This document discusses the role of clinical instructors in crafting optimal clinical learning experiences for healthcare students. It covers topics like role preparation for clinical instructors, implementing the instructor role, addressing student issues, and evaluating clinical learning. Some key points include the importance of mentoring for new clinical instructors, using teaching strategies like facilitating critical thinking and providing frequent feedback to students, addressing issues like student safety and misconduct, and basing evaluations on measurable behavioral outcomes to support student growth.

1. Chapter 24
Crafting the Clinical Experience: A
Toolbox for Healthcare
Professionals

2. Crafting the Clinical Experience: A
Toolbox for Healthcare
Professionals
• Role Preparation
• Implementing the Role
• Student Issues
• Evaluation of Clinical Learning

3. Crafting the Clinical Experience: A
Toolbox for Healthcare Professionals
• Optimal clinical learning is best achieved when
the teacher is a true educator.
• The clinical experience is a time in which the
student applies theory to practice.
• Establishing and maintaining professional
boundaries with students, remaining current
in practice, and teaching and implementing
evidence-based practice is an art and a science.

4. Role Preparation
• Although an educator may be an expert
clinician in his or her field, as an
educator, he or she may nor have the
foundation necessary to be a successful
clinical teacher.
• The educational institution must provide
the necessary mentoring for new faculty.

5. Role Preparation
• Scholarship Roles
– Discovery–the need for scientific inquiry
into the discipline of healthcare professions
– Integration–meaning, perspective, making
connections across disciplines, and placing
specialties in a broader context.

6. Role Preparation
• Scholarship Roles
– Teaching––the art of professional
education. Many educators are not taught
how to teach clinically.
– Application—calls upon the educator to
maintain competency in the clinical field

7. Role Preparation
• Clinical Instructor Teaching Strategies
– Creating and maintaining an open, collegial
relationship
– Adapting the experience of the student
– Facilitating clinical reasoning
– Making time for the student
– Receiving environmental support

8. Implementing the Role
• Clinical Orientation
• Crafting the Clinical Experience
• Clinical Rounds
• Clinical Decision Making
• Postclinical Conferences
• FIDeLity
• Conducting the Clinical Day

9. Implementing the Role
• Five Dimensions of passion that provide
a framework for clinical teaching
– Commitment
– Achievement
– Trust
– Caring
– Collaboration

10. Implementing the Role
• Clinical Orientation – How to Get off to a Good
Start
– The clinical instructor must complete all required
agency orientation and be knowledgeable of agency
policies and procedures.
– Instructors cannot just drop students off at the site
and expect the hospital staff to take over.
– Clinical instructors need to communicate clear
expectations for each clinical experience.

11. Implementing the Role
• Crafting the Clinical Experience
– It is critical to craft the clinical experience so
that the assignments match the course
objectives and are congruent with
theoretical concepts.
– An assignment sheet shows everyone which
students are working with which patients.

12. Implementing the Role
• Crafting the Clinical Experience
– It is imperative to follow agency policies
regarding the procedures in which students
may or may not participate.
– Credibility as a clinical instructor will be
tested by staff and students.
– Providing students with positive examples
as well as examples of omissions or errors
helps guide students’ reflective practice.

13. Implementing the Role
• Clinical Rounds
– Provide an opportunity to observe students
interacting with their patients and family
members.
– Use the teachable moment.
– Clinical instructors should use higher level
questions to facilitate critical thinking skills.
– Provide the students with an experience
that keeps them engaged and places them in
the role of a total patient care provider

14. Implementing the Role
• Clinical Rounds
– By eliciting feedback from both the student
and staff members, the instructor will be
able to determine whether an assignment is
too challenging or is not keeping the student
engaged.
– Developing self-awareness in students is a
professional priority.

15. Implementing the Role
• Clinical Decision Making
– Students progress from assessment decision
making to interventional decision making
with the capability of appraisal with risk to
themselves as well as to the patients
– Instructor must monitor and support the
student throughout the clinical day and
semester by being present and providing
feedback for the decisions they make

16. Implementing the Role
• Postclinical Conferences
– Taking Action Based Upon Analysis of
Patient Information
– Applying Evidence-Based Research to
Practice
– Incorporating Evidence-Based Practice
– Peer-to-Peer Feedback

17. Implementing the Role
• FIDeLity
– Taking Action Based Upon Analysis of
Patient Information
– Applying Evidence-Based Research to
Practice
– Incorporating Evidence-Based Practice
– Peer-to-Peer Feedback
– Frequent, immediate, discriminating,
lovingly

