Manage Clinical Practice

Introduction

What challenges do you face when students

are working in the clinical area to practice their
skills?

Is the facility appropriate?

Do the staff welcome your students?

Objectives

Select and prepare clinical instructors and staff

Coordinate clinical practice

Conduct clinical practice sessions

Monitor students progress

Clinical Practice Team

Students

Teacher

Clinical instructor

Staff members
working in the clinic

Selecting Clinical Instructors

Time available and a desire to work with

students
Proficient healthcare delivery skills that are
consistent with what is being taught
Excellent interpersonal communication skills
Organizational skills
Teaching skills

Strengthening Clinical
Instructors

Clinical knowledge and skills are up-to-date

and consistent with what is being taught

Teaching skills, such as demonstrating with

models, coaching, providing feedback, and
performing assessments, that they will need in
working with students

Preparing Clinical Instructors and

Staff #1

Meet to communicate objectives and

requirements for the clinical rotation and
discuss any questions

Inform the clinical instructors of the students

abilities and learning needs

Preparing Clinical Instructors and

Staff #2

Inform the clinical instructors and staff about to

give feedback on student performance (provide
them with the checklists, forms, feedback
reports)

Clinical practice carried out in communities and

homes requires making sure students and any
staff are fully aware of expectations

Coordinate Teaching #1

Work closely with all members of the team

Meet with clinical instructors in advance to

discuss student placement, preparation of the
staff and communications with students

Share copies of the syllabus with the clinical

instructors and staff

Coordinate Teaching #2

Give the clinical instructors or staff copies of

the student performance report

Discuss plans for student assessment

including sharing copies of the checklists and a
summary of the skills they will be responsible
for observing

Student Responsibilities #1

Review any assigned readings or checklists

Attend and actively participate in all clinical
practice visits
Take an active role in learning and
communicate questions and concerns to the
clinical instructor or teacher
Obtain comprehensive and targeted health
histories
Conduct physical examinations

Student Responsibilities #2

Present findings clearly and concisely

Observe demonstrations of skills and perform
skills
Select and interpret screening and diagnostic
laboratory tests in collaboration with the clinical
instructor
Co-manage patients with complex health
problems

Student Responsibilities #3

Educate and counsel patients and families

Coordinate and communicate patient
management with the clinical instructor
Document findings and experiences in an
organized, thorough manner
Evaluate clinical practice experience

Responsibilities of Teachers,
Clinical Instructors and Staff #1

Maintain up-to-date healthcare delivery skills

Review teaching materials or tools
Review learning objectives for clinical practice
Ensure that the necessary logistics have been
arranged
Orient clinical staff and any others involved in
teaching to the learning objectives and the
expected tasks

Responsibilities of Teachers,
Clinical Instructors and Staff #2

Communicate with other teachers or clinical

instructors
Orient students to each new clinical site, with
the assistance of a staff member
Ensure that students and clinical instructors or
staff members have the tools (checklists,
logbooks)
Review learning objectives with the students
and clinical staff

Responsibilities of Teachers,
Clinical Instructors and Staff #3

Select appropriate patients based on the

learning objectives for the session or rotation
Demonstrate skills for students
Observe students as they practice, and provide
frequent feedback on performance
Assist students, clinical staff, and other
teaching assistants with any difficulties

Responsibilities of Teachers,
Clinical Instructors and Staff #4

Sign and review the logbook

Plan with the students for additional
experiences
Assess and report on students performance
Monitor students progress throughout the
clinical practice experience, and report results
to other teachers or clinical instructors
responsible for the session or rotation

Use Objectives to Plan

Review the learning objectives to assist in

planning appropriate clinical practice activities

Determine which objectives can be met in the

outpatient department and which in the inpatient
ward.

External clinics, communities, and home visits are

other sites used in clinical practice activities.

The Outpatient Department

#1

First point of contact for most patients, so most

appropriate place to practice interviewing and
interpersonal and counseling skills as well as
clinical skills

Best place to develop an initial care plan and

to teach patients how to implement the plan at
home

The Outpatient Department

#2

The outpatient department also is an excellent

interim step between simulated practice and
working with very sick patients in the inpatient
ward.

The manual lists some objectives that can be

met in the outpatient setting. Can you think of
others?

The Inpatient Ward

In inpatient settings, patients are usually

seriously ill, and have already started a care
plan and specific treatments.

Inpatient wards are a good place to teach

patient management, practice healthcare
delivery skills, and demonstrate management
of rarely seen conditions.

Examples of Inpatient Ward

Skills #1

Assess clinical status

Perform specific clinical interventions such as

administering an intravenous solution

Document information on the patients plan of

care, treatment, and changes in condition

Examples of Inpatient Ward

Skills #2

Communicate
clearly with clinical
staff and family (as
appropriate) the
findings about a
patient

Review diagnostic
test results and
apply them to the
patients condition

Examples of External Clinics and

Home Visit Skills

Assessment of environmental hazards

Group and individual education skills
Communication skills
History-taking skills
Infant and postpartum visit assessment skills

Structure Clinical Practice

Sessions #1

Move from basic to more complex skills.

