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This tool kit was prepared by Hilda Haynes-Lewis, Jonas Veteran Healthcare Scholar (2014-2016) and Triniece Pearson, Jonas Nurse Leader Scholar (2014-2016) for the Graduate Nursing Student Academy (GNSA). AACN has not officially endorsed the materials contained therein.

Overview

The nursing shortage has fueled increased demand for nursing faculty. The average age of nursing faculty is increasing and many are expected to retire in the next decade. The demand to educate new nurses has led nursing schools to look for new solutions that solve the nursing faculty shortage. These solutions include developing new faculty roles that ease the transition from the bedside to academia. Since nursing faculty are on the forefront of creating the next generation of registered and advance practice nurses, increasing the number of nursing faculty, especially those of diverse ethnic backgrounds is also imperative to the advancement of the field.

Nurses are an integral part of the healthcare team. Changing from clinical to academic life and balancing both can cause role strain. Role strain stems from a conflict between the familiar expectations in your current role as a clinician and the new demands of an academic position. Taking time to thoroughly consider the transition to academia is the first step. This tool kit and webinar are here to inform and serve as a starting point when considering a faculty role. A guide to mapping out the transition and the responsibilities of desired faculty roles are discussed.

The purpose of this tool kit is to:

Explore the concept of role change and the impact of role change, from clinician to faculty, on the individual.

To provide a theoretical framework for transitioning into a faculty role as described in the literature.

To describe the faculty positions available for the clinician and provide a roadmap for attaining that position.

Note: The resources of this tool kit are not exhaustive. This document is a starting point of articles that inform the transition to nursing faculty.

The definition of role change or role transition has been described in the literature as any transition from one set of behaviors to another. According to Melesis (2010) role transition involves the need to attain new knowledge, changes in social status and interactions with others that may lead to feeling of instability and uncertainty since self-identity and role change can occurs simultaneously as you move from novice to master in the newly defined role.

Role theory posits that people learn to adapt to the roles given to them by society and the rules that are agreed upon by society for a given role. The roles that individuals have are learned behaviors (Goodling, 2003). Similarly Transition Theory states that people can learn and adapt to changes. Transitions theory notes that change happens over times therefore the experience of transition is fluid.
Suggested References
Anderson, J. K. (2009). The work-role transition of expert clinician to novice academic educator. The Journal of Nursing Education, 48(4), 203-208. doi:10.3928/01484834-20090401-02

Clark, N. J., Alcala-Van Houten, L., & Perea-Ryan, M. (2010). Transitioning From Clinical Practice to Academia. Nurse Educator, 35(3), 105-109. doi:10.1097/NNE.0b013e3181d95069

Goodling, S. M. (2003). Transition from academia to home health practice. Home Health Care Management & Practice, 16(1), 17-24. doi: 10.1177/1084822303260198

Meleis, A. I. (2010). Transitions theory: Middle-Range and situation-Specific theories in nursing research and practice. New York, EUA: Springer publishing company.

Ramsburg, L., & Childress, R. (2012). An initial investigation of the applicability of the
Dreyfus skill acquisition model to the professional development of nurse educators. Nursing education perspectives, 33(5), 312-316. doi.org/10.5480/1536-5026-33.5.312

Schoening, A. M. (2013). From bedside to classroom: The nurse educator transition model. Nursing education perspectives, 34(3), 167-172. doi.org/10.5480/1536-5026-34.3.167

The transition from the role of nurse clinician to that of faculty and a member of the academic society can result in internal conflict and cognitive dissonance since the expectations as a clinician and the multitude of demands of an academic position. Clarke et al (2010) states that this incongruence can result in role stress which has four causes; ambiguity, incongruity, conflict and overload, which are below.

Ambiguity

Ambiguity occurs when there is a deficiency of clarity surrounding the behaviors and responsibilities associated with the role are not well defined or understood by the parties involved; the clinician, the medical institution or the academic institution.

