No description available.

The diagnosis and management of patients requires professional know-how or medical craft knowledge. To explain how this knowledge is acquired, this research asked 'How do medical experts pass on their craft?' Other questions arose through successive data collections and progressive focusing on what medical experts did well in their work and teaching. The programme comprised: pilot interviews with three expert physicians; a case study in a hospital medical unit; and paired consultant/SHO interviews. Participant observation, interviews, and expert-novice comparisons explored clinical work, teaching, and learning in apprenticeship. Data analysis of participants' responses and ward round discussions allowed identified categories to cluster within three inter-related constructs instrumental to the acquisition of medical knowledge: gaining experience in the experiential process of clinical practice (1); and the products of experience which manifest as experts' clinical expertise (2) and teaching/learning expertise (3). These constructs can be located within a model of apprenticeship based on Spady's (1973) analysis of authority in effective teaching containing two frames of reference: the social, 'traditional-legal'; and the individual, 'expert-charismatic'. The medical apprenticeship is associated with similar perspectives: the 'traditional-experiential' represents the professional process of learning through patient care with its infrastructure of clinical methods in presentation, discourse, and commentary; and the 'expert-charismatic' represents clinical and teaching expertise coupled with vocational enthusiasm. Experienced experts synthesised two repertoires of knowledge and skills derived from the craft knowledge of medicine and pedagogy, respectively. Both crafts are required for effective clinical education. While apprenticeship accommodates a range of teaching/learning experiences, in postgraduate education experts pass on knowledge through the deliberate engagement of junior doctors in diagnosis and management. The skills involved in this process were largely unrecognised by most senior and junior doctors and were not perceived as 'clinical teaching' although learning was structured through service-based work.

Clinical instruction is an essential component of professional education in nursing and accounts for a significant portion of credits within baccalaureate nursing programs. Clinical instructors (CIs) are expected to have strong clinical knowledge as well as strong teaching skills. The objective of this study was to evaluate the effectiveness of an online education program for increasing CIs’ perception of teaching self-efficacy and knowledge about the clinical teacher role. A convenience sample of CIs (n = 32) at Queen’s University School of Nursing were recruited for this study. Over the span of seven weeks, participants completed self-paced online educational modules (Preceptor Education Program - PEP) available from the University of Western Ontario. A single sample pre-test, retrospective pre-/post-test research design was used. Participants completed teaching self-efficacy and teaching knowledge questionnaires pre-intervention (n=32) and post-intervention (n=21). Mean teaching self-efficacy scores increased significantly from pre-test to post-test (t = 6.7, p < .001). Teaching knowledge scores increased significantly from pre-test to post-test (t = 4.1, p < .05).The online modules had a significant impact on CIs’ teaching knowledge and self-efficacy. Descriptive data regarding participants’ satisfaction with the PEP modules was gathered; clinical instructors for the most part completed the PEP modules and were very satisfied with them. This online mode of clinical instructor education appears to be a feasible, facilitative and an accessible way to provide ongoing professional development and education for clinical instructors at Queen’s University. / Thesis (Master, Nursing) -- Queen's University, 2011-12-30 13:41:25.799

Magister Curationis - MCur / Background: Clinical supervision or clinical accompaniment is considered an integral part of nursing education and is crucial for the development of nursing students’ clinical competence. In order to achieve this, clinical supervision requires skilled human resources which vary from one educational institution to another and may include lecturers, clinical supervisors/facilitators and professional nurses. Clinical supervisors are required to be good educators as well as excellent clinicians. In addition, they often draw on their individual, personal and professional experiences to guide their teaching to meet the demands of both the clinical and academic contexts in which they work. However, the clinical teaching model or framework used by educational institutions is often not aligned to clinical practice activities and vice versa. This poses challenges for students due to the different expectations of educators and professional nurses in practice. Inadequately prepared clinical supervisors can have a detrimental effect on the delivery of the nursing programme that may include poor clinical teaching and inadequate integration of theory and clinical competencies, which ultimately leads to poorly trained nursing students. Aim of the study: The aim of this study was to explore the perceptions of clinical supervisors regarding their preparedness for clinical teaching. Methods: The study adopted a qualitative research approach, utilising an exploratory descriptive design. A non-probability purposive sampling method was used to select 12 clinical supervisors in the undergraduate programme. The researcher collected the data by means of semi-structured interviews with open-ended questions and analysed this data using content data analysis. Analysis of the data using ATLAS, ti 8 research software programme generated four themes and 18 categories. Findings: The findings indicated that clinical supervisors required time to adapt to their role and improve their knowledge and skills despite them having a positive experience during their orientation. Although appreciative of the support and guidance, clinical supervisors stated that not all colleagues were supportive, which in some instances had a negative impact on interpersonal relationships. The findings furthermore indicated that clinical supervisors apply all the steps of the five phases in the skills lab methodology employed by the School of Nursing at the university where the study was conducted. Clinical supervisors are required to be well informed and committed to continuing education in order to incorporate theory into practice with the latest developments and equipment in facilities. Furthermore, the findings indicated that inconsistency and failure to attend to students’ clinical learning needs can have a negative impact on student learning. Ethics: The researcher adhered to all principles of research ethics throughout the study.

