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Consolidating Clinical Learning Through Post-Rotation Small Group Activities

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Augmenting Health and Social Care Students’ Clinical Learning Experiences

Part of the book series: Professional and Practice-based Learning ((PPBL,volume 25))

Abstract

A significant proportion of the undergraduate medical curriculum is delivered in the workplace given its value in supporting students develop professional competencies. Clinical placements are often modelled on the cognitive apprenticeship where students learn about patient care under the close supervision of the expert clinician. Time-pressured clinicians, however, who have a patient-focussed approach to supervision often teach “on the run” rather than adopting a student-centred approach to learning whereby the full benefits of the cognitive apprenticeship can be realised. Students who do not have opportunities to participate fully in the healthcare team’s community of practice, albeit under close supervision, often report feeling underprepared for professional practice as a junior doctor (reference). As the core business of the healthcare setting is patient care, as opposed to clinical teaching, this situation is unlikely to change, and it is perhaps unwise to rely solely on the clinical placement to prepare medical students for full participation in the workplace. This chapter discusses an educational intervention known as the modified clinical debriefing tutorial (MCDT) that was designed to augment student learning during clinical placements. Final year medical students were exposed to six, 2-hour MCDTs where, in the presence of an experienced clinician, they were provided with additional space and time to examine and make sense of the day-to-day events of the clinical setting, as well as specific challenging incidents they encountered. Drawing on the principles of the cognitive apprenticeship model, tutors were trained to lead discussions such that students made their thinking visible through strategies such as reflection, articulation, modelling and scaffolding, with tutors using coaching and mentoring strategies. This intervention was evaluated, and results suggest that the MCDT affords students the opportunity to engage in and practise cognitive and metacognitive processes that are necessary to solve complex problems once they graduate. The MCDT is a valuable extension of the clinical placement that assists students adapt to the realities of the clinical workplace, both as students and once they graduate as junior doctors.

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Author information

Authors and Affiliations

  1. The University of Notre Dame Australia, Fremantle, Australia

    Carole Steketee, Niamh Keane & Katharine Gardiner

Authors
  1. Carole Steketee
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  2. Niamh Keane
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  3. Katharine Gardiner
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Corresponding author

Correspondence to Carole Steketee .

Editor information

Editors and Affiliations

  1. Education and Professional Studies, Griffith University, Mt Gravatt, QLD, Australia

    Stephen Billett

  2. Nursing & Midwifery, Monash University, Clayton, VIC, Australia

    Jennifer Newton

  3. School of Medicine, Griffith University, Southport, QLD, Australia

    Gary Rogers

  4. Medical Education Unit, Gold Coast University Hospital, Southport, QLD, Australia

    Christy Noble

Appendices

Appendices

1.1 Appendix 1: Educational Intervention Survey

  1. 1.

    Do you think CD tutorials in MED400 have been useful to your learning? Please explain your comments with two brief sentences.

  2. 2.

    Identify the extent to which of the following statements best describes your perception of the CDT as a useful learning experience.

    1. A.

      My understanding of what it means to be an effective clinician was enhanced by listening to other students’ experiences.

    2. B.

      Receiving feedback from an experienced practitioner about my rotation experiences consolidated my understanding of clinical work.

    3. C.

      The CDTs gave me time to reflect on, and make more sense of, my experiences while on rotation.

    4. D.

      The CDTs were an opportunity to explore the relationship between what I learned on campus and what I did on rotation.

  3. 3.

    Which of the following statements best describes your clinical debriefing tutorial environment?

    1. A.

      The location was comfortable/private.

    2. B.

      The atmosphere was relaxed and nonthreatening.

    3. C.

      The group numbers were the right size.

    4. D.

      The CD tutor had sufficient clinical experience to facilitate the tutorial.

    5. E.

      The CD tutor clearly outlined the expectations/outcomes.

    6. F.

      Discussions were open/interactive.

    7. G.

      Views of all individuals were equally respected and considered.

    8. H.

      I felt able to express my opinion.

  4. 4.

    Collegial support is important as a professional practitioner. Identify the extent to which the following statements allowed you to further develop collegiate relationships with your peers during CDT

    1. A.

      Engagement with my peers in clinical debriefing tutorials helped me to process-describe experiences in the clinical setting.

    2. B.

      Engagement with my peers in clinical debriefing tutorials helped me to understand experiences in the clinical setting.

    3. C.

      Engagement with my peers in CD group helped me to reflect on experiences in the clinical setting.

    4. D.

      Engagement with my peers in CD group helped me to manage future experiences in the clinical setting.

  5. 5.

    Opportunities to discuss critical incidents that occurred on rotation can help you learn more about yourself as a professional. Describe the extent to which the following statements allowed you to make sense of critical incidents (e.g. those situations that were either upsetting, thought-provoking, joyful or resonated with you).

    1. A.

      I was able to discuss critical incidents from rotation.

    2. B.

      I received relevant feedback on my critical incident experience.

    3. C.

      I learnt about other students’ experiences which helped me better understand mine.

    4. D.

      Opportunities to discuss critical incidents is important for my professional growth as a clinician.

    5. E.

      Presenting my critical incident as a case study was beneficial to my learning.

    6. F.

      I felt safe presenting this issue in the clinical debriefing tutorial.

    7. G.

      The clinical debriefing tutorial framework helped me explore this critical incident.

    8. H.

      I could have explored this issue without attending the clinical debriefing tutorial and achieved the same outcome.

    9. I.

      I have changed my behaviour after discussions in the clinical debriefing tutorial.

    10. J.

      I have developed a strategy to deal with this critical incident.

    11. K.

      I would have achieved the same outcome if the CD tutor was one of my peers.

    12. L.

      The case presentation enhanced my learning from Clinical rotation.

  6. 6.

    From your clinical debriefing tutorials, what strategies did you develop for the clinical setting that will be important for you to become a good doctor? Please write three short sentences describing the strategies you have developed.

  7. 7.

    What would you have liked to have discussed in your CD tutorial but did not?

  8. 8.

    Do you have any suggestions on how CD tutorial discussions could be improved?

Tutor discussion questions:

  1. 1.

    Summarise the threads of the discussion resulting from the survey.

  2. 2.

    Name the three most important factors in the CD tutorial discussion that enhanced the learning from clinical rotation experience.

1.2 Appendix 2: Transformational Pedagogies Framework (Adapted from De La Salle University)

Mezirow (1997) contends that the teacher has a critical role in creating situations that promote effective student participation in transformative learning. Transformative pedagogies that facilitate student participation have been captured in a framework for translating transformative learning theory into practice by De La Salle University. Table 9.2 is an adaptation of this framework and was the basis of analysis of responses to question 3.

Table 9.2 Transformational Pedagogies Framework (adapted from De La Salle University)
Full size table

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Steketee, C., Keane, N., Gardiner, K. (2019). Consolidating Clinical Learning Through Post-Rotation Small Group Activities. In: Billett, S., Newton, J., Rogers, G., Noble, C. (eds) Augmenting Health and Social Care Students’ Clinical Learning Experiences. Professional and Practice-based Learning, vol 25. Springer, Cham. https://doi.org/10.1007/978-3-030-05560-8_9

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  • DOI: https://doi.org/10.1007/978-3-030-05560-8_9

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