B. Gaberson and M.H. Oermann (Eds.), Clinical teachingstrategies in nursing (3rd ed., pp. 231-252). New York, NY: Springer Publishing Company.Hermann, M. (2006). Clinical issues. Technology and reflective practice: The use of online discussion to enhance postconference clinicallearning. Nurse Educator, 31(5), 190-191. Retrieved from http://journals.lww.com/nurseeducatoronline/pages/default.aspxHsu, L. (2007). Conducting clinical post-conference in clinical teaching: A qualitative study. Journal of Clinical Nursing, 16(8), 1525-1533. doi:10.1111/j.1365-2702.2006.01751.xLetizia, M. (1998). Strategies used in clinical postconference. Journal of Nursing Education, 37(7), 315-317. Retrieved fromhttp://www.healio.com/journals/jneMatheney, R.V. (1969). Pre- and post-conferences for students. American Journal of Nursing, 69(2), 286-289. Retrieved fromhttp://journals.lww.com/ajnonline/pages/default.aspxOermann, M. (2008). Ideas for postclinical conferences. Teaching & Learning in Nursing, 3(3), 90-93. Retrieved fromhttp://www.journals.elsevier.com/teaching-and-learning-in-nursing/Rentmeester, M. (2006). Integrating online discussion into clinical rotations. Journal of Nursing Education, 45(12), 528. Retrieved fromhttp://www.healio.com/journals/jneStokes, L.G., & Kost, G.C. (2012). Teaching in the clinical setting. In D.M. Billings and J.A. Halstead (Eds.), Teaching in nursing: A guide forfaculty (4th ed., pp. 311-334). St. Louis, MO: Saunders. 22