AJHPE 194

Clinical educators' self-reported personal and professional development after completing a short course in undergraduate clinical supervision at Stellenbosch University

A M S Schmutz, 1 BSc Physiotherapy; S Gardner-Lubbe, 2 PhD Mathematical Statistics; E Archer, 3 BCur Hons, MPhil (Higher Education)

1 Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Parow, Cape Town, South Africa

2 Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa

3 Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Parow, Cape Town, South Africa

Corresponding author: A M S Schmutz (amsschmutz@sun.ac.za)


Background. In 2007, a Supervision Course in Undergraduate Clinical Supervision was developed at the Faculty of Medicine and Health Sciences at Stellenbosch University in South Africa. The target group was inter-professional clinical educators that are involved in student education on the clinical platform. Although the course participants were professionals and specialists in their own fields, the majority of clinical educators have very little or no knowledge of adult education. The Supervision Course aims to develop clinical supervision skills of clinical educators by exposing these supervisors to basic principles of education and specifically clinical teaching, resulting in quality education for undergraduate students. The aim of this study was to determine the impact of this short course on the personal and professional growth of the clinical educator.

Methods. A qualitative study was performed, including an open-ended questionnaire that provided opportunity for the clinical educators to elaborate freely on their strengths, weaknesses and areas of desired improvement before and after the Supervision Course, and a semi-structured individual interview after the Supervision Course. The questionnaire data were categorised according to strengths, weaknesses and areas of desired improvement. An inductive approach was used to analyse the qualitative data. Key themes that emerged from the interviews were identified and grouped together in categories.

Results. The results are summarised in table format to identify themes with supporting quotes.

Conclusion. Although a small sample, this study demonstrates the personal and professional growth reported by attendees of a clinical supervision short course.

AJHPE 2013;5(1):8-13. DOI:10.7196/AJHPE.194


Background

In 2007, a Short Course in Undergraduate Clinical Supervision (Supervision Course) was developed at the Faculty of Medicine and Health Sciences (FMHS) at Stellenbosch University (SU) in South Africa, that has sub­sequently also been presented nationally.1 This Supervision Course is one of the faculty development initiatives to renew or assist faculty to perform their various roles effectively and aims to develop clinical supervision skills of clinical educators.2 The FMHS offers five undergraduate programmes in Health Sciences and therefore it was decided to follow a multidisciplinary team approach in the planning, constructing and implementation of this Supervision Course.

Clinical teaching is seen as a student-centred learning process which involves the translation of theory into the development of clinical reasoning skills.3 Effective clinical educators use several distinct, and sometimes overlapping, forms of knowledge during clinical teaching. 4 In addition, clinical teaching typically incorporates affective domains necessary for ethical client care and professionalism.3 Clinical educators therefore require more than just subject expertise to be effective in facilitating the transformation of students into professionals in the clinical setting.1 , 2 , 4

Clinical educators who are invited to attend the Supervision Course are from the multidisciplinary programmes of BSc Dietetics, B Occupational Therapy, BSc Physiotherapy, B Speech-Language and Hearing Therapy and MB ChB.

The Supervision Course consists of 1 contact session of 8 hours presented over 1 day. Topics that are discussed include the roles of the clinical educator,5 how adults learn, learning in the clinical environment, techniques of facilitating learning, assessment and feedback to students. 1 A study guide is provided for self-study, and within 6 weeks after attendance the clinical educator has to submit a reflective assignment on a recently completed supervision session. The clinical educator receives a certificate on completion of the assignment with continuous professional development points.1 Material provided in the Supervision Course includes recent literature, discussions and activities such as role play of the newly acquired teaching skills that encouraged the development of professional and personal growth of the participants.

After the first presentation of the Supervision Course, a study was done to establish the relevance and appropriateness of the course.1 The results indicated that the course participants were of the opinion that the course was appropriate and valuable. No drastic changes were suggested.1 The aim of this follow-up study was to describe the clinical educators' perceptions before and after attending the Supervision Course. We were specifically interested in the professional and personal development of clinical educators in the clinical context, defined as growing in the perceived competence of skills and the characteristics related to clinical teaching.