Move students from observation to direct work

with patients.

Structure activities to allow for the most

interaction with patients.

Structure Clinical Practice

Sessions #2

Plan a rotation system so that students do not

overwhelm one area.

Prepare activities that students can do when

there are no appropriate patients at the clinical
practice site.

Outpatient Teaching
Approaches

Apprentice

Team member

Supervisor

Lets take a look at each of these approaches

Apprentice

Students function as healthcare providers

while the clinical instructor or assigned staff
member closely observes and intervenes when
appropriate.

Slows patient flow but does provide excellent

practice opportunities.

Team Member

Students function as a member of the team

and see patients individually or in pairs in a
separate room and then report their findings
and recommended plan of care.

This gives students a more independent

experience but takes more of the patients
time.

Supervisor

Students are assigned to several different

rooms, and a clinical instructor or other
designated staff member moves back and forth
among the rooms providing feedback and
supervision.

This method allows students a great deal of

independence, but does not allow for much
direct supervision.

Inpatient Teaching
Approaches

Patient-centered
teaching

Ward rounds

Lets take a look at

these approaches

Patient-Centered Teaching

Student is assigned one or more patients to

follow.

Student works under supervision of staff and is

responsible for the patients care.

Student will present the patient during rounds,

assist in the care plan, and communicate with
staff about the patients condition.

Ward Rounds

Ward rounds may be used for either

observation or interaction.

Care must be taken during ward rounds to

protect the patients privacy and to avoid
talking as if the patient were an object.

It is better to discuss the patient in a private

location away from the bedside.

Ward Rounds - Observation

The students join rounds as an observer.

The healthcare provider managing the patients

care will report the patients presenting
complaint, initial findings and treatment,
laboratory and other diagnostic results and
interpretation, current condition, and future
plans.

Ward Rounds - Interaction

During ward rounds, the students are asked

questions about the patients condition and are
expected to respond.

Several of the students may have been asked

to prepare to present the patient to the group.

Positive Feedback

Positive feedback is often easy to give and can

be provided in the presence of the patient.

Keep the feedback simple and relaxed; too

much feedback may alarm the patient.

At the same time, the absence of feedback of

any kind can be disturbing to the student.

Constructive Feedback

Constructive feedback is difficult to give, but

particularly when a patient is present.

It is important to keep such feedback low-key

and restrained.

Avoid embarrassing the student and try and

save constructive feedback until the students
are gathered away from the patients.

Constructive Feedback
Techniques #1

Often a look or hand gesture (e.g., a touch on

the shoulder) can be as effective as words and
less of a concern to the patient.

In a quiet, direct manner, you can make simple

suggestions to facilitate the procedure, for
example, You might find it easier to insert the
speculum if you use gentle downward
pressure.

Constructive Feedback
Techniques #2

To help a student avoid making a mistake

during a procedure, ask a question about the
procedure itself.

Sometimes, even though they have had

extensive practice on models, students make
mistakes that can potentially harm the patient,
so you must be prepared to step in and take
over the procedure.

Cover Before the Clinical

Practice Session #1

The learning objectives for that day or the

clinical session
Any necessary scheduling changes
Students tasks for that day or session,
including the work assignments and rotation
schedule if applicable
Assignments to be completed that day or that
session

Cover Before the Clinical

Practice Session #2

The topic for the post-session meeting, so the

students can prepare cases or look for
experiences to share

Questions related to the session or from

previous sessions

Discussion about how feedback will be

provided in the clinical setting

During the Clinical Practice

Session #1

Check in periodically with clinical instructors and

staff

Coordinate any planned learning activities

Observe student-patient interaction

Continue to facilitate skill development

(demonstrate, provide feedback)

During the Clinical Practice

Session #2

Ask if students have been assessed on any of

the skills in their logbook

Assess student skills or ask staff to do this

Create a positive learning environment by

having a friendly and helpful manner

Protect Patients Rights

Inform the patient of the role of each person

involved and make sure that a licensed
provider is always present
Obtain the patients permission before having
students observe, assist with, or perform any
procedures
Respect the right to bodily privacy
Strictly observe the confidentiality

After the Clinical Practice

Session #1

Review the learning objectives and assess

students progress toward meeting them

Present cases seen that day, particularly those

that were interesting, unusual, or difficult

Provide an opportunity for students to ask

questions

After the Clinical Practice

Session #2

Ask students
questions about
cases or their care
plans

Tell students about

the logistics of future
clinical practice
sessions

Monitor Students Progress

Logbooks (also called a casebook) as seen in

Samples 9-1 and 9-2

Student performance reports

Field notebooks (often used during community

or home visits)

Summary

Lets review the information contained in the

job aid on Page 9-19.

What questions do you have about managing

clinical practice?

How will you plan and manage clinical practice

for your students?