Clinical Teaching Techniques

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  • Bio: I ’ m a recent nuclear medicine technology graduate from the Michener Institute and University of Toronto. I have been working at the Ottawa Hospital nuclear medicine department part-time since May 2008. In February 2009 I started a distance education masters of medical radiation science (nuclear medicine) program with Charles Sturt university. I ’ m currently taking ‘ Clinical Teaching Techniques ’ and ‘ Advanced Practice in Nuclear Medicine ’ .
  • The talk will be 30 minutes. One person fills out the ‘ observer ’ sheet. Everyone else fills out the ‘ evaluation ’ sheet. During the session ask questions, give feedback and make comments. At the end of the session: * more involved questions can be discussed * comments can be added to the ‘ evaluation ’ sheet Ask participants for input. The ideas in this talk could be used by students, clinical coordinators and licensed technologists. Why have a defined clinical education model/technique: * Can apply to all students at all sites, aiding in consistency of training. * May apply to similar disciplines (MRI, X-ray, radiation therapy).
  • The above is from: Rose & Best 2005, p. 3; U of T / TMI 2007, p. 4. The Michener Institute (TMI) and University of Toronto (U of T). Ask participants: Who are the CC and CLO? Different terms can be used to describe who coordinates and teaches students during the ‘ clinical ’ session: clinical educator, preceptor and clinical supervisor.
  • The above is from: CAMRT 2007; CMRTO, 2005, p.5; Rose & Best 2005, p. 3
  • The above list is from: Rose & Best 2005, p. 3; Winn 2005, p. 210; Stohschein et al. 2002, p. 163. The purpose of the program: Anywhere from teaching hands-on skills to certification. (CAMRT 2007; CMRTO, 2005, p.5; Rose & Best 2005, p. 3) The credentials of the CC (to mention a few): A mature and accomplished technologist, ability self-manage, supportive, a role model and teacher (Rose & Best 2005, p. 5, 46, 135, 284; Hawkins & Shohet, 2006, p. 50, 52; Fish & Twinn, 1997, p. 83; Steves, 2005, p. 206). The educational needs of the student The clinical site must be able to train and support. The personality of the student: Winn (2005, p. 211, 213) believes recognizing a student ’ s personality type (introverted, extroverted, judging, perceiving…) may help student progress and explain or identify potential problems. Different education models and techniques that can be used: To be discussed in a future slide. The willingness or ability of sites to take students: Can be an issue, due to staffing or policy Changes. The perception that students are a burden and adversely affect productivity: Stohschein et al. (2002, p. 163) disprove the commonly held opinion that students adversely affect productivity Funding for students: Some educational institutions provide funding to place students at the clinical site. Time constraints: A student ’ s clinical has to be finished before the next wave of students arrive.
  • The above is from: Rose & Best 2005, p. 52-54; TMI 2002, p. 1.
  • The above is from: Rose & Best 2005, p. 5, 46, 135, 284; Hawkins & Shohet, 2006, p.50,52; Fish & Twinn, 1997, p. 83; Steves, 2005, p. 206; TMI 2002, p. 1. Rose and Best (2005, p. 135) feel the most important characteristic of the CC is the level of experience. A CC qualified in the previous 18 to 24 months will be closer in academic knowledge to that of the student (Rose & Best 2005, p. 169), allowing both to relate to each other better. There is no mention in the literature if the CC should only act for only a given number of years. Having a time limit has pros and cons. Keeping the same CC may add consistency to the program but may cause the CC to burnout. Having different CCs every few years may provide new ideas and approaches and give the opportunity to other senior technologists to expand their practice.
