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84 Cards in this Set
- Front
- Back
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The 4 P's of an optimal clinical education
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Purpose
Place Person Planning |
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Specific goals of early fieldwork and clinical rotations
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-development of interpersonal skills
-compare theoretical knowledge to real-life situations -constructive use of feedback -become familiar with the role of OT/PT -engaging in professional activities to become more familiar with the scope of practice and issues affecting OT/PT |
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Elements of an appropriate clinical rotation
for early student |
-opportunity to practice non-complex patient care
-atmosphere receptive to students -staff interested in teaching students -sufficient and timely feedback -time to accomplish meaningful objectives -student encouraged to self-reflect |
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Expected outcomes of early clinical rotation
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-adequate knowledge of core principles and values
-demonstrate ability to work in a team -well defined professional identity -experience with closely supervised exam/assessment/tx |
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Specific goals of later fieldwork/rotations
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-decision-making consistently applies core principles/values
-demonstrate ability to fill all roles on a team -emerging skills as a practitioner who incorporates legal, ethical and practice act guidelines -minimal supervision needed for client management |
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Elements of appropriate clinical rotation for experienced student
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-increasing participation for entry-level practice
-development of professional skill expertise -clinical reasoning/problem solving -time management -rudimentary personnel supervision -ability to apply theory to practice |
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Expected outcomes of late clinical rotation
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-entry level competency with complex patients
-professional interaction with clinical and support staff -participate in educational experiences other than direct care (planning, rounds..) -adhere to legal and ethical requirements in supervision and delegation experiences -self-initiate opportunities to explore own interests -able to think through a situation and justify decisions -adequate skills with electronic documentation -assume increasing level of authority |
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Stages of Learning Vector Model
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1. exposure-student is novice, dependent on supervisor
2. acquisition- student can participate in planning/evaluating 3. Integration- student takes responsibility for planning, implementing, evaluating learning experience |
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3 types of behavior students need to display (creating learning objectives)
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cognitive
affective psychomotor |
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Order of cognitive expectations for students
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knowledge> comprehension> Application> Analysis> Synthesis> Evaluation
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General guidelines for creating learning objectives
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1. student centered
2. outcome-oriented vs process-oriented 3. outcome-oriented vs just stating material to be covered 4. describes one outcome only 5. specific vs general 6. observable and measurable |
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How many students can one therapist supervise?
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There is no ratio in OK
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Who can supervise OTA students?
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OTA students may be supervised by COTA who is working under a licensed OT
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Who can supervise OT students?
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Fieldwork I- no restrictions, can be a properly supervised COTA
Fieldwork II- direct, on site supervision by OK licensed OT |
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Billing for student services. Medicare A vs Medicare B
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Medicare A (SNF) allows therapy student services to be counted toward minutes if done under "line of sight" supervision.
Medicare B does not allow billing of student therapy. |
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3 stages of supervisory relationship
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-evaluation-feedback stage (CI=teacher)
-transitional stage (CI=colleague/peer) -self-supervision stage (CI=consultant) |
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2 ends of the spectrum for how CI/FWE behave toward students
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1. baseline approach- competent or not
2. mentoring approach- continual growth and only a piece of it happens at a particular facility |
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Baseline Approach
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looks for what students can/cannot do
expectations are clear to student emphasizes: problem identification, notification to student and school, establish expectations for improvement to complete rotation |
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Problems with a baseline approach
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-passes students who are barely competent
-possible to fail with single area deficits -growth toward competence is not valued |
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Mentoring Approach
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Sometimes the student doesn't know exactly what the problem is.