Cette thèse rend compte des effets de l’expérience et de l’expertise sur les pratiques d’enseignement en EPS. Cette recherche en SBF questionne le sens que l’enseignant d’EPS confère à sa pratique professionnelle analysée à partir du croisement des données théoriques de la didactique clinique. Cette orientation scientifique fondée sur la théorie du sujet en didactique « divisé » entre des contraintes contradictoires, permet au chercheur d’identifier le rapport personnel du praticien à l’activité enseignée soumise à la contingence de la transmission des savoirs. Elle justifie l’utilisation d’un point de vue méthodologique des trois temps de l’analyse didactique clinique : l’analyse du déjà-là qui renseigne sur l’intention de l’enseignant, l’observation in situ et les entretiens d’après-coup qui permettent à l’enseignant de réfléchir sur sa propre activité et au chercheur d’inférer les causes des phénomènes didactiques observés. Les analyses inter et intra sites rendent compte de chaque profil didactique et permettent de les comparer afin d’identifier les effets spécifiques de l’expérience et de l’expertise. Notre projet final est de présenter un « cadre générique» d’analyse et d’interprétation des pratiques d’enseignement en articulant les dimensions didactiques et cliniques afin de vérifier nos hypothèses. / This thesis takes into account the effects of the experience and expertise on the practice of teaching in physical education. This research in “Savate Boxe Française” questions the meaning that the physical education teacher gives to his professional practice which was analysed from the crossing of theoretical data of the clinical didactics. This scientific direction based on the theory of the subject in teaching, "divided" between often conflicting constraints, allows the researcher to identify the personal relation of the practitioner with the activity that is taught, that is the subject of the contingency of the knowledge transmission. It specifies and justifies the use of a methodological point of view of the three times of the clinical didactics analysis: analysis of “déjà-là” that provides information on the intention of the teacher, the observation in situ “l’épreuve” of teaching and the interviews of “après coup” that enable the teacher to reflect about his own activity and the researcher to infer the causes of the didactic phenomena observed. Inter and intra sites analysis compares them in order to identify the specific effects of the experience and expertise.Our final project is to present a "generic framework" analysis and interpretation of the teaching practice articulating the didactic and clinical dimensions to test our hypotheses.

An urgent need exists for balance between students learning the theory of clinical practice and becoming an expert. While theory is taught in the didactic setting, it is the experiential setting where the mastery of the clinical teacher is demonstrated. What does the master clinical teacher do that makes the student's learning experience so significant? One must recognize the moment, capture the learning opportunity, and draw the student in so that learning can occur. Effective clinical teaching is paramount in creating empowered students and practitioners. This qualitative case study of a doctoral pharmacy program identified two master clinical preceptors and shadowed one in a hospital and the other in a retail pharmacy. Interactions between clinical preceptors and students were captured through direct observation, audio-tape, and complemented with in-depth interviews. Content analysis identified emerging themes yielding an emerging model of master clinical teaching, illuminating teachable moments between student and clinical preceptor, and the manner in which they interacted with each other and the clinical environment. The model highlights an approach for making the critical time on clinical rotations as effective as possible and offers a practical means to study interactions between students and preceptors, discerning those that lead to teachable moments. Features of the teachable moments are identified. Although expertise cannot be taught, current and future clinical teachers can use this study to improve their teaching and effectiveness in clinical teaching practice. The methodology of this study can be applied to future studies in the same discipline, other rotations, or other disciplines. This study augmented the literature in qualitative research in pharmacy education for clinical practice by 1) utilizing a methodology that could be used in future studies 2) identifying features of teachable moments in the interactions of clinical preceptors and students 3) exploring how the clinical preceptors dealt with the changing environment of their clinical teaching 4) offering an emerging model to guide clinical preceptors for making the critical clinical teaching time as effective as possible. Future studies could utilize this emerging model to gain further insight on clinical teaching practices thus increasing the expertise of clinical teaching. / Ph. D.

An exploratory, descriptive qualitative design was used to describe and explore how the students experienced their clinical accompaniment in a specific programme. The researcher conducted a tape recorded interview to a 14 individual students, who voluntarily agreed to participate in the study, transcription followed, then data analysis was done following the steps as described by De Vos, Srydom, Fouché and Delport (2005:334) citing Creswell (1998:142) where open coding leads to themes and subthemes. From the findings of this study it was discovered that the students experienced dissatisfaction in terms of their development of clinical skills to competence as they were not given an opportunity due to negative circumstances around their training. Recommendations were made to improve clinical accompaniment of student nurses for all involved so that the student nurses acquire clinical skills, knowledge and values. / Health Studies / M.A. (Health Studies)