  • The above is from: Rose & Best 2005, p. 5, 46, 135, 284; Hawkins & Shohet, 2006, p. 50, 52; Fish & Twinn, 1997, p. 83; Steves, 2005, p. 206; TMI 2002, p. 1. Rose and Best (2005, p. 135) feel the most important characteristic of the CC is the level of experience. A CC qualified in the previous 18 to 24 months will be closer in academic knowledge to that of the student (Rose & Best 2005, p. 169), allowing both to relate to each other better. There is no mention in the literature if the CC should only act for only a given number of years. Having a time limit has pros and cons. Keeping the same CC may add consistency to the program but may cause the CC to burnout. Having different CCs every few years may provide new ideas and approaches and give the opportunity to other senior technologists to expand their practice.
  • Blair at rounds. The above is from: Rose & Best 2005, p. 5, 46, 135, 284; Hawkins & Shohet, 2006, p. 50, 52; Fish & Twinn, 1997, p. 83; Steves, 2005, p. 206; TMI 2002, p. 1.
  • Blair with rabbit (I ’ m in the rabbit outfit). The above is from: Rose & Best 2005, p. 5, 46, 135, 284; Hawkins & Shohet, 2006, p. 50, 52; Fish & Twinn, 1997, p. 83; Steves, 2005, p. 206; TMI 2002, p. 1.
  • The above is from: Rose & Best 2005, p. 4; Hawkins & Shohet, 2006; Fish & Twinn, 1997, p. 90; Lekkas, et al., 2007, p.19) Ask attendees if they know of others? Massage therapy, sports trainer…
  • The above is from: (Rose & Best 2005, p. 30 – 34, 129)
  • The above is from: (Rose & Best 2005, p. 30 – 34, 129)
  • The above is from: Rose & Best 2005, p. 30 – 34, 129; Lekkas, et al. (2007) Lekkas, et al. (2007) investigated CEd models for physiotherapy students and found: ‘ no one model is best ’ . Experimental learning (Rose & Best 2005, p. 123, 151): * knowledge is created through the transformation of experience * it is a continuous process * basic elements: * a description of the event * an analysis of the event * generating ideas and action plans to modify and improve practice
  • There is no literature on models/techniques explicitly for nuclear medicine. From Rose & Best (2005, p. 30 – 34) and Word 1999, dictionary: preparation: Discussing the method to be used and the student ’ s experience. encounter: The CC supervises the student performing the study. reflection: Think about experiences during the study. debriefing: The CC discussing the recent patient encounter with the student. feedback: The CC may comment about aspects of the patient encounter. assessment: evaluating student performance and attainment. explication: to explain something and develop an idea or show its implications
  • See previous slide, in the notes section, for definitions. Before a CEd technique is suggested, it may be best to understand the workflow in a NM department. When a patient is imaged or treated in a NM department it is called a study or procedure. The NM technologist must know how to perform many different kinds of studies. To perform a study a NM technologist will correctly identify the patient, explain the study to the patient, perform the study and release the patient. A NM technologist may perform 6 to 12 studies in one shift. Lekkas, et al. (2007) investigated CEd models for physiotherapy students. The ‘ models ’ they referenced primarily were based on the ratio of supervisor to student ratio. This ratio may be 1:1 to n:m. The Michener institute clinical handbook (2002, p. 1) states the CC may act as the teaching technologist but is never the only teaching technologist. This implies they promote the n:m ratio.
  • Supervision can be managerial or consultative (van Ooijen, 2000, p. 26). Managerial supervision implies the supervisor has a formal route to report, in one form or another, progress of the supervisee. Consultative supervision implies the supervisor has no managerial responsibility of the supervisee.
  • Whitman considers the assessment of the student ’ s performance one of the CC ’ s most important functions during the CEd. Assessing clinical skills and behavior are also requirements of the school and licensing college and can be used to determine if the student can progress to higher levels of practice (Rose & Best, 2005, p. 78).
  • The above adapted from Rose & Best (2005, p. 164). Assessments should be specific, accurate, objective, timely and usable (Rose & Best, 2005, p. 63, 65; Michener, 2002, p. 22).The results are recorded on standard assessment forms. Informal assessments may also be given day to day by staff. Palmer and Cherryman (2009, p. 38 - 44) discuss student problems and methods for supporting students during their clinical.
