Quality and Relevance: Instruction
Instruction provided during an education program must be relevant and produce quality graduates. This section emphasizes clinical instruction as a key contributor to quality. The emphasis is on developing competent and relevant health professionals who can process information to make correct clinical decisions.
Preparing professionals: Emphasize the development of clinical decision-making capacity, working in teams, and synthesis rather than memorization of information in instructional methodologies. In this age of increased access to changing information, health care workers need to focus less on memorizing facts and more on analyzing and synthesizing information to make appropriate decisions (Frank and Chen, et al. 2010). Health care workers need competence in “life-long learning” to adapt to evolving technologies, policies, and knowledge (Frank and Chen, et al. 2010). Work with faculty to help them understand the process for teaching clinical decision-making and ensure they are equipped to develop clinical decision-making skills in their students and to model life-long learning during their student interactions.
Foster collaboration, communication, and coordination between faculty and clinical instructors or preceptors. To help foster effective working relationships, include faculty and clinical instructors in workshop activities related to curriculum revision, development of teaching skills, or development and implementation of clinical or educational standards. A key health worker competency is the ability to provide care in interdisciplinary teams, so ensure educational approaches address these competencies (Frenk and Chen, et al. 2010). Some programs focus heavily on preceptor preparation by providing technical updates, documents, or other means to prepare clinical staff to supervise and mentor students. Facilitate partnerships between institutions and clinical sites to allow faculty to have consistent opportunities to practice and maintain clinical proficiency.
Importance of clinical instruction in pre-service education. Global standards for midwifery education emphasize the importance of clinical instruction. Prioritize clinical education in interventions. Early exposure to clinical practice will build self-confidence in students and promote effective learning from experienced providers (WHO 2006). The clinical site, whether hospital, community health post, or private clinic, provides opportunities for students to practice and master new competencies. Consistency between what is learned in the classroom, demonstrated in the simulated environment, and practiced in the clinical site is critical for competency development. In pre-service interventions, prioritize improving students’ clinical experience. Below are ways to strengthen the essential clinical practice portion of a curriculum.
Increase practice in simulation. Practice in simulation and with clients is critical for students to integrate knowledge and skills. This practice also ensures that students are not merely able to recall the didactic portion of the curriculum, but also to make appropriate clinical decisions and manage clients’ care. Educators should demonstrate and coach key tasks in a safe and simulated environment with checklists or clinical site protocols. Improve or develop skill development/simulation labs to increase students’ practice time in critical competencies. The Simulation Workshop materials include resources to facilitate a workshop to help institutions establish simulation or skills labs. The Standard ICM Competency-based Skills List is a document that lists the specific models, equipment and consumables that are needed to teach each competency in a simulation lab setting.
Preparing preceptors and clinical instructors: Mentoring skills, technical updates. Preceptors (also referred to as clinical instructors) are critical to clinical learning and facilitate experiential learning in ‘real world’ settings. The preceptor is responsible for the teacher/learner relationship and must have skills in clinical teaching, role modeling, and socializing students into the profession. Preceptors need formal preparation for this critical work. Brief teaching techniques, such as the One Minute Preceptor or the adapted Five Minute Preceptor (Bott, et al 2011) help develop student problem-solving skills and clinical reasoning while respecting the dual role of the preceptor as both teacher and care provider. The Clinical Mentoring Curriculum and the Clinical Mentorship Manual for Integrated Services are two resources that may be used to develop staff as clinical mentors or preceptors.
Ensure that clinical site practices are consistent with curriculum, institutional goals, and standards for service delivery. Many countries have national service delivery guidelines or standards that outline expected work practices. Clinical area performance standards may describe expected work practices and standardize clinical sites to ensure students will observe the desired practices. Based on gaps identified in the standards, clinical sites may be strengthened with infrastructure support, additional training, or performance support.
Lessons Learned: Quality and Relevance: Instruction
• Ensure the program has allocated funds for addressing infrastructure issues in related clinical sites, such as non-consumable supplies, or even consumable supplies for any planned training activities, including clinical practice.
• Facilitate the development of communication strategies to help preceptors and faculty collaborate in student learning and assessment.
• Ensure that educational and institutional policies and procedures allow for students to obtain direct experience with clients in critical competencies.