CONDUCTING AND STRUCTURING CLINICAL PRACTICE SESSIONS

By structuring clinical practice sessions (described in more detail below) and through the following practices, the trainer can help learners get the most out of the experience:

„ Let learners know which activities they can do independently and which require supervision. For example, if a learner is already competent in educating patients with HIV/TB co-infection, she/he can practice that portion of services independently and call in the trainer when practicing history-taking and physical examination to

diagnose HIV/TB co-infection.

„ Structure activities to allow learners the most interaction with patients. Although demonstration is appropriate in the beginning of clinical sessions, allow learners direct contact with patients as soon as you believe it is appropriate. The more learners work with patients, the more practical knowledge, experience and confidence they will acquire.

„ Plan a “rotation system” so that learners do not overwhelm one area. For example, three or four learners are the most that a specific area of a clinic can absorb without affecting service delivery. If there are more, plan a rotation system that allows ample time for all learners in each clinic area, based on your assessment of the

individual needs of each. This also helps balance the load for staff members who will be working with learners. For example, several learners can be assigned to the

counseling area, several to the screening area, several to the outpatient department, and several to different inpatient wards. They can change work areas every few hours, every day, or every few days—whichever seems most appropriate.

„ _{Prepare activities that learners can do when there are no appropriate patients at} the clinical practice site. There may be times when learners will not have any planned activities with patients. Provide alternative activities for learning such as interviewing patients about patient satisfaction, observing existing infection

prevention practices on the inpatient wards, reviewing charts, and learning about how care is documented.

Before the Clinical Practice Session

During much of clinical practice, the trainer may be overseeing several clinical staff—as they interact with learners—and providing overall supervision to many learners rather than providing direct guidance to a few.

First, to ensure that the practice runs as smoothly as possible:

„ Meet with clinical staff and any clinical instructors/preceptors to ensure review the day’s plan, see if there are any issues that need to be discussed/resolved and identify any interesting learning opportunities that might presently exist on the unit.

„ Ensure that they understand their role.

„ Visit the different areas where learners will be assigned to see if there are any problems or logistical issues that need to be addressed.

As will be further discussed in Chapter 8, ALL clinic staff should be oriented—well before clinical practice—to the purpose of the training, benefits of the training to their facility and health care system and their role in supporting it. Depending on your training program, clinic staff may even provide a supervisory role and need to be trained in using the appropriate assessment tools.

Next, meet with the learners before the session, either earlier in the week or early in the morning on clinical practice days. Although this meeting should be brief, it will help learners have a productive clinical experience. Items to be covered include:

„ The learning objectives for that day or the clinical session

„ Any necessary scheduling changes

„ Learners’ tasks for that day or session, including the work assignments and rotation schedule if applicable

„ _{Assignments to be completed during that day/session} „ Where to go if have questions or difficulties

„ The topic for the post-session meeting, so that the learners can prepare cases or look for experiences to share

„ Questions related to the session or from previous sessions, if they can be answered quickly; if not, postpone them until the post-session meeting

Training Perspectives: Laying the Groundwork for a Positive Clinical Practice Experience If possible, well before the course begins, the trainer should gain a working knowledge of the clinic, including how it is set up, how it functions, the client population and heaviest client flow times. The trainer should also initiate a good working relationship with the staff. Staff should understand their role in the clinical training so they can support the learners. They should also understand the overall purpose and objectives of the course, as well as the importance of the clinical practice component. Ultimately, the trainer will need to rely on the staff’s cooperation in notifying him/her of unique, unusual or especially pertinent client situations and allowing learners to provide services to these clients.

During the Clinical Practice Session

When you are working with clinical instructors and staff, check in with them periodically to make sure everything is running smoothly. Coordinate with them any planned

learning activities that may require your assistance.

„ _{Observe learner-patient interaction and ask questions to gauge learners’} understanding. This may also allow you to ask some questions to help the learners develop decision-making skills or explain the rationales for their decisions.

„ Continue the process of facilitating skills development as described earlier. Learners now have the opportunity to observe demonstrations, practice, receive feedback, and demonstrate competency in the real setting. Demonstrate skills, observe the learners’ performance of skills whenever possible and provide feedback. Ask learners if they have opportunities to be assessed in any of the skills in their logbook and if so, arrange for assigned staff or the clinical instructor to observe them as they perform these skills, or observe them yourself.

Safe and efficient provision of services must be the highest priority for everyone working in the clinic, regardless of individual roles and responsibilities, and must not be compromised for the sake of learning.

„ _{As always, maintain a positive learning environment. Learners will be intimidated}

and nervous at the beginning of clinical practice experiences. Help reduce their anxiety by having a friendly and helpful manner with them. Encourage the clinical instructors and staff also to help put learners at ease so they can learn well and feel comfortable asking questions.

After the Clinical Practice Session

If possible, meet with the learners at the end of the session. If you cannot meet with them every day, you should still meet with them regularly to assess the progress of their

learning in the clinical setting. Conduct these meetings away from the patient care area if possible. Ideally, clinics will have a small room you can use for small group activities or meetings with learners.

Below are several actions you can take at the end of the day, or periodically during the rotation, to help further learning:

„ Review the learning objectives and assess learners’ progress toward meeting them

„ _{Encourage learners to present cases seen that day, particularly those that were}

interesting, unusual, or difficult

„ Respond to clinical questions concerning situations and clients in the clinic or information in the reference manual

„ Provide an opportunity for learners to ask questions

„ Ask learners questions about cases or their care plans

„ Tell learners about the logistics of future clinical practice sessions

These meetings, especially extended sessions, should be conducted away from the client care area if possible. Although every clinic will not have a meeting room, an effort should be made to locate a space that will allow free discussion, small group work and practice on models and that will not interfere with efficient client care or other staff duties. The trainer may need to be very creative to find such a location. If weather permits, these sessions can be held outdoors. They can also be held at the classroom if it is nearby, although the trainer and learners may spend valuable time getting there.

MAXIMIZING LEARNING OPPORTUNITIES IN THE CLINICAL SETTING