  • The above diagram is the process, as it relates to clinical education theory, I observed during my clinical rotation.
  • The above is adapted from Mandy 1989 and Cox. 1993 in Rose & Best 2005,p.31-34 This might require too much time during a busy schedule. Johns (2000) goes into depth about becoming a reflective practitioner, providing a model for structured reflection and suggests writing regular entries in a reflective journal.
  • After the preparation phase the CC / technologist would offer an explanation of the procedure (study) that is about to be initiated. This would happen for new procedures and procedures the student has not performed often. Debriefing and reflective practice add steps for both the student and CC/technologist. Debriefing The CC / technologist must actively and openly discuss the recent patient encounter with the student. It is hoped that this may help the student view the experience differently. Reflective practice The student must think about (reflect) on experiences during the patient encounter: * Analyzing and evaluating anything out of the ordinary. * Think of what else might have done. * Think of an action plan in case it happens again.
  • Why? Old medical adage: “ see one, do one, teach one ” , may not always work.
  • For assignment purposes the word count to this point (excludes references and appendices): 2801.
  • This evaluation sheet was adapted from Friesen, Kaye & Associates (1998, p. 209 - 212).
  • Clinical Teaching Techniques

    1. 1. Robert Miner ( 11416152 ) Nuclear Medicine Technology Submitted for: Renee McGill Presented June 5, 2009 Due June 12, 2009 Charles Sturt University HLT403 Clinical Teaching Techniques A clinical education program for Nuclear Medicine Technologists
    2. 2. Is there a method behind how nuclear medicine technologists are trained? What makes the nuclear medicine clinical training special? Why have a defined clinical education model/technique? The ‘ Clinical Teaching Techniques ’ course discusses models, methods and techniques used in clinical education (CEd). This talk will touch on the current nuclear medicine CEd method used in Ontario and offer ideas for improvement. Introduction
    3. 3. Purpose of the session <ul><li>At the end of this session you will know: </li></ul><ul><ul><li>Theoretical principles / models currently used in clinical education. </li></ul></ul><ul><ul><li>The current method used for nuclear medicine technology students. </li></ul></ul><ul><ul><li>Ways in which the current method could be changed or improved to </li></ul></ul><ul><ul><li>enhanced the teaching and learning experience and outcomes. </li></ul></ul>
    4. 4. How many students are present? This group may be interested in the different ways CEd can be done and how to improve the CEd experience. How many practicing technologists are present? This group may compare their experience with CEd. How many have been or are currently a clinical coordinator? This group may be interested in different CEd models ( ‘ ways of doing things ’ ) Who can learn from this talk?
    5. 5. Terminology TMI and U of T use the terms: Clinical coordinator (CC): The technologist coordinating the CEd of the students. Clinical education director (CED): The technologist who administers CEd to the students. The (CED and CC) functions are typically the same person. The clinical liaison officer (CLO): Didactic faculty member who provides assistance to students during their clinical period; acts as the liaison between CC and the education institution. In this presentation the CC will refer to the combined CC and CED function.