Supervisor takes responsibility for: teaching, emotional support, assessment and feedback Emphasizes: self-identification of areas of deficit, CI and student assessment of progress |
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Problems with mentoring approach
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-short rotations make it difficult
-busy clinical setting with heavy caseloads -student may confuse role of mentor with advocate |
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Giving feedback with the baseline approach
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1. formal review at midterm and final
2. feedback provided only at student request or if error is observed 3. may have limited chances to improve in an area 4. concrete scoring |
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Giving feedback with the mentoring approach
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1. close working relationship makes internal/external feedback frequent and easy
2. ongoing b/c mentor constantly describes 3. provides a framework against which student can build on what he already knows |
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Feedback vs Criticism
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criticism: backward looking, focused on person and emotive. Given only in crisis when things go wrong
Feedback: forward looking, focused on the work and delivered in a calm manner. Given regularly for good and bad actions |
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Tips for giving feedback
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1. be prompt
2. contain encouragement (but honesty) 3. provide in terms of previously outlined goals 4. clearly link to level of accomplishment 5. focus on one aspect of performance at a time 6. focus on achievement 7. be specific 8. foster independence |
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Guidelines for delivering feedback
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1. tell student exactly what was well done
2. explain why the behavior was good and how it helped the patient 3. pause and allow student to reflect 4. encourage repeat performance based on Skinner's theory that reward motivates |
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Areas for potential bias from CI to student
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-anecdotal comments
-frequency/closeness of supervision -previous experience with similar student -'fit' with existing staff -student who differs from DPT/MOT norms due to appearance, age -multiple students implies one will be the 'worst' |
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"Summary of student supervision and delegation lecture"
IMPORTANT POINTS |
-state laws influence supervision decisions
-clinical learning depends on input and influences from student, supervisor, and community -expectations are established early and jointly -feedback based on knowledge of performance and results is essential for learning -feedback should be constructive, timely, consistent, specific and followed up on -feedback is a skill that improves with practice |
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Ways to prepare for giving written feedback
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1. be aware of sensitive areas
2. use a positive approach 3. work from the individual's strengths 4. conveying clear messages and limits 5. focus on the behavior, not the person 6. focus on the professional requirements not being met 7. establish mutually acceptable goals 8. have a third party present when needed 9. practice and rehearse |
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General principle for preparing anecdotal student comments
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Standardizing as much as possible the observation areas used for evaluation will make the discussion more objective
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What is libel?
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a false or malicious publication that exposes a person to public hatred, contempt, or ridicule, or injures their occupation
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Protecting yourself from libel
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information must be true and:
written with good motives written with justifiable ends written as privileged information as part of one's official duties |
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Dealing with competent but unmotivated students
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focus on generic abilities in your evaluation process
1. commitment to learning 2. interpersonal skills 3. communication skills 4. effective use of time and resources 5. use of constructive feedback 6. problem solving 7. professionalism 8. responsibility 9. critical thinking 10. stress management |
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Learning Contracts
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(Early Warning Systems)
1. identify problems 2. define means to resolve problems 3. define performance criteria expectations 4. define timelines for improvement |
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Possible outcomes for using learning contracts
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-performance improves
-student denies problems -student tries to improve and fails |
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Questions you need to ask yourself BEFORE dismissing a student
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*school should be involved at this point
-why did the student fail the clinical experience? -how was the student's performance documented? Does the documentation support the decision? -was the student aware of his or her poor performance? -was the student provided early notification regarding performance and given a chance to correct it? |
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Will the court overturn academic decisions?
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Not usually. believe that the professionals know what is best in that practice
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Disciplinary dismissal vs academic dismissal
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Academic- skill or knowledge based performance problems
determination of facts-cognitive assessment due process-informal hearing student has burden of proof disciplinary- behavior based performance problems determination of facts-violation of rules due process-formal hearing burden of proof-institution has burden of proof |
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Libel vs Slander
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libel is written defamation
slander is spoken defamation |
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Must a student disclose if they have a disability
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NO. But should consider:
-disability accommodations -disability is a fact and not a judgement of value -student who needs accommodations may not be successful without them -cannot usually request accommodations once they have started FW |
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Is the clinic required to provide reasonable accommodation for a student with a disability?
