A Clinical Teaching Technique for Nurse Preceptors: The Five Minute Preceptor

A Cycle of Reinforcing Challenges and Ideas for Action in Experiential Settings

Evidence suggests that both pharmacy students and preceptors are struggling in the experiential setting. Underlying this phenomenon is a potential interconnected and cyclic set of behaviors being reinforced between students and preceptors. These behaviors can contribute to or are the result of higher levels of burnout and a decrease in the development of student clinical skills and subsequent performance on rotation. In this review, the authors investigate various challenges commonly encountered in the experiential environment. These challenges can range from an observed decrease in student engagement, motivation, and critical thinking skills to an increase in preceptor burnout and culture shifts in the clinical practice environments. These factors all ultimately impact patient care and overall student performance. For each challenge identified, strategies will be presented that can be implemented by students, preceptors, and pharmacy programs to break the cyclic pattern identified.

Exodontia skills acquisition: Focusing on clinical teaching and training

OBJECTIVES

The aim of the research was to evaluate the traditional exodontia block course. The objectives were to explore the experiences and views of students, clinical teachers and dental practitioners of the various elements of the course curriculum.

METHODS

The study was a qualitative, participatory action research study using descriptive analysis. The study was conducted at a Dental Faculty in South Africa. A purposive sample of students, clinical teachers and dental practitioners were invited to participate. Focus group discussions were used to collect data which was analysed by an external coder.

RESULTS

The study population consisted of 15 undergraduate dentistry students, 10 clinical teachers and seven dental practitioners. Four broad themes with sub-themes emerged from the study. The main themes identified strengths and deficiencies of the traditional course and made recommendations for its improvement. The themes identified were i) Integration of knowledge and skills, ii) Block course structure, iii) Challenges associated, and iv) Recommendations for improvement. Overall, the participants were satisfied that the course met its objectives. The results pertaining to clinical skills acquisition identified that teaching the use of elevators and luxators in the course, and standardisation of terminology among all clinical teachers as areas requiring attention. Teaching and learning strategies such as community-based learning, peer learning, case reviews, feedback and visual technology were viewed by the student, as well as clinical teacher samples, as strategies most beneficial to clinical learning.

CONCLUSIONS

The review of the curriculum for exodontia skills acquisition and development, provided several benefits. Firstly, this research served as a quality assurance indicator. It further highlighted many teaching and learning strategies that would improve clinical skills development, reduce stress and anxiety, and support student learning. To a large extent, pertinent information was obtained that served to inform the subsequent redesigning of the course. The findings of the study augment the literature currently available on the best practice for exodontia skills acquisition and development and provide baseline information for the planning and redesign of related courses.

The mediating effect of clinical teaching behavior on transition shock and career identity among new nurses: A cross-sectional study

BACKGROUND

New nurse attrition is a worldwide problem. Because of the gap between theory and practice in their work, new nurses may experience transition shock, which can have a negative impact on their career identity. Clinical teaching behavior is an important component in reducing the impact of new nurse transition, stabilizing the hospital nursing workforce, and cultivating high-quality nursing talents.

OBJECTIVES

Based on the New Nurse Transition Model, to explore the mediating role of clinical teaching behavior in the relationship between transition shock and career identity in the new nurse population of Gansu Province.

DESIGN

A cross-sectional study.

SETTING

Seventeen hospitals in Gansu province of China.

PARTICIPANTS

A total of 1684 new nurses (1590 female and 94 male) were recruited from seventeen hospitals in Gansu province.

METHODS

Three questionnaires include: The Clinical Teaching Behavior Inventory (CTBI-23), the Transition shock of Newly Graduated Nurses Scale (TSNGNS), and the Nurse's Career Identity Scale (NCIS). Structural equation modeling was used to deal with the relationships among clinical teaching behavior, transition shock, and career identity.

RESULTS

Transition shock was found to be negatively related to both career identity and clinical teaching behavior, with clinical teaching behavior mediates the relationship between transition shock and career identity.

CONCLUSIONS

The clinical teaching behavior of the teaching staff plays a role in mediating the relationship between new nurses' sense of career identity and transition shock. Accordingly, the teaching behavior of clinical teaching should be improved and the quality of clinical teaching behavior should be improved to increase the career identity of new nurses and reduce the turnover rate of new nurses.

The relationships between clinical teaching behaviour and transition shock in newly graduated nurses

AIM

To explore the relationships between clinical teaching behaviour and transition shock in newly graduated nurses and significant differences in the northwest and northeast China.

