The purposes of this perspective article are to identify areas of need within clinical education, to describe various models and tools that are proposed and utilized in clinical education, and to explore the extent to which these models and tools might meet the identified needs of clinical education. A synthesis of the literature suggests that the clinical education process in physical therapy currently is characterized by 7 primary needs and that 10 models currently exist to guide the general process or to provide specific tools and practices to enhance its effectiveness. Roles and relationships are critical components in successful clinical education. Theory suggests that clinical educators and students should engage in an intentional, structured process of changing roles during the course of the clinical education experience and that nontechnical competencies such as communication, collaboration, and reflection are crucial for effective practice and may be developed in the clinical education setting. Developing a clearer understanding of the current status of physical therapy clinical education can assist clinical educators in the use of the available models and tools or in developing a new model that addresses potentially unique needs.

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Assessing the need for change in clinical education practices.

The purpose of this paper is to raise awareness of peer learning as a process that is potentially beneficial to clinical education. Peer learning is a well documented learning strategy in paediatric educational literature. Many allied health clinical education programs purport to utilize it as a learning technique. Do we really know what peer learning is, how to promote it and why it is beneficial to facilitate it? This paper addresses these questions by considering terminology and definitions of peer learning and briefly outlining theoretical justification for its use in clinical education. Literature regarding the application of peer learning in clinical education is reviewed and the reported and purported benefits of peer learning are discussed.

Peer learning in clinical education

Reflective practice is reported to enhance clinical reasoning and therefore to maximize client outcomes. The inclusion of targeted reflective practice in academic programmes in speech-language therapy has not been consistent, although providing opportunities for speech-language therapy students to reflect during their clinical practice has been reported. Indeed, there has been limited investigation of the nature of speech-language therapy students' reflections. (1) To describe the breadth and depth of reflection skills of novice speech-language therapy students by utilizing structured reflective learning journals. (2) To evaluate the use of a coding system to determine its reliability and relevance in identifying reflection skills. Participants were 52 students in their second year of a 4-year undergraduate speech-language therapy programme. Mean participant age was 20.5 years; all students were female. Participants completed guided written reflections following three interviews with a standardized patient (an actor portraying a parent of a child with delayed speech development). Reflections were coded by two raters. Nine participants' reflections were recoded by raters A and B to establish intra-rater reliability. Inter-rater reliability between these two raters was calculated and a third rater completed coding of 20% of students' reflections to further establish inter-rater reliability. Results indicated that the majority of students were categorized as 'reflectors'. All students demonstrated at least one element of reflection. Their reflective writing primarily focused on a discussion of the content of and strategies used within the interviews, and reflection on and for action. Results also indicated that the coding system used within the study was reliable in determining both the breadth and depth of student reflections. This study found that novice speech-language therapy students can reflect on their clinical learning experiences within a structured clinical environment involving standardized patients. Only a small number of novice students were found to be critical reflectors who were able to analyse the content of clinical interviews, view the interaction from the perspective of the patient, and record changes to their own perspective which occurred as a result. The coding system was established as reliable and thus relevant for use in furthering research on reflective practice within speech-language therapy and other disciplines. Further investigation of reflective skills within other clinical environments and with additional clinical experience is recommended.

Reflections on clinical learning in novice speech-language therapy students.

Objective: To develop a model for clinical education in athletic training education based on integration of various allied health professional clinical education models. Background: Clinical education is a critical component of allied health education programs. It allows for the transfer of knowledge and skills from classroom to practical application. Clinical education needs to be structured. In addition the Clinical Instructor (CI) also needs to facilitate athletic training students' development into effective, evidence-based practitioners. Description: A brief discussion on the need for transfer of knowledge in athletic training education is discussed. A review of the various clinical education models from allied health professional education is presented. Finally, a model for athletic training clinical education is presented with implications for practice. Clinical Advantages: As athletic training education continues to develop, a need to formalize clinical education and develop a clinical education m...

A Conceptual Framework for Clinical Education in Athletic Training.

This article sets out to discover how learning could be enhanced in the physiotherapy training given on placements. The study describes the experiences of 32 physiotherapy students during their trainee periods and focuses on their views of the supervision provided and of its effects on their performance. The research data were collected from discussions conducted in six small groups over a period of 2.5 years. In order to refresh the participants’ memory, videotaped extracts from their training sessions were shown during the discussions. An ethnomethodological method was applied in both collecting and analysing the data. The results show that conventional instruction led to continued adherence to the model given. The transformative approach, in contrast, encouraged the students to learn through reflection as they observed and analysed physiotherapy sessions, discussed with their supervisor and worked on their written assignments. Moreover, reflective learning helped the students as they were given more responsibility for their own actions. When supervisors asked the students questions or did not immediately provide direct answers, students learned to analyse situations themselves as well as to look for information and to find solutions. These methods appear to be the ‘keys’ in transformative physiotherapy training in which four phases are cyclically repeated: the experience gained from therapy sessions; the reflection prompted by supervisor–student discussions; the planning which incorporates clinical reasoning; and the actual therapy sessions together with guidance. Based on these findings and on the empirical evidence, a model of supervision, which encourages reflective learning and transformative physiotherapy, has been outlined.

Reflectivity in supervised practice: conventional and transformative approaches to physiotherapy

Student approaches to academic learning have received much attention in educational psychology. However, little has been published on student approaches to learning in the clinical practicum. In this paper, student learning styles are described and a model of clinical supervision is proposed which incorporates sound principles of student learning. The reflective learning model proposed here may be superimposed on the “Goldhammer” supervision cycle. Suggestions for facilitating student learning are made using this process and ongoing research to evaluate the success of this approach is outlined.

Stephanie Mandy

Papers

Facilitating Student Learning in Clinical Education