    6. 6. <ul><li>The purpose of the clinical component is: </li></ul><ul><ul><li>to teach the student hands-on skills, </li></ul></ul><ul><ul><li>to provide opportunities to practice those skills, </li></ul></ul><ul><ul><li>to assess how well the student masters the </li></ul></ul><ul><ul><li>required skills </li></ul></ul><ul><ul><li>to demonstrate a specific set of competencies </li></ul></ul><ul><ul><li>prior to writing their licensing exam (in the </li></ul></ul><ul><ul><li>case of technologists in the medical radiation </li></ul></ul><ul><ul><li>science program) </li></ul></ul>Clinical Education (CEd)
    7. 7. <ul><li>The core elements of a CEd program include the: </li></ul><ul><ul><li>Clinical Coordinator (CC) </li></ul></ul><ul><ul><li>Student(s) </li></ul></ul><ul><ul><li>Clinical education model </li></ul></ul><ul><ul><li>Clinical education techniques. </li></ul></ul>CEd Elements
    8. 8. <ul><li>Some of the issues to be addressed in a CEd program: </li></ul><ul><ul><li>The purpose of the program. </li></ul></ul><ul><ul><li>The credentials of the CC. </li></ul></ul><ul><ul><li>The educational needs of the student. </li></ul></ul><ul><ul><li>The personality of the student. </li></ul></ul><ul><ul><li>Different education models and techniques that can be used. </li></ul></ul><ul><ul><li>The willingness or ability of sites to take students. </li></ul></ul><ul><ul><li>The perception that students are a burden. </li></ul></ul><ul><ul><li>Funding for students. </li></ul></ul><ul><ul><li>Time constraints. </li></ul></ul>CEd issues
    9. 9. <ul><li>The Clinical Coordinator (CC): </li></ul><ul><ul><li>Is a practicing technologist </li></ul></ul><ul><ul><li>The CEd role is part of his or her job description. </li></ul></ul><ul><ul><li>Is responsible for all stages of the CEd placement </li></ul></ul><ul><ul><li>and ensures other staff members know how to </li></ul></ul><ul><ul><li>evaluate students </li></ul></ul>The Clinical Coordinator
    10. 10. The desired qualities of a CC are many: The CC <ul><ul><li>Has a high level of knowledge, both in theory and in practice. </li></ul></ul><ul><ul><li>Has the ability to self-manage and manage others. </li></ul></ul><ul><ul><li>Is available for the student(s). </li></ul></ul><ul><ul><li>Will allow students personal and profession growth. </li></ul></ul><ul><ul><li>Flexible. </li></ul></ul>
    11. 11. The desired qualities of a CC are many: The CC <ul><ul><li>Can act as a role model, colleague and teacher. </li></ul></ul>
    12. 12. The desired qualities of a CC are many: The CC <ul><ul><li>Is supportive. </li></ul></ul>
    13. 13. The desired qualities of a CC are many: The CC <ul><li>Has a sense of humor. </li></ul>
    14. 14. Various disciplines use CEd <ul><li>The disciplines commonly discussed in the literature: </li></ul><ul><ul><li>Pharmacy </li></ul></ul><ul><ul><li>Nursing </li></ul></ul><ul><ul><li>Occupational therapy </li></ul></ul><ul><ul><li>Physiotherapy </li></ul></ul><ul><ul><li>Counselor (social worker) </li></ul></ul><ul><li>Other medical radiation science programs </li></ul><ul><li>(MRI, X-ray, radiation therapy) also use CEd. </li></ul>
    15. 15. Various clinical education methods Like some pathologies CEd models are named after their founder: Mandy: A supervision cycle that starts with a pre-observation Session. The session is observed and analyzed. Feedback is given and separate analysis takes place between student and CC.
    16. 16. Various clinical education methods Cox: This method is made up of an experience and explanation cycle. Each cycle is expanded further.
    17. 17. Various clinical education methods Burnard: A model adapted for nursing using self assessment, setting of a time table with requirements from a syllabus, a learning process using theory and skills, the use of the experimental learning cycle (concrete experience, reflective observation, conceptualization and active experimentation) and then evaluation (by self, peer or clinician). On the other hand, Lekkas, et al. (2007) based their ‘ models ’ on the supervisor to student ratio.
