Creating An Effective Learning Environment. Lynne Yong Ee Lin, Ph.D. Licensed Clinical Psychologist Penang Adventist Hospital

Transcription

1 Creating An Effective Learning Environment Lynne Yong Ee Lin, Ph.D. Licensed Clinical Psychologist Penang Adventist Hospital

2 Introduction HEALTHCARE TRAINING = APPRENTICESHIP Requires hands-on practical training BUT Medicolegal considerations greater caution and limit the scope of trainee experience Patients know their rights demand for qualified practitioners.

3 Fine Balance Training Needs vs. Patient Safety Theory not enough: Big jump from theory to practice UNETHICAL.

4 Simulation Simulation can give equivalent levels of performance to hands-on training. Example: Usefulness of Virtual Training- Conventional and virtual training produced similar levels of performance when procedure was carried out in real conditions. Ganier, F., C. Hoareau, et al. (2014). "Evaluation of procedural learning transfer from a virtual environment to a real situation: a case study on tank maintenance training." Ergonomics 57(6): No significant difference in simulated prostate biopsies between novices and expert Urologists. However, does not indicate improvement of skills or competence. Fiard, G., S. Y. Selmi, et al. (2014). "Initial validation of a virtual-reality learning environment for prostate biopsies: realism matters!" J Endourol 28(4):

5 What Makes An Effective Learning Environment? Should simulation be an integral part of healthcare training?

6 1. Safety Is ESSENTIAL Physical Safety Patient s welfare Students environment Protective gear Hazardous material management Safe infrastructure Emotional Safety Perception of Safety

7 2. Close Supervision Student teacher interaction Small group discussions to clarify processes and outcome Providing demonstrations Constructive feedback Feedback based on mistakes and not improvement reported as ineffective for learning ** No significant association between students perception and subsequent performance Suksudaj, N., D. Lekkas, et al. (2015). "Features of an effective operative dentistry learning environment: students' perceptions and relationship with performance." Eur J Dent Educ 19(1): Effective supervision style are coaching and mentoring Abusive supervision is not associated with improved talent development Subramaniam, A., A. D. Silong, et al. (2015). "Effects of coaching supervision, mentoring supervision and abusive supervision on talent development among trainee doctors in public hospitals: moderating role of clinical learning environment." BMC Med Educ 15: 129.

8 3. Step by Step Mastery Mastery of procedures requires 1. Understand theory 2. Observation 3. Simulation 4. Practice on patients Accountability (logbook, adverse event reporting) Students/Trainees Tutors

9 Effective Clinical Teaching Environment 1. Autonomy 2. Supervision 3. Social support / Supportive environment 4. Workload 5. Role clarity 6. Learning opportunity 7. Work diversity 8. Physical facilities Rezaee, R. and S. Ebrahimi (2013). "Clinical learning environment at Shiraz Medical School." Acta Med Iran 51(1):

10 Negative Learning Environment 1. Lack of opportunity for clinical practice 2. Lack of time for supervision 3. Insufficient feedback 4. Negative attitudes of staff towards students and teaching 5. Presence of too many students at one time 6. Too few educational session 7. Poor organization Dolmans, D. H., I. H. Wolfhagen, et al. (2008). "Factors adversely affecting student learning in the clinical learning environment: a student perspective." Educ Health (Abingdon) 21(3): 32.

11 Students Needs

12 1. Meaningful Learning Experience Why they do the things they do Application in clinical practice Use of simulation to smooth the transition Involvement of clinicians for realism Cremonini, V., P. Ferri, et al. (2015). "Nursing students' experiences of and satisfaction with the clinical learning environment: the role of educational models in the simulation laboratory and in clinical practice." Acta Biomed 86 Suppl 3: Liaw, S. Y., Y. Koh, et al. (2014). "Easing student transition to graduate nurse: a SIMulated Professional Learning Environment (SIMPLE) for final year student nurses."

13 2. Professional Engagement Healthcare training happens in Clinical Placements Where they develop clinical competence Where they develop professional identity Professional Work Engagement is a motivational factor Tomietto, M., D. Comparcini, et al. (2015). "Work-engaged nurses for a better clinical learning environment: a ward-level analysis." J Nurs Manag.

