Susan Neville

Clinical Education: Students' and Clinical Tutors' Views

Summary Various studies have shown that clinical education is a rewarding yet problematic area of education for both physiotherapy students and clinical tutors. In this study 40 third-year BSc(Hons) physiotherapy students and 64 clinical tutors were asked for their views regarding what constitutes a ‘good’ and a ‘poor’ clinical experience. The main factors highlighted by the students were the attitude and behaviour of the tutors, the environment and social atmosphere and the quality of the learning experience. The main factors highlighted by the clinical tutors were the attitude and ability of the students, student development, and personal and professional growth. It was concluded that there is far more to the role of clinical tutor than excellence in clinical practice and that a more structured education for clinical tutors, to help them in this role, needs to be developed.

Role Play and Simulation

In role-play exercises, learners act out roles without a specific script although they are usually given information about the characters they are to play, and the situations they are in. Role play can be used to change behavior, widen perspectives, change attitudes, improve social skills, and develop alternative solutions to problems. Perhaps, role playing is the next best thing to experience a genuine event. Role play can also be used to help learners gain skills in treating, assessing, and interviewing patients and clients, and to gain confidence when talking to groups or coping with difficult personal situations; it is used extensively in assertiveness training. The terms “simulation” and “case study” are used interchangeably. Simulation exercises are sometimes carried out in an attempt to gain insight into various disabilities, for example, the participants may be obliged to wear blindfolds or use wheel-chairs. These exercises have been severely criticized by many disabled people for being unrealistic, for trivializing and individualizing disability, and for fostering negative attitudes.

Teaching Practical Skills

Practical skills are widely used in therapy. There are fine gradations of movement used in passive manual mobilization techniques applied to peripheral or spinal joints, the manipulation of soft tissues used in massage, and the specialized neuromuscular facilitation techniques used, for example, in the re-education of facial musculature. Practical skills are also needed to lift patients or clients safely and to assist them with functional activities, such as feeding, dressing, transferring from bed to chair, and walking. One of the ways in which a therapist might begin to teach a practical skill is to demonstrate it to the learners while, at the same time, carefully explaining it. For observation and instruction to succeed, it is essential that learners are motivated and attentive. It is usually best to demonstrate the entire sequence first; it is vital that the demonstration is fluent and of a high standard. If the therapist has not practiced the skill recently, or if the equipment is unfamiliar, then time must be spent rehearsing the skill beforehand.

Evaluating the Teaching and Learning Process

Evaluation is an important aspect of the teaching and learning process. It is concerned with collecting evidence on, and making judgments about teaching and learning, for the purpose of improvement. It concerns the extent to which the teaching and learning experience is seen to be of value. Evaluation, like assessment, should not only be addressed once the teaching has taken place, but should also be considered at the planning phase and be an integral part of the teaching and learning experience. Evaluation is often confused with assessment as both are concerned with collecting evidence about what has been taught and learned; the results of assessment may be used for evaluation purposes. Teaching and learning are perceived in different ways. Just as learners have preferred ways of learning, therapists develop preferred ways of teaching, and the two may not necessarily match. Informal evaluation is likely to be a continuous process that comes naturally to those therapists who are committed to education, and who strive to make their contact with learners as meaningful and successful as possible.

Small Group Teaching

When asked to teach, many therapists may, understandably, be tempted to lecture to large groups of people, to save themselves time. However, learners, be they undergraduates, colleagues, or people from other professions, are likely to assimilate more if they are taught in a small group setting. In this situation, there is a greater opportunity for participation and for therapists to offer individuals immediate feedback and help when required. Seminars and tutorials are useful methods for achieving these aims. The seminar is a small group teaching method where, ideally, the number of learners should not exceed 10. A learner is asked to present a paper to the rest of the group, which is then discussed. Tutorials involve the teaching of one learner or a group of learners ideally not exceeding five. It is a teaching method associated with the older universities and, if used frequently, requires a high learner-teacher ratio.

Active Learning During Lectures

This chapter focuses on active learning during lectures. Even if therapists are only teaching for an hour or two, there are many activities that can be incorporated into their lectures. These will help to hold the interest of the learners and will encourage participation. This is particularly important when teaching large groups where many people feel inhibited. During the lecture, it can be useful to divide the learners into small groups. This has the advantage that those who tend not to participate in a larger context may contribute their ideas and gain confidence. Learners can also test ideas on a few of their peers before presenting them to the whole group. Very specific instructions are required to be given if small group activities are to work well; the learners must know precisely what is required of them or muddle will ensue. A certain amount of time pressure can inspire good group work, though too little time can trivialize the tasks undertaken.

Knowing the Learners

Teaching is not something that is simply done to others. Education takes place only if someone is learning and any teacher needs to understand who those learners are. Learners also bring to the learning situation their cultural backgrounds. Learners may be disabled, may be carers, or may recently have been therapy patients themselves. They may have just attained excellent “A” level results or feel under-confident of what they perceive to be their low level of education. They may have easily made the transition from one educational institution to another or be quaking with remembered fear after 20 years out of a classroom. The important thing, from the therapists point of view, is that this panorama of experience within the group of learners should not be seen only as a problem but also as something that can be used to positive advantage. In addition to devising strategies to cope with who the learners are, the therapist should be very clear as to what the learners want and need to know.

Organizing Conferences and Presenting Conference Papers

Publisher Summary When therapists have gained experience in the teaching role, they may decide to organize a conference, either small or large, for the benefit of the learners whom they wish to assist. A vital thing to think about when planning a conference is the budget, for without a budget little can take place. Even for an evening meeting with one guest speaker, who is happy to talk without a fee, the price of the coffee and biscuits must come from somewhere. If the conference is a large event, then it is essential for the organizer to enlist the help of other people and even other agencies. The organizer may, for example, need to communicate with catering, administrative, and caretaking staff, and those in the media resources department. All of these require considerable communication and organizational skills. Conference organizers will get the most out of speakers if they are clearly briefed. Every speaker will need some information about the delegates so that the knowledge they impart can be tailored accordingly.

The Discussion Group

Publisher Summary Group discussion is an active, democratic teaching method where each participant has the right to contribute ideas, and in which the teacher does not dominate. The members of the group pool their knowledge and learn from each other. Discussion is a particularly useful method for exploring complex, multifaceted issues. By considering the interpretations and ideas of others, individual learners are provided with a wider perspective. Although the therapist should generally take a “back seat” in discussions, this does not mean that no preparation is required. Preparing for a discussion is more demanding than lecture preparation, because the therapist has less control over proceedings and cannot fully anticipate where the discussion will lead. Therapists who decide to use this method must have a sound grasp of the subject matter themselves. Detailed notes are not necessary when planning a discussion, but an outline plan should be made. Running a discussion group well is not an easy task, but can be learned and improved upon with practice.

Helping People to Learn: Practical Factors

Before engaging successfully upon a teaching task, it is necessary for a therapist to have various areas of knowledge. For example, it is essential to know something of the background of those who are to be taught. A therapist will not teach a group of children in the same way as a group of colleagues and a third approach would be appropriate for a group of student therapists visiting the department. An understanding of the intellectual processes of learners and of the subject in hand is invaluable to a therapist, but a large part of the teaching and learning process pivots upon practical tasks to be undertaken by both therapist and learner. The learning process will be enhanced if steps are taken to ensure that these practical tasks are undertaken efficiently, and in a way and to a timescale that suits all parties. If the therapist wishes the learners to have brought equipment with them, then the learners should be aware of this expectation.