Student Preparation Before Clinical Placements
Sharon A. Lesner, PhD
Professor of Audiology
The University of Akron
The Northeast Ohio AuD
Consortium (NOAC)
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Adapted from Dr. Sharon Lesner's presentation at the Audiology Education Summit II, (February 3-5, 2006, Phoenix, Arizona)
What Are the Essential Characteristics of Ways to Sequence Course Work and Clinical Experiences?
Considerations for Course Work and Clinical Experiences
- Standard III, 2012 Standards for the Certificate of Clinical Competence in Audiology
- Time spent in clinical practicum experiences should occur throughout the graduate program.
- Students shall participate in practicum only after they have had sufficient preparation to qualify for such experience.
- Students must obtain a variety of clinical practicum experiences in different work settings and with different populations so that the applicant can demonstrate skills across the scope of practice of audiology.
- The program must provide evidence of appropriate sequencing of course work and clinical practicum. Typically, information in basic sciences and normal processes precedes information in disorders, and information in disorders precedes clinical application.
- Essential Characteristics
- The clinical experience should promote a progression of student skills and didactic instruction that lead to independence.
- Clinical teaching should reflect this progression and be commensurate with the clinical skills of the student.
- Clinical education should occur throughout the program.
- Experiences should promote a progression of skills.
- Experiences should be diverse.
- Students should begin in their first semester with experiences commensurate with their background and knowledge.
What Are the Differences Among Teacher, Preceptor and Mentor?
- Teacher
- Focus = discipline-based teaching
- Centered on content with personal aspects secondary
- Teacher/student
- Preceptor
- From the Latin word praecipere = to teach
- Focus = Patient-centered teaching
- Preceptor/apprentice
- Mentor
- Focus = personal development
- One-to-one relationship that is sustained
- Mentor/protege
- Doctor
- From the Latin docere = to teach
What Constitutes Clinical Teaching?
- Labs
- Grand rounds
- Case studies
- Observation
- Assisting
- Direct patient care
- Record keeping, etc.
- Journal clubs
- Simulated patients
- Simulators-For example, Ear Exam Simulator
- 10 normal
- 10 abnormal middle ear findings
When Should Clinic Activities Start?
Only 3 out of 17 schools of optometry offer clinical experiences in 1st year (Maier, Smith, Coffey, 2005).
What Models of Clinical Education Are Available?
- Models of Clinical Teaching
Where Should Clinical Experiences Be Obtained?
What Are the Essential Characteristics of Effective Methods of Measuring Student Readiness for Clinical Placements?
Certification Standard (2007 Standards for Certificate of Clinical Competence in Audiology)
Standard V. Assessment
Applicants for certification must demonstrate successful achievement of the knowledge and skills delineated in Standard IV by means of both formative and summative assessments.
Standard V-A: Formative Assessment
The applicant must meet the education program's requirements for demonstrating satisfactory performance through ongoing formative assessment of knowledge and skills.
Standard V-B: Summative Assessment
The applicant must pass the national examination adopted by ASHA for purposes of certification in audiology.
- The program conducts ongoing and systematic formative and summative assessment of the performance of its current students.
- Variety of assessment techniques.
- Administered by a variety of individuals.
- Feedback is provided.
- Applicants may also be part of the process through self-assessment.
- Essentials
- Student skill development should be monitored regularly
- Feedback should be provided to promote clinical skills on a regular basis.
- Clinical skill expectations should be explicit at every clinical training phase.
Grading vs. Assessment vs. Evaluation
- Evaluation
- A judgment of how well a student meets the "values" of the school or profession
- Qualitative
- Grading
- Involves assigning a label or rank to the level of performance
- Quantitative
- Assessment
- Includes the entire process of evaluation and grading. What are the purposes of assessment?
- Formative versus Summative
- Formative
- Purpose is to "form" or shape the subsequent performance of the student
- Narrative description
- Feedback is important
- Done during an experience
- Summative
- Done at the end of experience
- "Sums" up the student's performance
- Usually includes a grade and narrative
- How should students be assessed?
