Robert Miner (11416152)Nuclear Medicine TechnologySubmitted for: Renee McGillPresented June 5, 2009Due June 12, 2009Charles Sturt University

HLT403Clinical Teaching Techniques

A clinical education program for Nuclear Medicine Technologists

Is there a method behind how nuclear medicine technologists are trained?

What makes the nuclear medicine clinical training special?

Why have a defined clinical education model/technique?

The ‘Clinical Teaching Techniques’ course discusses models, methods and techniques used in clinical education (CEd).

This talk will touch on the current nuclear medicine CEd method used in Ontario and offer ideas for improvement.

Introduction

Purpose of the session

At the end of this session you will know: • Theoretical principles / models currently used in clinical education.• The current method used for nuclear medicine technology students. • Ways in which the current method could be changed or improved to enhanced the teaching and learning experience and outcomes.

How many students are present? This group may be interested in the different ways CEd can be done and how to improve the CEd experience.

How many practicing technologists are present?This group may compare their experience with CEd.

How many have been or are currently a clinical coordinator?This group may be interested in different CEd models (‘ways of doing things’)

Who can learn from this talk?

Terminology

TMI and U of T use the terms:

Clinical coordinator (CC):The technologist coordinating the CEd of the students.

Clinical education director (CED): The technologist who administers CEd to the students. The (CED and CC) functions are typically the same person.

The clinical liaison officer (CLO):Didactic faculty member who provides assistance to students during their clinical period; acts as the liaison between CC and the education institution.

In this presentation the CC will refer to the combined CC and CED function.

The purpose of the clinical component is:• to teach the student hands-on skills, • to provide opportunities to practice those skills,• to assess how well the student masters the required skills• to demonstrate a specific set of competencies prior to writing their licensing exam (in the case of technologists in the medical radiation science program)

Clinical Education (CEd)

The core elements of a CEd program include the:• Clinical Coordinator (CC)• Student(s)• Clinical education model • Clinical education techniques.

CEd Elements

Some of the issues to be addressed in a CEd program: •The purpose of the program.•The credentials of the CC. •The educational needs of the student.•The personality of the student.•Different education models and techniques that can be used. •The willingness or ability of sites to take students. •The perception that students are a burden.•Funding for students. •Time constraints.

CEd issues

The Clinical Coordinator (CC):• Is a practicing technologist• The CEd role is part of his or her job description. • Is responsible for all stages of the CEd placement and ensures other staff members know how to evaluate students

The Clinical Coordinator

The desired qualities of a CC are many:

The CC

• Has a high level of knowledge, both in theory and in practice.• Has the ability to self-manage and manage others.• Is available for the student(s).

• Will allow students personal and profession growth.

• Flexible.

The desired qualities of a CC are many:

The CC

• Can act as a role model, colleague and teacher.

The desired qualities of a CC are many:

The CC

• Is supportive.

The desired qualities of a CC are many:

The CC

• Has a sense of humor.

Various disciplines use CEd

The disciplines commonly discussed in the literature:• Pharmacy• Nursing• Occupational therapy• Physiotherapy• Counselor (social worker)

Other medical radiation science programs (MRI, X-ray, radiation therapy) also use CEd.

Various clinical education methods

Like some pathologies CEd models are named after their founder:

Mandy: A supervision cycle that starts with a pre-observation Session. The session is observed and analyzed. Feedback is given and separate analysis takes place between student and CC.

Various clinical education methods

Cox: This method is made up of an experience and explanation cycle. Each cycle is expanded further.

Various clinical education methods

Burnard: A model adapted for nursing using self assessment, settingof a time table with requirements from a syllabus, a learning processusing theory and skills, the use of the experimental learning cycle(concrete experience, reflective observation, conceptualization andactive experimentation) and then evaluation (by self, peer or clinician).

On the other hand, Lekkas, et al. (2007) based their ‘models’ on the supervisor to student ratio.

Various clinical education methods

The underlying themes of these models/techniques: • preparation • encounter• reflection

These stages can be padded with other steps such as: • debriefing • explication• feedback• evaluation and assessment

What’s currently used for NM students in Ontario?