Methods and analysis

All clinical educators who attended the last two Supervision Courses in 2010 were invited to participate in this study. This included a pre-post questionnaire consisting of three open-ended questions that provided opportunity for the clinical educators to elaborate freely on their strengths, weaknesses and areas of desired improvement before and after the Supervision Course, and a semi-structured individual interview after the Supervision Course.

The questionnaire data were categorised according to strengths, weaknesses and areas of desired improvement while an inductive approach was used to analyse the qualitative data. Key themes that emerged from the interviews were identified and grouped together in categories.

Open-ended questions

The three open-ended questions were completed by clinical educators before and after completion of the Supervision Course. Thirty participants completed the open-ended questions before attending the Short Course and 19 participants completed the open-ended questions after the Supervision Course. Due to unforeseen commitments in the clinical settings as well as time-related issues, not all the clinical educators who completed the open-ended questionnaire initially, completed it again. The questionnaire data were categorised according to strengths, weaknesses and areas of desired improvement.

Semi-structured individual interviews

After the Supervision Course all the clinical educators were invited to take part in semi-structured individual interviews. Fifteen clinical educators took part in the individual semi-structured interviews. Due to logistical difficulties, six of the clinical educators answered the semi-structured individual interviews electronically. One person conducted the interviews with the clinical educators. The interviews were digitally recorded and transcribed verbatim. These data were analysed by one of the authors, using an inductive approach to identify key themes and patterns. The key themes that emerged were confirmed by one of the clinical educators who took part in this study after the themes were tabulated.

Ethical approval for this study was obtained from the Health Research Ethics committee of Stellenbosch University (N10/03/067). Informed consent was requested from all participants prior to commencement of the study, and anonymity of the Supervision Course participants was respected throughout the study procedures.

Results

A total of 30 clinical educators completed the informed consent forms initially.

Open-ended questions

It is clear that ‘encourage’, ‘advise practical issues’, ‘outcome based’, ‘students apply knowledge’, ‘acknowledge student strength and limitations’, ‘break information into small chunks’ and ‘guiding’ are particularly viewed as strengths before the training. After the training, phrases like ‘relationship with students’, ‘mutual respect’, ‘facilitation’ and ‘leader’ are quoted more often. The phrases between the column headings ‘Before: Strengths’ and ‘After: Strengths’ were quoted by some as strengths before the training and by others (or the same participants) as strengths after the training.

Similarly, ‘curriculum knowledge’, ‘unclear expectations’, ‘patience’, ‘journal clubs’ and ‘prepared demos’ feature as weaknesses in the questionnaire before training. Weaknesses and areas for improvement are fairly similar (in close proximity on the plot). After the training the main weaknesses mentioned were ‘new techniques’, ‘time management’, ‘flexibility’, ‘overly protective of students’, ‘delegating’, ‘teaching skills’, ‘perfectionist’ and ‘discussion skills’.

The phrases that were used by some as strengths, others as weaknesses and both before and after the training are ‘role model’, ‘directing’, ‘communication’, ‘teaching’, ‘problem solving’, ‘level of student’, ‘demonstration’ and ‘punctual’.

Harden and Crosby identified 12 roles of the teacher that can be summarised in 6 areas of activity.5 The six areas include: teacher as information provider, the teacher as role model, the teacher as facilitator, the teacher as assessor, the teacher as planner and the teacher as resource developer.5 These areas of activities were used for analysis of the open-ended questions.

The themes that were identified from the open-ended questions, with supporting quotes, are presented in Table 1. Some phrases were quoted as strengths prior to the Supervision Course and by others (or the same clinical educators) as strengths after the Supervision Course.