- Who should assess students?
- Self-assessments
- Preceptor
- Faculty
- Peer
- Patient/family
- What types of assessments?
- Self-assessments
- Knowledge-based examinations
- Practical exams
- Comprehensive examinations (Summative)
- Considerations in Choice of Evaluation Method
- Time requirements
- Which faculty members will participate
- Scheduling
- Use of clinical equipment
- How to grade
- What to grade
- Frequency of grading
- What should be assessed clinically?
- Sample - NOAC Formative Assessment
- Preparation
- Interpersonal Communication
- Diagnostic Skills, Group 1
- Diagnostic Skills, Group 2
- Audiologic Treatment Skills
- Interpretation and Report Writing
- Professionalism
- NOAC Summative Assessment
- Patient Care
- Applied Audiology Knowledge
- Practice-based Learning and Improvement
- Interpersonal & Communication Skills
- Professionalism
- System-based Practice
- How should students be graded?
- Dichotomous versus Scalar Grading
- Compensatory versus "Weakest-Link"
- Descriptive versus Quantitative
- Developmental Approaches
- NOAC Clinic Grading
- 7-point Likert Scale
- Average score for each area
- Overall average
- Comments section
- B- or lower in any area requires remediation and no grade is issued
- When should students be assessed?
- What about national exams? When should they be taken?
- Who should assign grades?
- According to College Law Digest:
- Educational institution "owns" the student
- Clinical site "owns" the patients
- What can be done about grade inflation?
- It exists!
- 1960's to 1970's - A's have doubled, C grades have been reduced by ½ (Weller, 1984)
- Internal medicine: 43% "unable to appropriately identify incompetent students based on grades" (Speer, Solomon, & Fincer 2000)
- How should feedback be provided?
- Need for timely and constructive feedback
- What should be done with problem students?
- Types of problems typically identified
- Academic
- Non-academic
- How should problem students be handled?
- Remediation plans
- Technical standards
- ADA considerations
- Legal issues
What Are the Essential Characteristics of Effective Communication Regarding Student Readiness Among the Academic Programs, Students, and Clinical Sites?
- Standard 3.8 ( Standards for the Accreditation of Graduate Programs in Audiology and Speech-Language Pathology)
- Clinical education obtained in external placements is governed by agreements between the program and the external facility and is monitored by program faculty.
- Essentials
- An individual dedicated to communication with clinical sites should maintain contact with off-site preceptors.
- A formalized skill assessment tool and method of assigning grades should be in place.
- A formalized assessment system should be used to evaluate both students and site.
- Summit I: Essentials
- There is clear, frequent, and documented communication between the university and clinical sites.
- There is clear, frequent, and documented communication between the university and students.
What Information Is Needed by the Clinical Site About Potential Students?
- Knowledge
- Clinical skills
- Personality
- Recommendations
- Grades
- Portfolios
- Interviews
- Proof of liability insurance
- HIPAA certification
- Immunization status
- Criminal background check
What About the Problem of Bias?
- Family Educational Rights and Privacy Act (FERPA)
- ADA
What Are the Expectations of the University Concerning Student Assessment at the Clinical Site?
- What types of assessments?
- When should they be done?
- What should be done with the results?
What Information About Preceptoring Is Helpful and/or Needed by the External Site?
- Methods of preceptoring
- Instruments for student assessment
- Syllabi that include expected outcomes
- Information about how to set expectations and goals
- Methods of preceptor development
- Preceptor handbooks
- Preceptor calendars
- Web sites
- Home Pages
- One-Minute Preceptor
- Alliance for Clinical Education (ACE)
- Discussion boards
- Chat rooms
- Readings
- Workshops
- Focus groups
- Newsletters
- Visits/Phone calls/Email
What Are the Benefits of Partnerships?
- Realistic expectations
- Input flows both ways
- Known personalities
- Reduced competition and improved efficiency
- Resource sharing rather than competition
- Greater investment in the process
- Enhanced collaboration