DESIGN

A cross-sectional design.

METHODS

A total of 211 (nurses) and 925 (preceptors) were recruited in six Third-class different hospitals from July to August 2019.

RESULTS

The transition shock is negatively correlated with the clinical teaching behaviour in northwest and northeast China, while the transition shock in the northwest is higher than that in the northeast for the behindhand economy and natural limit.

CONCLUSION

The transition process of newly graduated nurses in northeast China with ethnic minorities and the behindhand economy is more difficult. For newly graduated nurses, personal health and a supportive environment need further improvement. Teaching strategies for preceptors need to be enhanced. Two-way feedback is more useful for both the newly graduated nurses and preceptors to improve quality care, and holistic care.

Implementation of One-Minute Preceptor for Clinical Teaching in Obstetrics and Gynaecology

Background

In absence of a dedicated teaching curriculum for non-PG residents in Obstetrics and Gynecology department, a concise teaching learning method, One-Minute Preceptor (OMP) with feedback being its core component may be introduced to translate their theoretical knowledge into clinical practice.

Methods

This descriptive cross-sectional study included four faculty members and 20 residents. Each resident was exposed to three OMP sessions pertaining to common gynecological case scenarios with a gap of at least two days in between the sessions with faculties acting as preceptor and as observer. After three OMP sessions, feedback from residents and faculty regarding their teaching and learning experience after implementing this tool was obtained through separate pre-validated questionnaires graded on Likert's scale.

Results

The satisfaction index of the residents and faculties for OMP was found to be 96.3% and 95%, respectively. All residents and faculty members had consensus that OMP addressed the learning gaps (mean score 4.45 ± 0.51 and mean score 4.5 ± 0.57, respectively) and expressed being highly satisfied with OMP in busy clinical settings as compared to traditional method of teaching with mean score of 4.9 ± 0.30 and 4.75 ± 0.5, respectively. The faculties had consensuses that OMP can assess all domains of learning (mean score 4.75 ± 0.5). All residents and faculties opined that the time allotted to address all micro-skills was less and 60% residents advocated allotting at least 5 min time to the teaching encounter.

Conclusion

Our study indicates the beneficial role of OMP in time-constraint clinical environment and warrants further research to review the time frame keeping in view the learners' needs and the discipline.

Development of a clinical learning model to enhance patient safety awareness competency among Thai nursing students

Background

Enhancing patient safety awareness competency in nursing students is a necessity as they will be the next generation of professional nurses to take care of patients. One of the strategies is to create an innovative learning model using questioning as part of the metacognitive thinking concept.

Objective

This study aimed to develop a clinical learning model to enhance patient safety awareness competency among Thai nursing students and determine its effectiveness.

Methods

The study used a research and development design with two phases: (1) the development of a clinical learning model to enhance patient safety awareness competency among nursing students, and (2) the evaluation of the effectiveness of the developed clinical learning model. The evaluation was done quantitatively and qualitatively. In the quantitative strand, a quasi-experimental method using repeated measures design was used in 24 students. While in the qualitative strand, a qualitative descriptive design was employed in 24 students and three teachers.

Results

In the first phase, the DUIR clinical learning model was developed, consisting of four processes: 1) Doubt (D), 2) Understanding (U), 3) Insight (I), and 4) Reflected value (R). The patient safety awareness competency included two components: managing patient safety and solving problems related to unsafe patient care. In the second phase, the model was evaluated by the students and the teachers. It revealed that nursing students' patient safety awareness competency was very high, and the competency was statistically different before and after the learning model.

Conclusion

The developed DUIR learning model using a questioning strategy is considered effective to encourage students to reflect critically on their own clinical experiences in order to achieve quality and safe care outcomes, thereby enhancing patient safety awareness for nursing students in a sustainable way. This model serves as an input for Thai nursing education and beyond.

The View From Here: Understanding the Lived Experiences of New Graduate Nurses With 8-10 Months of Experience

This qualitative study is based on individual interviews with 16 new graduate nurses during their 8th to 10th month of employment. Four themes emerged from the data that reflected their lived experience: well on my way, finding my family, good days/bad days, and in recovery…moving forward. Nursing professional developers play an important role in continuing to support new graduate nurses to complete the transition to practice.