Ambiguity is a common occurrence because most clinicians have not been socialized into the culture of academe.

Incongruity

Incongruity is the incompatibility between the different aspects contained in the role. There can be conflict between the skills and abilities, values and expectations or role obligations.

Conflict

Role conflict arises when the expectations are perceived to be contradictory or incongruent and can result in irreconcilable demands on the part of the nurse or the institution.

Overload

Overload occurs when the demands of the roles or roles overwhelm the new faculty member resulting in difficulty in meeting the obligations of the role in the prescribed time.

Overload can lead to workplace tension, anxiety, and personal conflict that can result in the exhibition of negative behaviors.

Components of a Smooth Transition

Become immersed in academic culture by reading journals on nursing education in addition to clinical journals.

Suggested References

Anibas, M., Brenner, G. H., & Zorn, C. R. (2009). Experiences described by novice
teaching academic staff in baccalaureate nursing education: A focus on mentoring. Journal of Professional Nursing, 25(4), 211-217. doi.org/10.1016/j.profnurs.2009.01.008

Clark, C. L. (2013). A mixed-method study on the socialization process in clinical
nursing faculty. Nursing education perspectives, 34(2), 106-110. doi.org/10.5480/1536-5026-34.2.106

Clark, N. J., Alcala-Van Houten, L., & Perea-Ryan, M. (2010). Transitioning from
clinical practice to academia: University expectations on the tenure track. Nurse Educator, 35(3), 105-109.doi: 10.1097/NNE.0b013e3181d95069

Duffy, R. (2013). Nurse to educator? Academic roles and the formation of personal
academic identities. Nurse education today, 33(6), 620-624. doi.org/10.1016/j.nedt.2012.07.020

Gazza, E. A. (2009). The experience of being a full-time nursing faculty member in a
baccalaureate nursing education program. Journal of Professional Nursing, 25(4), 218-226. doi:10.1016/j.profnurs.2009.01.006

McDonald, P. J. (2010). Transitioning from clinical practice to nursing faculty: Lessons
learned. Journal of Nursing Education, 49(3), 126. doi:10.3928/01484834-20091022-02
Penn, B. K., Wilson, L. D., & Rosseter, R. (2008). Transitioning from nursing practice to
a teaching role. Online journal of Issues in Nursing, 13(3).
doi:10.3912/OJIN.Vol13No03Man03

Roberts, S. J., & Glod, C. (2013, April). Faculty roles: Dilemmas for the future of nursing
education. In Nursing forum (Vol. 48, No. 2, pp. 99-105).doi: 10.1111/nuf.12018

Schaar, G. L., Titzer, J. L., & Beckham, R. (2015). Onboarding New Adjunct Clinical
Nursing Faculty Using a Quality and Safety Education for Nurses-Based Orientation Model. Journal of Nursing Education, 54(2), 111-115. doi:10.3928/01484834-20150120-02

Weidman, N. A. (2013). The lived experience of the transition of the clinical nurse expert
to the novice nurse educator. Teaching and Learning in Nursing,8(3), 102-109. doi:10.1016/j.teln.2013.04.006

Ziehm, S., & Fontaine, D. K. (2009). Clinical faculty: tips for joining the ranks. AACN
advanced critical care, 20(1), 71-81. doi: 10.1097/NCI.0b013e31819453ab

Bednash, G., Breslin, E. T., Kirschling, J. M., & Rosseter, R. J. (2014). PhD or DNP: Planning for Doctoral Nursing Education. Nursing Science Quarterly, 27(4), 296-301. doi:10.1177/0894318414546415

Sonson, S. L. (2013). DNP-prepared APRNs: Leading the magnet?? charge. Nursing Management, 44(7), 49-52. doi:10.1097/01.NUMA.0000431425.39076.81

What Is Tenure?
A guaranteed job contract given to academic professionals that have shown skills over a period of time. It provides security from being laid off without sufficient justification. Primary responsibilities include: teaching and research, independent program of research, publications,teaching undergrad and/or graduate students, serving as an academic/research advisor of students involvement.