No models defined explicitly for nuclear medicine (NM).The current approach for NM is a method that has evolved over time, but has similarities to models by Lekkas, et al., Cox and Mandy:

• There are multiple supervisors/technologists per student.• Assessment of performance (competencies signed off…).• There can be several students per site.• A patient session would include:

• preparation • encounter• patient release • feedback

Supervision

Since most NM studies (procedures) require injections or the administration of a radioactive substance to a live patient, the NM student is under constant supervision.

The student is primarily supervised in a managerial fashion.

Assessment is key in evaluating proficiency and targeting the needs of the student (Whitman et al. 1984, p. 5).

The educational institution and regulatory college establish the skills and competencies required.

If assessment of performance is so important then when and how should it be done?

Assessment mechanisms

Assessments occur in a formal session between the student and CC. Assessment can happen:

• At scheduled intervals during the clinical period (formative assessment):• to provide feedback on what is going well• to identify what needs more work, and• to suggest methods the student can use to correct deficiencies

• At the end of the placement (summative assessment)• to evaluate the student’s performance over the complete clinical session

Assessment mechanisms

What’s currently used for NM students in Ontario.

Encounter (interview patient, perform study)

Supervision and feedback

Patient released

Preparation

Next procedure.

How can the current method be improved?

When you say ‘improved’, what do you mean?

Improved for the school, hospital, certification or student?

Since it is a regulated profession, perhaps it’s best to work in a ‘top-down’ direction, making changes that conform to competency requirements.

If the current method already meets the competency requirements, then what changes can be made resulting in a better technologist?

How can the current method be improved?

Reflective practice is suggested as a way to actively learn from situations out of the norm. It is suggested doing this you become a better health care provider (Rose & Best 2005, p. 150 - 156; Johns, 2000, p. 34 - 35). In Reflective practice you think about (reflect) on experiences during the patient encounter:

• You analyze and evaluate anything out of the ordinary.• Try to think of what else you might have done.• Think of an action plan in case it happens again.

Debriefing The CC discussing the recent patient encounter with the student. It’s used in models by Mandy and Cox

Modifications to the current method

Encounter (interview patient, perform study)

Supervision and feedback

Explanation of procedure

Patient released

Student reflects

Preparation

Technologist debriefs student

New procedure is next.

Next patient is same type of study.

Supervision and feedback

Could this be applied elsewhere?

Could be adapted to MRI, X-ray, radiation therapy, but would need acceptance (buy-in) from the stakeholders: the school, student and clinical site.

Can it apply to practicing technologists? Yes – for new equipment (technegas, Symbia)Yes – for new protocols (gastric emptying)

Summary

This talk discussed basic elements and issues of clinical education.

The current method used in nuclear medicine technology was covered and possible improvements were suggested.

Questions and discussion

Time for questions.

Comments may be added to the evaluation form.

Appendix A: Observer sheet

Appendices

Observer sheet

Observe the educational session and comment on the following issues.  The feedback you provide will be used by the educator to reflect on the effectiveness of their session, materials and their

effectiveness in this role.  They will use this information to complete an assignment for their course, so please ensure your comments are honest and comprehensive.

1. Why was the teaching session actually performed - was it stated during the session?

2. Were there learning outcomes written for this session and how were they presented? Were they reinforced at the end of the session?

3. What learner needs assessment was undertaken and how did the educator explain the relevance of the session to participants?

4. What techniques did the educator include to actively involve the participants during the session?

Appendix A: (continued)

Appendices

5. What opportunity did participants have for receiving feedback?

6. What were the educator's attitudes and attributes?

7. Comment on any environmental constraints (e.g. physical, time etc.) that were evident and what strategies were/could be implemented to overcome them.