14 3. Mentoring Apprenticeship Learn from others with experience How the real world works Learning tricks of the trade Knowing the Little things that matter. P, O. L. (2015). "Becoming a professional: What is the influence of registered nurses on nursing students' learning in the clinical environment?" Nurse Educ Pract 15(6):

15 4. Supportive Environment Felt Acceptance from clinical staff Support from clinical staff Clinical staff s interest and welcome of trainees Allows development of a sense of belonging Positive ward atmosphere / hospitable environment Learning not compromised Lekalakala-Mokgele, E. and E. M. Caka (2015). "Facilitative and obstructive factors in the clinical learning environment: Experiences of pupil enrolled nurses." Curationis 38(1). Magnani, D., R. Di Lorenzo, et al. (2014). "The undergraduate nursing student evaluation of clinical learning environment: an Italian survey." Prof Inferm 67(1): Gan, R. and L. Snell (2014). "When the learning environment is suboptimal: exploring medical students' perceptions of "mistreatment"." Acad Med 89(4):

16 5. Sense of Control Need to know what to expect to reduce anxiety Orientation to the rotation - Familiarization Introduction to the team Understanding organizational flow and issues Understanding protocol Normalizing initial negative emotions like anxiety, overwhelmed, apprehension, fear Bowrey, D. J. and J. M. Kidd (2014). "How do early emotional experiences in the operating theatre influence medical student learning in this environment?" Teach Learn Med 26(2):

17 6. Respect for Differences Differences in learning curves and learning needs Learning styles Background Education Previous hands on training

18 Giving Constructive Criticism Enhance Learning

19 How to Build an environment of learning: Allowing mistakes or ignorance, Focus on improvements and solutions ( This is where simulation is very important ) Focus on the problem, not the person Allow the person to come up with their original reasoning if feasible then offer your solution Reinforce the solution. Focus on understanding the process

20 Cont Address the group as a whole make it into a teaching moment If it is the individual then address it privately. No learning occurs when it is based on shame. Fear is not a conducive environment for growth and learning Suspend judgment decisions should be based on facts

21 Reinforcement To know when they are doing well To know what they are aspiring towards Cater based on personality Be specific in praise Follow up with other forms of appreciation Reward based on work

22 References Ganier, F., C. Hoareau, et al. (2014). "Evaluation of procedural learning transfer from a virtual environment to a real situation: a case study on tank maintenance training." Ergonomics 57(6): Fiard, G., S. Y. Selmi, et al. (2014). "Initial validation of a virtual-reality learning environment for prostate biopsies: realism matters!" J Endourol 28(4): Suksudaj, N., D. Lekkas, et al. (2015). "Features of an effective operative dentistry learning environment: students' perceptions and relationship with performance." Eur J Dent Educ 19(1): Subramaniam, A., A. D. Silong, et al. (2015). "Effects of coaching supervision, mentoring supervision and abusive supervision on talent development among trainee doctors in public hospitals: moderating role of clinical learning environment." BMC Med Educ 15: 129. Rezaee, R. and S. Ebrahimi (2013). "Clinical learning environment at Shiraz Medical School." Acta Med Iran 51(1): Dolmans, D. H., I. H. Wolfhagen, et al. (2008). "Factors adversely affecting student learning in the clinical learning environment: a student perspective." Educ Health (Abingdon) 21(3): 32. Cremonini, V., P. Ferri, et al. (2015). "Nursing students' experiences of and satisfaction with the clinical learning environment: the role of educational models in the simulation laboratory and in clinical practice." Acta Biomed 86 Suppl 3:

23 Liaw, S. Y., Y. Koh, et al. (2014). "Easing student transition to graduate nurse: a SIMulated Professional Learning Environment (SIMPLE) for final year student nurses." Tomietto, M., D. Comparcini, et al. (2015). "Work-engaged nurses for a better clinical learning environment: a ward-level analysis." J Nurs Manag. P, O. L. (2015). "Becoming a professional: What is the influence of registered nurses on nursing students' learning in the clinical environment?" Nurse Educ Pract 15(6): Lekalakala-Mokgele, E. and E. M. Caka (2015). "Facilitative and obstructive factors in the clinical learning environment: Experiences of pupil enrolled nurses." Curationis 38(1). Magnani, D., R. Di Lorenzo, et al. (2014). "The undergraduate nursing student evaluation of clinical learning environment: an Italian survey." Prof Inferm 67(1): Gan, R. and L. Snell (2014). "When the learning environment is suboptimal: exploring medical students' perceptions of "mistreatment"." Acad Med 89(4): Bowrey, D. J. and J. M. Kidd (2014). "How do early emotional experiences in the operating theatre influence medical student learning in this environment?" Teach Learn Med 26(2):

24 Thank You