Tenured Positions

Tenured Professor
After all other promotions have been reached

Associate Professor
On-Track to be a Full Professor upon evaluation of requirements needed for promotion. These requirements may vary by University/department.

Assistant Professor
Entry level tenure-track position for PhD graduates. DNP graduates may also be eligible for entry-level tenure-track positions depending on the University. On-Track to be an Associate Professor upon evaluation of requirements needed for promotion. These requirements may vary by University/department.

Non-tenured Positions

Adjunct Faculty
Non-tenure/part-time/per course. Primary duty is teaching. This includes developing syllabi, coordinating curriculum, facilitating class instruction, evaluating student performance, holding office hours, maintaining course website (blackboard).

Bachelors Degree (Required)

Master's Degree or DNP (May be required if teaching at graduate level

Nursing Experience (Active RN License

Clinical Instructor
Primary role is supervising students during clinical rotations. Coordinating with clinicians at clinical sites, making student assignments, instructing students on how to perform duties in the clinical site, evaluate students' work.

Active RN License

2+ years of clinical experience

BSN (MSN or DNP Preferred)

Research Faculty
Sustain a program of research that provides their salary. Publish in peer-reviewed clinical journals, present research findings at conferences, advise students in research activities. Serve on thesis and dissertation committees. Teaching expectations are limited.

Suggested Resources:

Faculty Roles

Duffy, R. (2013). Nurse to educator? Academic roles and the formation of personal academic identities. Nurse Education Today, 33(6), 620-624. doi:10.1016/j.nedt.2012.07.020

Roberts, S. J., & Glod, C. (2013). Faculty roles: Dilemmas for the future of nursing education. Nursing Forum, 48(2), 99-105. doi:10.1111/nuf.12018

Tenure

Gaugler, J. E. (2004). on the Tenure Track in Gerontology: I Wish I Had Known Then What I Know Now. Educational Gerontology, 30(6), 517-536. doi:10.1080/03601270490445122

Singh, M. D. (2015, July). An Exploration of the Pre-Tenure and Tenure Process Experiences of Nursing Faculty. In Sigma Theta Tau International's 26th International Nursing Research Congress. STTI

Smeltzer, S. C., Sharts-Hopko, N. C., Cantrell, M. A., Heverly, M. A., Wise, N. J., Jenkinson, A., & Nthenge, S. (2014). Challenges to research productivity of doctoral program nursing faculty. Nursing Outlook, 62(4), 268-274.

Sussman, S. M. (2012). Job satisfaction and support for transitions in the nursing academy: A qualitative study of tenured nursing faculty who stay in academia (Doctoral dissertation, Teachers College, Columbia University).

Non-Tenure

Paul, P. A. (2015). Transition from novice adjunct to experienced associate degree nurse educator: A comparative qualitative approach. Teaching and Learning in Nursing, 10(1), 3-11.

Nicholes, R. H., & Dyer, J. (2012). Is eligibility for tenure possible for the doctor of nursing practice-prepared faculty?. Journal of Professional Nursing, 28(1), 13-17.

Schaar, G. L., Titzer, J. L., & Beckham, R. (2015). Onboarding New Adjunct Clinical Nursing Faculty Using a Quality and Safety Education for Nurses-Based Orientation Model. Journal of Nursing Education, 54(2), 111-115. doi:10.3928/01484834-20150120-02

Website Resources:
AACN Career Center
AACN's online resource dedicated to employment opportunities in nursing education.

HigherEd Jobs Listing of faculty positions (on-site or remote)

Education Nurses.com
Provides nursing education modules for new educators

Graduate Nursing Student Academy Career Network
Job board developed through partnership between AACN and AfterCollege.