Rethinking clinical instruction through the zone of proximal development

BACKGROUND

The complexity of the learning environment and intricacy of nursing tasks make it difficult for students to learn without the assistance of an expert. Teaching in the zone of proximal development (ZPD) aims at positioning learners in the zone of what they can do and develop with assistance to reach full potential and independence. ZPD is deemed essential to understand how teaching and learning take place; however, its implications for clinical educators are limited and need further exploration.

OBJECTIVES

This research study aimed at exploring the instructional strategies that preceptors use to guide and support the development of undergraduate nursing students, from what they are capable of doing with assistance to what they can become and do independently.

DESIGN

The qualitative multiple case study research design was used to gain insights into the teaching experiences of 18 nurse preceptors situated in three recognized hospitals in Lebanon.

METHODS

Each preceptor was interviewed face-to-face using questions that were developed from a three-hour observation. Vygotsky's learning principles formed the reference point for this study. Analytic induction and constant comparison of preceptors' responses were applied throughout the study to unravel assisted strategies that target the potential learning zones of the student.

RESULTS

Three assumptions emerged from the data to underpin the preceptors' assistive strategies that help move learners from a cannot-do-level to can do independently. The assumptions are: (1) learning from clinical experience, (2) teaching beyond student ability, and (3) teaching for autonomy. In-depth analysis of both assumptions and strategies that focus instruction within each student's ZPD converged on a framework of three constructs: differentiated instruction, instructional scaffolding, and influencing a positive learning environment.

CONCLUSION

It is imperative that clinical educators be most receptive to instruction that targets the student's ZPD, as the zone represents a potential phase in student learning. This study provides a ZPD framework for intensifying learning gains from clinical practice.

A BEME realist synthesis review of the effectiveness of teaching strategies used in the clinical setting on the development of clinical skills among health professionals: BEME Guide No. 61

Background: Literature describing the effectiveness of teaching strategies in the clinical setting is limited. This realist synthesis review focuses on understanding the effectiveness of teaching strategies used in the clinical setting.Methods: We searched ten databases for English language publications between 1 January 1970 and 31 May 2017 reporting effective teaching strategies, used in a clinical setting, of non-procedural skills. After screening, we used consensus to determine inclusion and employed a standardised instrument to capture study populations, methodology, and outcomes. We summarised what strategies worked, for whom, and in what settings.Results: The initial search netted 53,642 references after de-duplication; 2037 were retained after title and abstract review. Full text review was done on 82 references, with ultimate inclusion of 25 publications. Three specific teaching strategies demonstrated impact on educational outcomes: the One Minute Preceptor (OMP), SNAPPS, and concept mapping. Most of the literature involves physician trainees in an ambulatory environment. All three have been shown to improve skills in the domains of medical knowledge and clinical reasoning.Discussion/conclusions: Apart from the OMP, SNAPPS, and concept mapping, which target the formation of clinical knowledge and reasoning skills, the literature establishing effective teaching strategies in the clinical setting is sparse.

The relationship between caring preceptor, self-efficacy, job satisfaction, and new nurse performance

OBJECTIVE

It is not uncommon for new nurses to experience dissatisfaction and underperformance in their professional practice as a nurse in their first year on the job. In this transitional phase, new nurses need a preceptor to guide them. The provision of preceptor guidance with caring value and support for new nurse self-efficacy is a critical element that new nurses require. This study aimed to analyze the relationship between caring preceptor, self-efficacy, job satisfaction, and the performance of new nurses.

METHOD

The research method used a cross-sectional design based on a sample set of 123 new nurses selected using the total population sampling method. Data were analyzed using correlation testing and multiple linear regression.

RESULTS

The results showed that there was a strong correlation between a caring preceptor and job satisfaction (r=0.522, p=0.0001) and new nurse performance (r=0.572, p=0.0001). There was a moderate correlation between self-efficacy with job satisfaction (r=0.371, p=0.0001) and new nurse performance (r=0.240, p=0.008).

CONCLUSION

For new nurses, the presence of a caring preceptor and self-efficacy are predictors of job satisfaction and performance. The preceptor had to care, which contributed to increasing the self-efficacy of new nurses.