This research explores how experienced nurses perceive their role as clinical teachers in an environment that is challenged not only with on-going changes in healthcare delivery, but also by the expectation that it will continue to provide positive clinical learning opportunities for undergraduate student nurses. Schools of nursing in Australia have undergone rapid and far-reaching change as a consequence of the legislated transfer of nursing eduction to the tertiary sector. Expectations that nurse academics will possess higher degrees and be actively involved in research mean that faculty members have less time to be directly involved in their students’ learning during clinical practice placements. The literature indicates that the responsibility for moment to moment teaching and learning thus appears to have been implicitly given to clinical staff who may not possess any formal qualifications for teaching, yet are largely responsible for students’ learning through clinical placements. Indeed some clinicians report a worrying lack of knowledge of clinical supervision models giving cause for further concern about the nature of the clinical learning environment. Schools of nursing expect that clinical practica will provide opportunities for students to learn how to be a nurse through guided questioning, analysis and critical thinking. It is evident that in some settings, this represents an ideal situation and not the reality. Critical reflection on these issues has informed the purpose of this research and helped to shape the following questions that focus the conduct of the study: Research Question One. How do experienced nurses create positive clinical learning environments for student nurses? Research Question Two. How do experienced nurses resolve the often-contradictory demands of nursing students and those of the practice setting? Research Question Three. How do changes in the healthcare environment impact on the experienced nurse's role as a clinical teacher? The theoretical framework for this study was underpinned by the interpretive philosophies of hermeneutic phenomenology and symbolic interactionism, because they acknowledge the personal experiences and meanings of the participants. A case study approach was utilised because it acknowledges the given context of the participants. Data were collected from six experienced nurses through a series of semi-structured interviews, informal interviews and periods of participant observation supported by field notes and the researcher’s diary. Participants identified that their perception of their role as clinical teachers was constructed of three intersecting roles: that of facilitator of learning, assessor and socialiser. This study concludes that several factors influence these nurses’ perception of their role as clinical teachers. In particular, the positivist work culture of the clinical setting and nurses’ own past experiences and world view of nursing combine to shape these nurses’ perception of their role as clinical teachers. The research concludes that the expectations that students will be supported in their endeavours to be critically thinking, problem solving and reflective practitioners may, in fact, be unrealistic in the current, economically constrained, clinical environment. It is evident that experienced nurses, despite being willing to be involved with clinical teaching, have to function in rapidly changing environments that do not always offer opportunities for nurses to reflect on their practice. However, the creation of positive clinical learning environments in these circumstances requires an increased understanding and appreciation by both schools of nursing and their students of the impact of change on these nurses and their clinical environment. This appreciation may result in more effective collaboration between nursing education and nursing service to assist student nurses to learn not merely through repetitive practice and busywork, but also through opportunities to observe, question and understand their nursing practice.

An exploratory, descriptive qualitative design was used to describe and explore how the students experienced their clinical accompaniment in a specific programme. The researcher conducted a tape recorded interview to a 14 individual students, who voluntarily agreed to participate in the study, transcription followed, then data analysis was done following the steps as described by De Vos, Srydom, Fouché and Delport (2005:334) citing Creswell (1998:142) where open coding leads to themes and subthemes. From the findings of this study it was discovered that the students experienced dissatisfaction in terms of their development of clinical skills to competence as they were not given an opportunity due to negative circumstances around their training. Recommendations were made to improve clinical accompaniment of student nurses for all involved so that the student nurses acquire clinical skills, knowledge and values. / Health Studies / M.A. (Health Studies)

Magister Curationis - MCur / The nurse preceptors underwent a preceptorship training programme offered by the University of the Western Cape, School of Nursing, which prepared them for this teaching role. A quantitative study was done following this preceptorship training programme but no qualitative study since. It is vital to explore the experiences of these trained nurse preceptors regarding clinical teaching practice post the training programme. The aim of the study was to explore trained nurse preceptors‟ experiences regarding their clinical teaching practice in the Western Cape. The objective was to describe trained nurse preceptors‟ experiences of their clinical teaching practice in the service settings in the Western Cape. An exploratory, descriptive, contextual design was used to describe the experiences of trained nurse preceptors in the Western Cape. A purposive sample was selected from three levels of healthcare service settings. Semi-structured interviews were conducted by the researcher with nine individual nurse preceptors who voluntarily agreed to participate in the study. Data analysis was done following Collaizi‟s‟ steps which led to coding of categories and themes. The findings indicated that preceptorship training programme had changed the nurse preceptors‟ perceptions. These nurse preceptors were prepared by the programme and ready for the preceptor role. Their teaching skills were strengthened and improved. They accepted the training programme as adequate preparation to facilitate clinical teaching and learning of students and found it to be effective for their self-development. These findings will inform v the managers about clinical teaching practice, assist the offering institution with the evaluation of the preceptorship training programme and add to an existing literature about the experiences of nurse preceptors. This research recommends that the education institutions, in collaboration with the clinical facilities initiate a qualitative study to explore the experiences of students preceptored by trained nurse preceptors. Such a study will further explore the effectiveness of the preceptorship training programme from the perspective of the students. With the positive feedback from the participants, it is essential that the training of preceptors remains one of the continuing education programme offered by the University of the Western Cape. Permission to conduct this research was obtained from the University of Western Cape, Senate Higher Degrees Committee, and Western Cape of Provincial Department Research Team in Western Cape as well as from the Chief Executive Officers of the three levels of healthcare service settings.