Table 1. Themes that emerged from the open-ended self-assessment questionnaire, with examples of supporting quotes

Strengths/weaknesses

Area of activity of the clinical educator

Sub-components of the area

*Quotes – before the Supervision Course

*Quotes – after the Supervision Course

Strengths

Role model

Satisfying patients

Having extensive clinical experience to draw from as a supervisor

Mutual respect

Enjoying my job

I aim to be a good role model

I care about helping students to reach their potential

Encouraging students

Honesty and openness


Punctual

Being on time with marking assignments


Enthusiastic

Enthusiastic and motivated to channel subject matter

Willingness to put in extra effort

Good listener


I enjoy being with the students and facilitating their professional growth


Approachable

Being approachable

Availability to students; approachable

Information provider


Lecturing, directing, motivation

Knowledge of the field

Enthusiastic and motivated to channel subject matter

Facilitator of learning

Lecturing

To advise on practical issues in clinical setting, informal discussions and guiding students, thus aiming that they apply knowledge

Significant clinical experience

Leader, I'm able to create a learning environment for students

Directing

A desire to encourage students to do their best ...

Fostering a rewarding and professional relationship with students

Organising

Ability to break information into smaller chunks and explain in a user-friendly format


Good experience and knowledge in subject matter


Planning

I'm able to guide students

Planning and good time management


Motivating

The ability to help students build bridges between theoretical knowledge and practical application; basically guiding their insights through prompts

Motivating students

Planner


Organisational skills and planning

I am consistent and put high value in my responsibilities; I plan ahead

Assessor/examiner

Feedback

Good at providing feedback to students; I am assertive

Planning and good time management, able to give feedback

Giving positive feedback

... my ability to do continuous assessment of the student as the affiliation progresses

Good listener, fair and equal evaluation

Objective feedback not related to students' personality

Acknowledging students’ strengths and limitations

'weaknesses' helps focus the student

Strengths/weaknesses

Area of activity of the clinical educator

Sub-components of the area

*Quotes – before the Supervision Course

*Quotes – after the Supervision Course

Weaknesses

Assessor/examiner

Up to date with lecture notes

Lack of formal training, lack of curriculum knowledge

Still need to put in more planning

Need to make expectations clear prior to the clinical content; time management


Journal clubs


Feedback

Feedback – don't know when to give it to students, always scared that I may hurt their feelings

… negative feedback – tend to always sugar-coat things which may lead to confusion/ misunderstanding; not always structured enough

I am often worried that feedback might be ‘de-motivational’ to students – especially if they are experiencing difficulties

My feedback skills improved, but I feel that there's still room for improvement

Assessment

Assessment of students


Assessment – adjusting expectations to the level of a student

'Spoon-feeding’ – I tell them the answers if they don’t know it

Assessments of students

Inexperience, especially regarding assessment [sic]


Planner Assertiveness

Can be more assertive

Not always assertive enough
Patience

Patience levels with students who do not co-operate

Impatient; trying to do too much at a time

Sometimes a little impatient with the process of learning; too lenient with students at times

Being overly protective of students

I need some assistance in planning techniques; problem solving needs some assistance

Perfectionist and expect that of them
Time management

Time management

Time management

Tendency to spend too much time with students


Some quotes have been translated from Afrikaans to English for the purpose of this manuscript.


Semi-structured individual interviews

The themes that were identified from the semi-structured individual interviews, with supporting quotes, are presented in Table 2.

Table 2. Themes that emerged from open-ended individual semi-structured interviews, with examples of supporting quotes

Questions

Themes

*Quotes from clinical educators

What were your expectations of the Supervision Course and have they been met?

To increase knowledge and improve skills

... we actually only have knowledge in our own subject, but we don't have any knowledge in terms of educational techniques or the correct way of doing things

You do something every week and you do the same thing, and I did want to be exposed to more innovative ways of supervising and tutoring

CPD points

I expected to get CPD points, and sorry, I'm being honest

What is your view of Clinical Supervision?

Positive


Teaching skills and learning methods

... it's a scientific skill we have to acquire ...

Often people graduate and they are just told to supervise students and no one has taught them, no one has modelled behaviours for them and they go and do their own thing, and often you are just doing the wrong thing all the time

It's vitally important and underestimated

You can make or break a student

Motivation

... so I motivate them positively ...