National Council of State Board of Nursing - Nurse Licensure Compact
To determine if you live in a state included in the Nurse Licensure Compact

Professional Organizations to Consider:
It is important to maintain membership in professional associations that are tied to your area of specialization or instruction.
Association of Black Nursing Faculty National Association of Ethnic Minority Nurse Associations National Organization of Nurse Practitioner Faculties Professional Nurse Educators Group Sigma Theta Tau International The International Society of Nursing

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Transitioning from Clinical Nursing to Nursing Faculty

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The American Association of Colleges of Nursing (AACN) is the national voice for baccalaureate and graduate nursing education. AACN works to establish quality standards for nursing education; assists schools in implementing those standards; influences the nursing profession to improve health care; and promotes public support for professional nursing education, research, and practice.

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Understanding How to Deliver Effective Nursing Education

As facilitators of nursing education, how can we best ensure that our learners are processing the new knowledge delivered to them through our educational programs? Designing sessions with this in mind should be a fundamental component of how we plan and facilitate education.

Xu (2016) suggests ten strategies to improve nurses' learning:

Strategy 1: Lecture

Despite being sometimes considered passive or boring, lecturing is believed to be a time-efficient, cost-efficient, effective way to present large amounts of new information to groups of learners. The ability to utilise different presentation techniques (e.g. slide-shows, videos etc.) can mean that students may find this approach to learning fun.

Strategy 2: High-Fidelity Simulation

Very realistic clinical scenarios help nurses to develop competence, teamwork, confident and critical thinking with minimal risk of harm to clients.

Strategy 3: Concept-Mapping

This learning strategy helps learners to note the ways that different ideas interlink. Concept maps can help students acknowledge their current understandings and form new ideas. Concept maps help learners to organise or process their knowledge logically.

It is suggested that this visual learning technique promotes critical thinking, analysis and evaluation. Learners also develop an understanding of their knowledge gaps and future learning needs.

Strategy 4: Online Courses

Online learning is helpful to nurses due to its flexibility, accessibility and cost-effectiveness. There is also a wide array of new and fresh content that can be found online.

Strategy 5: Games

Games in nursing education promote a positive, fun, engaging environment that increases motivation and interest of learners. Games can foster critical thinking skills and can be combines with other learning techniques such as lectures. Games can be played using various formats, even mobile apps.

Strategy 6: Role-Playing

Role-plays are not the same as simulations because they are not scripted and involve improvisation. Role-plays are important in nursing education as they facilitate the practice of communication and conflict management. It is important to debrief following role-playing to offer support and reflection, as well as further learning.

Strategy 7: Jigsaw Classroom

This technique involves making 'home groups' to complete tasks. A member is chosen to gather data and return the information to the home group. This strategy helps learners to increase their listening skills, engagement, and empathy. Again, it is imperative that there is an opportunity for thorough debriefing following the activity to ensure that support, reflection and increased learning can ensue.

Strategy 8: Case Study

Case studies are stories that are realistic and complex, that usually involve a conflict or issue that needs to be resolved by the learner. The aim is to close the gap between theory and practice, and improve action-planning and critical thinking. The educator needs to inform the learners of summarised suggestions to resolve the case study after the learners have had an opportunity to work on the case themselves.

Strategy 9: Debating

This approach facilitates critical thinking, alternative perspectives, and an opportunity to practice verbal communication and higher order of learning. This approach can help the learners develop research skills, and clear presentation of their ideas or arguments. Debriefing or discussion following the debate can help to provide learners with support, feedback, collaboration and critical thinking/evaluation.

Strategy 10: Problem-Based Learning

This approach involves giving learners an opportunity for learning through self-directed study, as well as teamwork. The educator may ask questions about a scenario and provide learners with feedback.

Learning is unique to the individuals's needs and is therefore not 'one size fits all' (American Psychological Association 2017).

As nurse educators, it is important that we recognise this and select appropriate teaching strategies in order to engage our learners, ensure that they effectively process the information that we are teaching them, and to deliver high-quality education.