    18. 18. Various clinical education methods <ul><li>The underlying themes of these models/techniques: </li></ul><ul><ul><li>preparation </li></ul></ul><ul><ul><li>encounter </li></ul></ul><ul><ul><li>reflection </li></ul></ul><ul><li>These stages can be padded with other steps such as: </li></ul><ul><ul><li>debriefing </li></ul></ul><ul><ul><li>explication </li></ul></ul><ul><ul><li>feedback </li></ul></ul><ul><ul><li>evaluation and assessment </li></ul></ul>
    19. 19. What ’ s currently used for NM students in Ontario? <ul><li>No models defined explicitly for nuclear medicine (NM). </li></ul><ul><li>The current approach for NM is a method that has evolved </li></ul><ul><li>over time, but has similarities to models by Lekkas, et al., Cox and Mandy: </li></ul><ul><ul><li>There are multiple supervisors/technologists per student. </li></ul></ul><ul><ul><li>Assessment of performance (competencies signed off…). </li></ul></ul><ul><ul><li>There can be several students per site. </li></ul></ul><ul><ul><li>A patient session would include: </li></ul></ul><ul><ul><ul><li>preparation </li></ul></ul></ul><ul><ul><ul><li>encounter </li></ul></ul></ul><ul><ul><ul><li>patient release </li></ul></ul></ul><ul><ul><ul><li>feedback </li></ul></ul></ul>
    20. 20. Supervision Since most NM studies (procedures) require injections or the administration of a radioactive substance to a live patient, the NM student is under constant supervision. The student is primarily supervised in a managerial fashion.
    21. 21. Assessment is key in evaluating proficiency and targeting the needs of the student (Whitman et al. 1984, p. 5). The educational institution and regulatory college establish the skills and competencies required. If assessment of performance is so important then when and how should it be done? Assessment mechanisms
    22. 22. <ul><ul><li>Assessments occur in a formal session between the student and CC. </li></ul></ul><ul><ul><li>Assessment can happen: </li></ul></ul><ul><ul><li>At scheduled intervals during the clinical period (formative assessment): </li></ul></ul><ul><ul><ul><li>to provide feedback on what is going well </li></ul></ul></ul><ul><ul><ul><li>to identify what needs more work, and </li></ul></ul></ul><ul><ul><ul><li>to suggest methods the student can use to correct deficiencies </li></ul></ul></ul><ul><ul><li>At the end of the placement (summative assessment) </li></ul></ul><ul><ul><ul><li>to evaluate the student ’ s performance over the complete </li></ul></ul></ul><ul><ul><ul><li>clinical session </li></ul></ul></ul>Assessment mechanisms
    23. 23. What ’ s currently used for NM students in Ontario. Encounter (interview patient, perform study) Supervision and feedback Patient released Preparation Next procedure.
    24. 24. How can the current method be improved? When you say ‘ improved ’ , what do you mean? Improved for the school, hospital, certification or student? Since it is a regulated profession, perhaps it ’ s best to work in a ‘ top-down ’ direction, making changes that conform to competency requirements. If the current method already meets the competency requirements, then what changes can be made resulting in a better technologist?
    25. 25. How can the current method be improved? <ul><li>Reflective practice is suggested as a way to actively learn from situations out of the norm. It is suggested doing this you become a better health care provider (Rose & Best 2005, p. 150 - 156; Johns, 2000, p. 34 - 35). In Reflective practice you think about (reflect) on experiences during the patient encounter: </li></ul><ul><ul><li>You analyze and evaluate anything out of the ordinary. </li></ul></ul><ul><ul><li>Try to think of what else you might have done. </li></ul></ul><ul><ul><li>Think of an action plan in case it happens again. </li></ul></ul><ul><li>Debriefing </li></ul><ul><li>The CC discussing the recent patient encounter with the student. </li></ul><ul><li>It ’ s used in models by Mandy and Cox </li></ul>
    26. 26. Modifications to the current method Encounter (interview patient, perform study) Supervision and feedback Explanation of procedure Patient released Student reflects Preparation Technologist debriefs student New procedure is next. Next patient is same type of study. Supervision and feedback
    27. 27. Could this be applied elsewhere? Could be adapted to MRI, X-ray, radiation therapy, but would need acceptance (buy-in) from the stakeholders: the school, student and clinical site. Can it apply to practicing technologists? Yes – for new equipment (technegas, Symbia) Yes – for new protocols (gastric emptying)
    28. 28. Summary This talk discussed basic elements and issues of clinical education. The current method used in nuclear medicine technology was covered and possible improvements were suggested.