8. How were the learning materials provided by the educator used?

9. Are there any ways in which the effectiveness of the session could have been improved?

Appendix B: Evaluation form

Appendices

Clinical Teaching Techniques evaluation form

Presenter: Robert Miner Date: June 5, 2009

I found this session to be (Please circle):Uninteresting 1 2 3 4 5 InterestingWorthless 1 2 3 4 5 ValuableSlow 1 2 3 4 5 FastToo Difficult 1 2 3 4 5 Too EasyChaotic 1 2 3 4 5 OrganizedIrrelevant 1 2 3 4 5 RelevantUnrealistic 1 2 3 4 5 Practical

1. What was of most value to you?

2. How could the course be improved?

Appendix B: (continued)

Appendices

3. What is your overall impression of the talk? (Please circle) Poor 1 2 3 4 5 Good

Evaluate the presenter (Please circle): Poor.…….…Good

Knowledge of subject 1 2 3 4 5Promoted group participation 1 2 3 4 5Able to provide clarification 1 2 3 4 5Approachability 1 2 3 4 5Clarity of talk 1 2 3 4 5Overall impression 1 2 3 4 5

Comments/Suggestions: .

Appendix C: Related Links

Appendices

Link to CSU and masters program:http://www.csu.edu.au/special/nuclear-medicine/index.htm

Link to The Michener Institute:http://www.michener.ca/

References

Canadian association of medical radiation technologist (CAMRT). (2007). Certification handbook. Ottawa

College of medical radiation technologist of Ontario (CMRTO). (2005). What you must know about registration. Toronto

Fish, D., & Twinn, S., (1997). ‘Versions and views of good practice', in Quality practice: Versions and views of good practice, Reed Educational

and Professional Publishing, Oxford, pp. 89-109.

Foley, R., Smilansky, J., (1980). Teaching Techniques. A handbook for health professionals. New York: McGraw-Hill

Friesen, Kaye and Associates, (1998). Designing instruction workshop. Participant manual.

Hawkins, P., Shohet, R., (2000). Supervising in the helping professions. (2nd ed.) Open Buckingham, UK.: University Press

References

Joffe, B., (2005). Models of clinical education. In M. Rose and D., Best (Ed.), Transforming practice through clinical education, professional supervision and mentoring. Churchill Livingston, Edinburgh: Elsevier

Johns, C., (2000). Being and becoming a reflective practitioner: A reflective and holistic approach to clinical nursing, practice development and clinicalsupervision. Blackwell Science, Oxford, p. 34- 67.

Lekkas, P., Larsen, T., Kumar, S., Grimmer, K., Nayland, L., Chipchase, L., Jull, G., Buttrum, P., Carr, L., Finch J., (2007). No model of clinical education for

physiotherapy students is superior to another: a systematic review. Australian Journal of Physiotherapy 52, 19-28

McAllistar, L., (2005). Finding the meaning and preventing burnout. In M. Rose and D., Best (Ed.), Transforming practice through clinical education, professional supervision and mentoring. Churchill Livingston, Edinburgh: Elsevier

Palmer, C., Cherryman, F., (2009). Supporting student success. Journal of Medical Imaging and Radiation Science, 40(1), 38-44.

Rose, M., Best, D., (2005). Transforming practice through clinical education, professional supervision and mentoring. Churchill Livingston, Edinburgh: Elsevier

Ryan , S., (2005). The challenging learning situation. In M. Rose and D., Best (Ed.), Transforming practice through clinical education, professional supervision and mentoring. Churchill Livingston, Edinburgh: Elsevier

Stern, D., Rone-Adams, S., (2006). An Alternative model for first level clinical education experiences in physical therapy. The Internet Journal of Allied Science and

Practice. 3(4), 1-23

Steves, A., (2005). Improving the clinical instruction of student technologists. Journal of Nuclear Medicine Technologist, 33, 205-209.

References

Strohschein, J., Hagler, P., May, L., (2002). Assessing the need for change in clinical education practices. Physical Therapy, 82(2), 160-172

The Michener Institute for applied health sciences (2002). Clinical teaching technologist handbook. Nuclear medicine technology program. Toronto

University of Toronto/Michener radiation science program. (2007). Clinical handbook class of 2008. Toronto

van Ooijen, E., (2000). The supervisory relationship, in clinical supervision: a practical approach. Churchill Livingstone, Edinburgh. 25-55.

Whitman, N., Schwenk, T., (1984). Preceptors as teachers. A guide to clinical teaching. Salt Lake, Utah: University of Utah school of medicine

Winn, J., Grantham, V., (2005) Using personality type to improve clinical education effectiveness. Journal of Nuclear Medicine Technologist, 33, 210-213.

References