Teaching the millennial radiology resident: applying a five-step 'microskills' pedagogy

Radiology is a unique medical specialty that focuses on image interpretation and report generation with limited patient contact. Resident read-out sessions with teaching are a quintessential part of reporting workflow practices in teaching institutions. However, most radiologist-educators do not have formal training in teaching and learning experiences vary. The five-step 'microskills' model ('one-minute preceptor' technique) developed by Neher is an easily adopted teaching model that complements the workflow of the typical read-out session, and can be utilised by radiologists of varied teaching experience and seniority. The steps are: (a) get a commitment; (b) probe for supporting evidence; (c) teach general rules; (d) reinforce what was done right; and (e) correct mistakes. Feedback is important to the model and accounts for two out of five microskills. The teaching model emphasises knowledge application and establishing relevance, which is useful in engaging the millennial resident. It is easily assimilated and applied by radiologist-educators.

Deliberate teaching tools for clinical teaching encounters: A critical scoping review and thematic analysis to establish definitional clarity

PURPOSE AND METHOD

We conducted a scoping review of tools designed to add structure to clinical teaching, with a thematic analysis to establish definitional clarity.

RESULTS

Six thousand and forty nine citations were screened, 434 reviewed for eligibility, and 230 identified as meeting study inclusion criteria. Eighty-nine names and 51 definitions were identified. Based on a post facto thematic analysis, we propose that these tools be named "deliberate teaching tools" (DTTs) and defined as "frameworks that enable clinicians to have a purposeful and considered approach to teaching encounters by incorporating elements identified with good teaching practice." We identified 46 DTTs in the literature, with 38 (82.6%) originally described for the medical setting. Forty justification articles consisted of 16 feedback surveys, 13 controlled trials, seven pre-post intervention studies with no control group, and four observation studies. Current evidence of efficacy is not entirely conclusive, and many studies contain methodology flaws. Forty-nine clarification articles comprised 12 systematic reviews and 37 narrative reviews. The most number of DTTs described by any review was four. A common design theme was identified in approximately three-quarters of DTTs.

CONCLUSIONS

Applicability of DTTs to specific alternate settings should be considered in context, and appropriately designed justification studies are warranted to demonstrate efficacy.

The one-minute preceptor model: A systematic review

BACKGROUND AND PURPOSE

Teaching models provide a systemic framework for didactic and clinical teaching. The One-Minute Preceptor (OMP) is one teaching model, providing five microskills to organize a learning experience for students in the clinical environment. This review aims to integrate the literature on the OMP model by highlighting potential use for nurse practitioners while identifying directions for future research.

METHODS

Electronic databases were searched from December 2017 to January 2018 for articles published in English. The databases included PubMed, CINAHL, and MEDLINE using terms including "preceptor," "clinical teaching," "time-efficient teaching," and "precepting." Of 32 articles in the final search, only 12 experimental quantitative studies were included in the synthesis and 20 descriptive studies in the discussion.

CONCLUSIONS

The OMP model is supported by literature for its effectiveness as a teaching model and preference by students and preceptors. It has been shown to increase teaching techniques including feedback and assessment of students' clinical reasoning.

IMPLICATIONS FOR PRACTICE

The OMP model has the potential to overcome clinicians' barriers to precepting nurse practitioner students. Future research may evaluate the use of this model specific to nurse practitioner preceptors and students, perceived time benefits in clinical teaching, overall improvement in clinical teaching, and use in interprofessional precepting.

Nursing interns' perception of clinical competence upon completion of preceptorship experience in Saudi Arabia

BACKGROUND

Nursing interns are newly graduate students with limited real-life work experiences. These novices are in the process of enhancing their competencies in the delivery of quality nursing care with the guidance of the preceptors. Hence, it is relevant to examine the impact of preceptorship, as a teaching strategy, among nursing interns during their preceptorship years in clinical settings.

OBJECTIVE

The aim of this study is to determine if the preceptorship program has provided the nursing interns the needed education in enhancing clinical competence.

SETTING

The study was conducted in one of the tertiary hospitals in Riyadh, Saudi Arabia.

PARTICIPANTS

Convenience sampling was used to recruit 92 undergraduate nursing interns who have completed the five-years nursing education including preceptorship.

METHODS

The nursing interns completely answered the survey questionnaires which covers Benner's Competencies, Knowles' Adult Learning Theory and the Nursing Process.

DESIGN

The study followed a mixed-methods design wherein a descriptive cross-sectional approach was used to identify factors affecting the nursing interns' perception towards clinical competence. Two open-ended questions referring to the improvement of internship program and competency were concurrently collected which was the qualitative portion of the study.