Student relationship

It’s actually quite exciting to see that happen, to see the students take the stuff and grow and quickly, quickly get skills and so on under their belt

Negative


Time management, delegation

Being pressurised: no time, rushing, rushing!

Negative feedback

Feedback: sometimes you don't always know how to say something to a student, especially in my case, because I am scared; I do not want to get the student into trouble so I say nothing

How would you describe your previous supervision sessions? (before Supervision Course intervention)

Too much talking/lecturing

Giving student too much info

Uncertainty due to lack of knowledge

Not letting students participate more in the process

... I'm a bit of a spoon-feeder

... dominating, not facilitating ...

Own limitations

Regret most: at that stage, my own lack of subject knowledge was probably the biggest problem with the supervision

How would you describe your relationship with students during supervision? (after Supervision Course intervention)

Professional

I try very hard to have a good professional relationship with all the students

Role model

... students are motivated and see you as motivating and inspiring and so on ...

Approachable

I'm very relaxed, so I like to be approachable and I hope that they would see me in that way and that they could ask me anything

Too friendly

Too good sometimes, a bit too friendly

How would you describe your supervision sessions after completion of the Supervision Course?

Importance of role model

I think that I strive to have a relationship of respect and professional relationships with students, and I try to motivate them to do more and to think more and to read more and to be interested in a case and not just seem interested in the material It's about being interested myself and pointing out other little things about it and telling them what they need and what the implications are and so on

The other thing that I've also learnt is that you are a role model, that what you do will have impact on what the students do at the end of the day

Questions

Themes

*Quotes from clinical educators


Planned

... I am more structured now; I'm not a very structured person generally

Feedback

I have become a lot more aware of the importance of feedback and how I give feedback

Student responsibility

Being more aware of guiding students to think about the answer/ find the answer by asking themselves the right questions instead of just telling them the answer

Indicators of change

I try to facilitate more than to teach, get them involved and responsible for their own learning

... moving away a bit from spoon-feeding, bit more facilitating

... it's a work in progress

What are your goals for future supervision sessions?

Skill

To incorporate even more techniques

Assessment

I think I would definitely like to improve on my assessment of the students

... formative assessments earlier in the block so that you've got more time to fix things, and if you need to do it again, you can do it again

Planning

So, I have found that I tend to plan, actually sit down and have a block plan

Role model

... to be a good role model

How would you define your own personal growth after completion of the Supervision Course?

Confidence

I feel more comfortable and confident teaching the students or demonstrating techniques to the students

Growth/learning

I feel like it’s just begun

I think I see a bit more the bigger picture ...

My understanding of learning has much improved and that changed the ways I am teaching

Skills

Gaining some skills that I have not thought of before

Literature

The articles just gave you a different insight of your role and how you can improve ...

*Some quotes have been translated from Afrikaans to English for the purpose of this manuscript.

Discussion

The aim of this study was to explore and describe clinical educators' perceptions before and after a Supervision Course intervention. We were specifically interested in the professional and personal development of clinical educators in the clinical context, defined as growing in the perceived competence of skills and the characteristics related to clinical teaching. This is congruent with literature, where participants reported an increase in knowledge and educational principles and gains in teaching skills,2 which confirms that faculty development serves to develop competence in members of staff.

The open-ended questions referred to strengths and weaknesses. It was interesting that the strengths and weaknesses could overlap, or in fact be the same. We suggest that clinical educators develop over time or they are at different levels of their own supervising journey. Another issue refers to the 12 various roles of the clinical educator that are written about in Harden and Crosby and categorised into 6 areas of activity of the teacher.5 From our study 5 areas of activity were clearly identified as part of the strengths: role model, information provider, facilitator of learning, assessor/examiner and planner. The areas of activity that were identified as weaknesses included assessor, assertiveness and time pressures. Time pressures are mentioned as a challenge of clinical teaching in Spencer, as well as competing demands, being clinical, administrative and research.4

Some clinical educators highlighted summative assessment and time management as weaknesses. These areas are not directly addressed in the material of the Supervision Course, although formative assessment is. The importance of faculty development encompassing a whole variety of training opportunities to address all the needs of educators can thus not be over-emphasised. Literature confirms that we should continue to build on the success of such an initiative and develop programmes that extend over time to allow for cumulative learning, practice and growth.2 Also, due to time constraints, many of the clinical educators could not take part in the full research study. This underlines the issue of time-related commitments.