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no. only for an employee, not for a student
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Considerations when receiving feedback from students
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-maintain unconditional positive regard and insist on civil behavior
-stay focused on behavior and not the person -develop ways to work collegially even if you are very different people -keep an open mind for explanations/motivations that may not seem fair or rational |
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Simple steps that can make supervision rewarding for both sides
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allow students time to obtain info and create their own solutions
confirm learning via feedback and QA provide hands on experience appropriate to students' knowledge, skills and comfort encourage thinking respect students and value their input demonstrate professional behavior by using EBP |
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Important things to remember when working with students
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-student is a novice and not an expert
-students will make mistakes. Mistakes are good learning experiences -Careful documentation of student performance is critical -clinical experience is where they can practice safely |
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Pedagogy approach
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therapist is the expert and always knows what's best
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Andragogy approach
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Malcolm Knowles
adult learners are different than children self-directed learning adults do not learn by external pressure, need to have internal buy-in |
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Knowles' specific principles of Androgogy
(know example of each category for test) |
1. Need to know- seek education when needed for practical reasons, goals or personal gain
2. Indep learner- want educational design that treats the learner as independent and self-directed co-participant of the educational experience 3. Life experience- want non-academic accomplishments and knowledge valued 4. Task centered and practical- seed education to meeting job-related needs 5. Internally motivated- internal rewards and not grades, parental approval, or therapist approval |
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Who qualifies as an adult learner?
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any person bringing a past that is rich in experiences into the present learning situation (not always an adult)
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What is criterial reflecion?
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used by adult learners
3 interrelated processes -adults question and then reframe an assumption that up to that point has been accepted as commonsense -adults take alternative perspectives on previously taken for granted ideas -adults come to recognize how culture induces and unconscious acceptance of dependent roles/relationships |
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What is experiential learning?
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used by adult learners
-willingness to change how we experience and interpret things that happen to us and to the world around us changes according to the language, analysis, and vantage point we use -quantity or length of experience is not necessarily connected to its richness or intensity |
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Tips for respectful engagement of adult learners
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-start with questions about learner's values
-enhance immediate application of material by basing examples on patient's concerns -pose alternative, thought provoking questions and scenarios to encourage critical thinking and buy-in |
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Adult learning must incorporate...
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-an activity that has meaning for the learner
-the learner's culture and expectations -the environment where learning is applied -past experiences that will affect learning -shared ownership of the problem as a sign of respect |
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Ways to facilitate a student's movement toward more self-directed and responsible learning
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-lead the student toward inquiry before supplying them with too many facts
-regular constructive and specific feedback -review goals and acknowledge goal completion -encourage use of resources |
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Differences between teaching facts and teaching psychomotor skills
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-facts require mental connection to real life tasks; psychomotor skills require physical and mental practice PLUS mental connection
-facts require therapist to have expert knowledge; psychomotor skills require therapist to have basic competence in task -facts are taught identically to patient and caregiver; psychomotor skills are different for patient and caregiver |
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Process model of education-based intervention
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Phase 1: Pre-assessment
Phase 2: Assessment and planning Phase 3: Implementation Phase 4: Outcome Assessment |
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Elements that influence patient learning
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literacy/functional health literacy
preferred learning style of patient stage of learning for the patient |
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Are PT/OTs required to provide a translator for non-English speaking patients?