18. Implementing the Role
• FIDeLity
– Frequent
• Feedback needs to be often
– Immediate
• Immediate open ended questions
• With delayed feedback students cease to care
about why their answer or activity was good or
not

19. Implementing the Role
• FIDeLity
– Discriminating
• distinguishing features of good and poor
performance in ways that are clear to students
are imperative
– Lovingly
• Empathy and personal understanding is an
essential component in providing the feedback

20. Implementing the Role
• Conducting the Clinical Day
– The structure is based on a plan for both
instructor and students.
– Patient care assignments for each clinical
experience must be tied to course
objectives.
– Plan and track times for specific
interventions.

21. Implementing the Role
• Conducting the Clinical Day
– The student is responsible for keeping the
staff informed of the outcome of
interventions implemented.
– It is the student’s responsibility to provide
accurate and timely patient status reports.

22. Student Issues
• A good clinical educator knows the
student’s background and learning
needs.
• Early intervention is recommended with
students who are not doing well in
clinical to improve their performance.
• At times the clinical instructor may be
called upon to manage a challenging
student situation

23. Student Issues
• Unprofessional Behavior
– May be observed by the clinical instructor or
reported by someone else.
– Students should be engaged early on in the
significance of professional accountability for
security and confidentiality related to
information technology.
– It is the instructor’s role to enforce compliance
with issues such as absenteeism, tardiness, dress
codes, etc.

24. Student Issues
• Incivility
– Defining clear guidelines and setting
boundaries should begin on the first day of
the clinical experience.
– If clinical instructor’s interventions with the
student are unsatisfactory, he or she should
seek guidance from a senior faculty
member.

25. Student Issues
• Academic Dishonesty and Unethical
Behavior
– It is the instructor’s responsibility to comply
with policy and report violations.
– Students may view unethical clinical
behaviors differently from unethical
classroom behaviors.
– Altering charts or failing to report errors
can be signs of more serious problems and
may affect patient outcomes.

26. Student Issues
• Safety
– Reporting and investigating causal system
failures and revealing the primary error to
the physician and the patient is the primary
role of the healthcare professional.
– The instructor must assess each student’s
preparation for delivering safe patient care
prior to the beginning of the clinical
experience.

27. Student Issues
• Safety
– The clinical instructor must document and
provide feedback to a student who has had a
breach of patient safety.
– The clinical instructor must follow agency
guidelines for reporting such incidents.

28. Evaluation of Clinical Learning
• Evaluation is an opportunity for growth.
• Should be based on a standard
evaluation tool.
• The instructor must collect enough data
on which to base the evaluation against
behavioral outcomes over time.

29. Evaluation of Clinical Learning
• Formative evaluation should allow
students the opportunity to internalize
the process of self reflection and self
discovery in his or her personal practice.
• Say what you mean, and mean what you
say.

30. Evaluation of Clinical Learning
• The final clinical evaluation allows the
instructor to analyze and deliver to the
student the progress of clinical
performance over time.
• The summative evaluation prepares the
student to move forward in the program
with guided input regarding their
current state of practice.

31. Evaluation of Clinical Learning
• Learning contracts or clinical warning
forms are used by clinical instructors to
delineate unsafe clinical practice or
breaches in professional practice.
• These documents become part of the
evaluation process and become part of a
remediation plan.

32. Evaluation of Clinical Learning
• Clinical Practice Failure
– Clinical failure is the lack of clinical
competence and the inability of the student
to meet course objectives.
– Not all students succeed.
– Some students decide on different career
paths; for other students it is a wake up call
to work harder.

33. Evaluation of Clinical Learning
• Clinical Practice Success
– Students who have inherited a passion for
lifelong learning from their clinical
instructors will be well equipped and
resilient to meet the demands as they grow
in their professional roles

34. Evaluation of Clinical Learning
• Clinical Practice Failure
– Students who fail may attempt to blame
failure on the clinical instructor, hence the
importance of the paper trail.
– In the face of clinical failure, what really
matters is how the student and teacher
interact.
– Teachers need to become partners who
stand with, rather than against, vulnerable
students.

35. Conclusion
• Optimal learning outcomes are not
achieved when the teacher is just an
authority figure and content expert.
• In order for expert clinicians to become
effective teachers, additional knowledge
and skills are required.