Some of the feedback received from clinical educators during the semi-structured individual interviews indicated that their own supervision skills developed and improved from giving too much information or spoon-feeding, to facilitating. Reilly mentions that in talking to learners, the educator's own clinical reasoning is the most powerful predictor of a learner's satisfaction and that this is not the same as talking off the top of one's head, a habit common among ineffective teachers.6 Bearing this in mind, it was deducted that these clinical educators were indeed growing into being more effective teachers.

Conclusion

Clinical educators experienced change and personal growth after completion of the Supervision Course. The importance of broad faculty development at Stellenbosch University is accentuated in these themes as not one course can cover all the relevant roles and expectations of clinical educators. We therefore recommend a development plan for all clinical educators and to utilise all opportunities to enhance the learning of clinical educators and eventually the learning and teaching of students. It would be interesting to investigate longitudinal cases of individual clinical educators over a longer period of time.

We experienced some limitations that deserve expanding on. Our sample size was small because of the small number of participants accommodated during the Supervision Course. The questions used in the semi-structured individual interviews had limited scope and can be developed for future use. The inclusion of multidisciplinary clinical educators diluted some of the data. In future studies it would be interesting to also compare same disciplines with each other as well as the multidisciplinary group.


Acknowledgements.
We would like to extend a word of appreciation to M van Heusden for involvement and leadership during the study as well as conducting all the individual semi-structured individual interviews. The research was funded by the Fund for Innovation and Research into Learning and Teaching (FIRLT), Stellenbosch University, South Africa.

References
    1. Archer E. Improving undergraduate clinical supervision in a South African context. AJHPE 2011:3(2):6-8.

    1. Archer E. Improving undergraduate clinical supervision in a South African context. AJHPE 2011:3(2):6-8.

    2. Steinert Y, Mann K, Centeno A, et al. A systematic review of faculty development initiatives designed to improve teaching effectiveness in medical education: BEME Guide No.8. Medical Teacher 2006;28:497-526.

    2. Steinert Y, Mann K, Centeno A, et al. A systematic review of faculty development initiatives designed to improve teaching effectiveness in medical education: BEME Guide No.8. Medical Teacher 2006;28:497-526.

    3. McAllister L, Lincoln M, McLeod S, Moloney D. Facilitating Learning in Clinical Settings. Cheltenham, UK: Nelson Thornes, 1997.

    3. McAllister L, Lincoln M, McLeod S, Moloney D. Facilitating Learning in Clinical Settings. Cheltenham, UK: Nelson Thornes, 1997.

    4. Spencer J. ABC of learning and teaching in medicine – learning and teaching in the clinical environment. BMJ 2003;326:591-594.

    4. Spencer J. ABC of learning and teaching in medicine – learning and teaching in the clinical environment. BMJ 2003;326:591-594.

    5. Harden RM , Crosby J. AMEE Guide No 20: The good teacher is more than a lecturer – the twelve roles of the teacher. Medical Teacher 2000;22(4):334-347.

    5. Harden RM , Crosby J. AMEE Guide No 20: The good teacher is more than a lecturer – the twelve roles of the teacher. Medical Teacher 2000;22(4):334-347.

    6. Reilly BM. Inconvenient truths about effective clinical teaching. Lancet 2007;370:705-711.

    6. Reilly BM. Inconvenient truths about effective clinical teaching. Lancet 2007;370:705-711.

Article Views

Abstract views: 3260
Full text views: 3736

Comments on this article

*Read our policy for posting comments here