RESULTS

The preceptorship program enhanced the preceptees competencies in the clinical setting primarily in priority-setting with acutely ill patients, multitasking and demonstrating complex nursing skills. The majority of the nursing interns perceived preceptorship as a constructive experience. The availability, approachable attitude, and trustworthiness of the preceptor were viewed as influential factors in improving the interns' clinical competence. Variations were significant with phases of internship and type of school. Furthermore, results showed positive correlation between the nursing interns' efficacy and clinical competencies in professional behavior, general performance, and core nursing skills.

CONCLUSION

Preceptorship program positively impacts nursing interns' skills in handling actual patients in clinical setting. Hence, the preceptorship program is an effective teaching strategy which advances the novice to the next stage of developing clinical competence.

The Improvement of Student Competency in a Clinical Study in Indonesia: What Factors Played an Important Role?

Background: The improvement of nursing student competency currently is still being an issue for the majority of nursing education institutions in Indonesia. This is due to partnership with hospitals has not been supported by adequate policies and other factors.Objectives: The purpose of this study was to identify the appropriate model in improving student competency in a clinical study. Design used in this study was observational study with cross-sectional approach.Methods: The research design used cross-sectional approach with involving five hospitals (Fatmawati Jakarta Hospital, Hasan Sadikin Bandung Hospital, Kariadi Semarang Hospital, Sardjito Yogyakarta Hospital, Soetomo Surabaya Hospital) and five universities namely Muhammadiyah Jakarta University, Padjajaran Bandung University, Gadjah Mada Jogjakarta University, Diponegoro Semarang University,  Airlangga Surabaya University. Three hundred and eighty-four participants were recruited from these sites. Data were analyzed  using multiple logistic regression.Results: The result showed that partnership contributed 3,36 times, the patient variations 2,96 times, job description of clinical educator 2,30 times, a role model 2,28 times, expertise of faculty educator  2,08 times, toward the achievement of student competency in clinical study.Conclusions: It can be concluded that partnership aspect, the patient variation, job description of clinical educator, role model, expertise of faculty educator, and level of education have significant role to improve the achievement of student competency in clinical study. The results of this study can be used by nursing educational institutions, hospitals and government to organize nursing education model that has been present for more optimal achievement of student competencies.

Efficient and effective precepting of pharmacy students in acute and ambulatory care rotations: A Delphi expert panel study

PURPOSE

Using the Delphi process, a panel of experienced preceptors achieved consensus on best practices to increase preceptor efficiency and effectiveness.

METHODS

The Delphi panelists completed 3 survey rounds and a face-to-face meeting. Survey questions covered several topics, including preparation of students for rotations, preceptor efficiency and effectiveness, potential resident contributions to precepting, methods of developing critical-thinking skills and providing assessment and feedback, precepting time metrics, and barriers to preceptor effectiveness. Panel consensus was defined as agreement of ≥80%.

RESULTS

Fifteen of 36 invited preceptors (42%) completed all 3 survey rounds. The expert panel reached consensus on 6 essentials for effective rotations, 8 precepting contributions that could be made by appropriately trained residents, precepting barriers, 4 strategies for teaching critical thinking, and 5 valuable characteristics of the One Minute Preceptor model. Panelists reported on time spent with students presenting new patient cases (median, 10 minutes per case), time devoted to assessment of students' clinical performance (median, 22 minutes per student weekly), and time dedicated to student professional development (median, 20 minutes per student weekly).

CONCLUSION

Important strategies for preceptors identified by the panel included (1) a thorough orientation to logistics, expectations, and scheduling of activities, (2) using appropriately trained residents in student training, (3) providing opportunities for critical thinking and therapeutic decision-making, (4) giving frequent, quality feedback on clinical activities, and (5) giving feedback to learners on a regular basis.

Integrating the 3Ds: a nursing perspective

The 3Ds (diversity, disparities, and determinants) that serve as a framework for this supplement are concepts that are key foundations of nursing education, practice, and research. Despite this fact, however, the nursing profession has faced challenges recognizing the full potential of these concepts. While their importance is documented and acknowledged, they are not clearly evident or easily recognized within the nursing profession. In fact, there are many barriers to the integration of these concepts. We identify and address two barriers to addressing health disparities and increasing diversity: disconnects and discrimination. Furthermore, we discuss three factors-dissemination, durability, and data-that may facilitate nursing's efforts to integrate the 3Ds into the profession. Five pivotal models that address these barriers and facilitators are presented as exemplars that have the potential to guide efforts to address diversity, disparities, and social determinants of health and act as catalysts for change within the nursing profession.