    29. 29. Questions and discussion Time for questions. Comments may be added to the evaluation form.
    30. 30. Appendix A: Observer sheet Appendices <ul><li>Observer sheet </li></ul><ul><li>Observe the educational session and comment on the following issues.  The feedback you provide </li></ul><ul><li>will be used by the educator to reflect on the effectiveness of their session, materials and their </li></ul><ul><li>effectiveness in this role.  They will use this information to complete an assignment for their course, </li></ul><ul><li>so please ensure your comments are honest and comprehensive. </li></ul><ul><ul><ul><li>1. Why was the teaching session actually performed - was it stated during the session? </li></ul></ul></ul><ul><ul><ul><li>2. Were there learning outcomes written for this session and how were they presented? </li></ul></ul></ul><ul><ul><ul><li>Were they reinforced at the end of the session? </li></ul></ul></ul><ul><ul><ul><li>3. What learner needs assessment was undertaken and how did the educator explain </li></ul></ul></ul><ul><ul><ul><li>the relevance of the session to participants? </li></ul></ul></ul><ul><ul><ul><li>4. What techniques did the educator include to actively involve the participants during </li></ul></ul></ul><ul><ul><ul><li>the session? </li></ul></ul></ul>
    31. 31. Appendix A: (continued) Appendices <ul><ul><ul><li>5. What opportunity did participants have for receiving feedback? </li></ul></ul></ul><ul><ul><ul><li>6. What were the educator's attitudes and attributes? </li></ul></ul></ul><ul><ul><ul><li>7. Comment on any environmental constraints (e.g. physical, time etc.) that were </li></ul></ul></ul><ul><ul><ul><li>evident and what strategies were/could be implemented to overcome them. </li></ul></ul></ul><ul><ul><ul><li>8. How were the learning materials provided by the educator used? </li></ul></ul></ul><ul><ul><ul><li>9. Are there any ways in which the effectiveness of the session could have been </li></ul></ul></ul><ul><ul><ul><li>improved? </li></ul></ul></ul>
    32. 32. Appendix B: Evaluation form Appendices Clinical Teaching Techniques evaluation form Presenter: Robert Miner Date : June 5, 2009 I found this session to be (Please circle): Uninteresting 1 2 3 4 5 Interesting Worthless 1 2 3 4 5 Valuable Slow 1 2 3 4 5 Fast Too Difficult 1 2 3 4 5 Too Easy Chaotic 1 2 3 4 5 Organized Irrelevant 1 2 3 4 5 Relevant Unrealistic 1 2 3 4 5 Practical 1. What was of most value to you? 2. How could the course be improved?
    33. 33. Appendix B: (continued) Appendices <ul><li>3. What is your overall impression of the talk? (Please circle) </li></ul><ul><li>Poor 1 2 3 4 5 Good </li></ul><ul><li>Evaluate the presenter (Please circle): </li></ul><ul><ul><ul><li>Poor.…….…Good </li></ul></ul></ul><ul><li>Knowledge of subject 1 2 3 4 5 </li></ul><ul><li>Promoted group participation 1 2 3 4 5 </li></ul><ul><li>Able to provide clarification 1 2 3 4 5 </li></ul><ul><li>Approachability 1 2 3 4 5 </li></ul><ul><li>Clarity of talk 1 2 3 4 5 </li></ul><ul><li>Overall impression 1 2 3 4 5 </li></ul><ul><li>Comments/Suggestions : . </li></ul>
    34. 34. Appendix C: Related Links Appendices <ul><li>Link to CSU and masters program: </li></ul><ul><ul><ul><li>http://www.csu.edu.au/special/nuclear-medicine/index.htm </li></ul></ul></ul>Link to The Michener Institute: http://www.michener.ca/