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yes, according to JCAHO
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Impact of health illiteracy
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-ask fewer questions
-less compliance with interventions -incorrect compliance with instructions |
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Impact of informed consent on patients who lack health care literacy
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-tx options may not be fully understood, so some patients may not request treatments that best meet their needs
-informed consent documents may be too complex so patients may not really make informed decisions about accepting or rejecting interventions |
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How to identify a patient with functional and health literacy issues
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1. identify highest grade completed in school
2. watch for poor compliance with treatments and appointments 3. patient observes and mimicking others even if their program is not identical 4. does not know the names of regularly used medications 5. makes excuses for not reading 6. brings someone who can read to appointments 7. vocalization or sub-vocalization when reading 8. confusion or frustration when reading 9. take words and illustrations literally 10. fatigue quickly when completing multiple forms |
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Steps for managing literacy issues in patient care
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1. prescreen patients (REALM, STOFHLA)
2. assess grade level readability of materials (Fry, Computer Assessment, SAM) 3. take a big picture look at patient education materials (SAM) 4. layout decisions related to design, format, and wording choices |
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Fry Formula
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manually calculated
results only show a potential problem count number of syllables/sentences in passage |
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Def Cultural competence
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'a set of cultural behaviors and attitudes integrated into the practice methods of a system, agency, or its professionals, that enables them to work effectively in cross cultural situations'
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Def Aculturation
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adopting the behavior patterns of the dominant culture; the process of assimilating new ideas into an existing cognitive structure. Process of replacing one's first culture with a second culture
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cultural differences, including culture of poverty, lead to these behaviors
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-failure to recognize symptoms of disease and illness
-delay in seeking care due to cost or mistrust -may not comprehend what is prescribed as effective services |
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Def of Cultural Competence in Action
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having the capacity to work effectively and interact with people from cultures different than our own
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Campinha-Bacote Model
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model of cultural competence
views cultural awareness, knowledge, skills, encounters, and desires as 5 constructs of cultural competence *no one will ever become completely 'culturally competent' |
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def cultural desire
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the beginning of cultural knowledge. Motivation of the therapist to want to start the process of becoming culturally aware, knowledgeable, skillful and seeing cultural encounters
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requirements for cultural competence
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1.cultural awareness: process of conducting a self-exam of one's own biases and in-depth exploration of one's own culture
2. Cultural knowledge: being familiar with selected cultural characteristics, values, and behaviors of another group 3. Cultural Skill: accepting and appreciating differences between cultures without assigning judgement 4. Cultural encounter: OT/PT's willingness to directly engage in face to face cultural interactions to prevent possible stereotyping |
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ETHNIC interview strategy
(be able to work through for exam-practice week 6 slides) |
Explanation-why do you think you have symptoms
Treatments-what have you tried(home remedy) Healers- alternative or folk healers Negotiate-mutually acceptable options Intervention- may include alternative tx Collaboration- family, community, healers |
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LEARN strategy for goal setting
(be able to write out/work through for exam-practice week 6 slides) |
Listen with empathy for pt perception of problem
Explain your perception of problem Acknowledge/discuss similarities and differences in perceptions Recommend treatment but consider pt suggestions Negotiate agreement |
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Health Belief Model (1950s)
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states that health-related behavior (good or bad) is volitional, so interventions are targeted to either change a patient's cognitions (beliefs) or motivate the patient to follow through with any good beliefs that already exist
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According to Health Belief Model, these three elements explain whether you will follow a recommended action to change a behavior
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1. are you ready to take action
2. is the likely outcome worth the investment 3. is there a cue(trigger) that makes you want to change |
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Prochaska's stages of change model
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originally developed to address addiction behavior, but applies to behavioral changes requiring high involvement by the patient
5 stages: -pre-contemplation -contemplation -preparation -action -maintenance |
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Pre-contemplation stage
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client is not thinking seriously about changing behavior and does not seek intervention
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Contemplation stage
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client is seriously thinking about pros/cons of changing behavior within the next 6 mos
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Preparation stage
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client is ready to make the change. Focus on brainstorming to remove any barriers that prevent the change in behavior
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Action stage
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patient takes steps to change behavior and model new behavior. takes 30 days-6 mos for new behavior to become ingrained.
*this is the riskiest stage for regressing |
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Maintenance stage
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after 6 successful months. patient models new behavior without conscious thought.
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Prochaska model vs HBM
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prochaska helps therapist identify which stage of change pt is in so we can design interactions for that stage
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ADHERE approach- encourages patient to have adherence mindset
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Acknowledge need for tx with the pt
Discuss potential tx strategy options and consequences of non treatment Handle any concerns pt may have Evaluate functional health literacy Review key points of plan Empower by eliciting pt commitment |
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FRAMES
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helps get pt back on track. eliminate authoritative words. give pt the power
Feedback Responsibility lies with pt Advice giving Menu of change options Empathetic style Self-efficacy is enhanced |
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ABC approach of behavioral modification
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Antecedents- what led up to behavior
Behavior-what was not acceptable Consequences-motivation requires pt involvement |
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Benefits of electronic technology in patient education
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-methods constantly being updated and match preferences of a technologically savvy patient
-incorporates visual/auditory input to allow learning on multiple levels -provides immediate and convenient access to information, education, and performance monitoring tools |