    35. 35. References <ul><li>Canadian association of medical radiation technologist (CAMRT). (2007). Certification handbook. Ottawa </li></ul><ul><li>College of medical radiation technologist of Ontario (CMRTO). (2005). What you </li></ul><ul><li>must know about registration. Toronto </li></ul><ul><li>Fish, D., & Twinn, S., (1997). ‘ Versions and views of good practice', in </li></ul><ul><li>Quality practice: Versions and views of good practice, Reed Educational </li></ul><ul><li>and Professional Publishing, Oxford, pp. 89-109. </li></ul><ul><li>Foley, R., Smilansky, J., (1980). Teaching Techniques. A handbook for health </li></ul><ul><li> professionals. New York: McGraw-Hill </li></ul><ul><li>Friesen, Kaye and Associates, (1998). Designing instruction </li></ul><ul><ul><ul><li>workshop. Participant manual. </li></ul></ul></ul><ul><li>Hawkins, P., Shohet, R., (2000). Supervising in the helping professions. </li></ul><ul><li>(2 nd ed.) Open Buckingham, UK.: University Press </li></ul>
    36. 36. References Joffe, B., (2005). Models of clinical education. In M. Rose and D., Best (Ed.), Transforming practice through clinical education, professional supervision and mentoring . Churchill Livingston, Edinburgh: Elsevier Johns, C., (2000). Being and becoming a reflective practitioner: A reflective and holistic approach to clinical nursing, practice development and clinical supervision. Blackwell Science, Oxford, p. 34- 67. Lekkas, P., Larsen, T., Kumar, S., Grimmer, K., Nayland, L., Chipchase, L., Jull, G., Buttrum, P., Carr, L., Finch J., (2007). No model of clinical education for physiotherapy students is superior to another: a systematic review. Australian Journal of Physiotherapy 52, 19-28 McAllistar, L., (2005). Finding the meaning and preventing burnout. In M. Rose and D., Best (Ed.), Transforming practice through clinical education, professional supervision and mentoring . Churchill Livingston, Edinburgh: Elsevier
    37. 37. Palmer, C., Cherryman, F., (2009). Supporting student success. Journal of Medical Imaging and Radiation Science , 40(1), 38-44. Rose, M., Best, D., (2005). Transforming practice through clinical education, professional supervision and mentoring . Churchill Livingston, Edinburgh: Elsevier Ryan , S., (2005). The challenging learning situation. In M. Rose and D., Best (Ed.), Transforming practice through clinical education, professional supervision and mentoring . Churchill Livingston, Edinburgh: Elsevier Stern, D., Rone-Adams, S., (2006). An Alternative model for first level clinical education experiences in physical therapy. The Internet Journal of Allied Science and Practice. 3(4), 1-23 Steves, A., (2005). Improving the clinical instruction of student technologists. Journal of Nuclear Medicine Technologist , 33, 205-209. References
    38. 38. <ul><li>Strohschein, J., Hagler, P., May, L., (2002). Assessing the need for change in </li></ul><ul><li>clinical education practices. Physical Therapy , 82(2), 160-172 </li></ul><ul><li>The Michener Institute for applied health sciences (2002). Clinical teaching technologist </li></ul><ul><li>handbook. Nuclear medicine technology program. Toronto </li></ul><ul><li>University of Toronto/Michener radiation science program. (2007). Clinical </li></ul><ul><li>handbook class of 2008. Toronto </li></ul><ul><li>van Ooijen, E., (2000). The supervisory relationship, in clinical supervision: a practical </li></ul><ul><li> approach. Churchill Livingstone, Edinburgh. 25-55. </li></ul><ul><li>Whitman, N., Schwenk, T., (1984). Preceptors as teachers. A guide to clinical teaching. </li></ul><ul><li>Salt Lake, Utah: University of Utah school of medicine </li></ul><ul><li>Winn, J., Grantham, V., (2005) Using personality type to improve clinical education </li></ul><ul><ul><ul><li>effectiveness. Journal of Nuclear Medicine Technologist , 33, 210-213. </li></ul></ul></ul>References

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