References:

American Psychological Association 2017, Education psychology promotes teaching and learning, APA, Washington, DC, viewed 21 November 2017, http://www.apa.org/action/science/teaching-learning/index.aspx?tab=2

Xu, JH 2016, 'Toolbox of teaching strategies in nurse education', Chinese Nursing Research, vol. 3, iss. 2, pp. 54-57, viewed 21 November 2017, http://www.sciencedirect.com/science/article/pii/S2095771816300482

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10 Teaching Strategies to Improve Your Nursing Education | Ausmed

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As facilitators of nursing education, how can we best ensure that our learners are processing the new knowledge delivered to them through our educational programs? Designing sessions with this in mind should be a fundamental component of how we plan and facilitate education.

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Using Social Media in Nursing Education An Emerging Teaching Tool

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5 Ways to Get Nursing Students Engaged in Your Classroom

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Reach that "holy grail" of teaching by utilizing these concept-based strategies for engaging students in learning in your nursing program.

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Editor's note: This text-based course is a written transcript of the live seminar, "Strategies for Clinical Teaching," presented by Joanne Schupbach, M.S., M.A., Manager Audiology Clinical Education, Assistant Professor, Rush University Medical Center.

The course handout is available here (PDF) - it is recommended to download the course handout prior to reading the text course.

In my role here at the university, my interests have focused on clinical education including clinical teaching, supervision and mentorship. Today I would like to share some information with you regarding what makes a positive learning environment and specific strategies that can be used in clinical teaching. Rush University is a multidisciplinary health care institution. Much of what I have learned about clinical teaching has come from evidence in other areas of health care including nursing, physical therapy, occupational therapy, and medicine. These disciplines have considerable literature and evidence on the critical aspects of clinical training including ideal preceptor qualities, what makes a positive learning environment and teaching rubrics. Some of what I will discuss may not be new to you, but I hope that you will glean some useful information on specific strategies and how you might include them, to modify or add to your current teaching skills. By the end of the session I will have identified some key elements for a positive learning environment as well as some teaching strategies that enhance student learning. I will also discuss effective teaching techniques based upon the student's level of learning.

Clinical Teaching Goals

Clinical preceptors have a great responsibility when training students and often this training takes place in a fast-paced, high workload environment. Catherine Burns, a Ph.D. nurse and her colleagues, Beauchesne, Ryan-Krause, and Sawin (2006) wrote an excellent paper entitled "Mastering the Preceptor Role - Challenges for Clinical Teaching". They proposed these goals for the clinical learning experience:

Increase students' knowledge and skills

Refine practice efficiency and effectiveness

Promote increasing clinical independence

Prepare students for optimal health outcomes with patients

Become a competent, compassionate, independent and collaborative clinician

This is quite a mandate for all of us. Other nursing colleagues have stated that "nursing is a practice discipline with an appreciable amount of nursing theory originating in practice" (Craddock, 1993, p. 217-224; Phillips, Davies, Neary, 1996a, p. 1037-1044/1996b, p. 1080-1088). Others have said that "learning the art and science of nursing is a complex, intricate process, demanding competence that is highly cognitive and firmly rooted in practice" (Taylor & Care, 1999, p.31-36. I think you could easily substitute the word "audiology" for "nursing" in these statements and they would be equally accurate.

Positive Learning Environment

With these goals in mind, let's discuss what makes a positive learning environment. The 2005 Audiology Education Summit Report includes this comment, "Preceptors must understand that those assigned for practicum are students and appreciate the tentativeness and peculiarities of a clinician in training" (ASHA et al., 2005). This is an excellent statement to set the tone for an optimal experience. I like the term peculiarities. The diversity of members in any group adds to the richness of the experiences. Students' personalities and skill sets are all different as are those of their preceptors. Both the preceptor and the student need to demonstrate an appreciation and respect for these differences. Yonge, Krahn, Trojan, Reid, and Haase (2002, p 22 - 27) authored an article entitled "Being a Preceptor is Stressful" and made this comment, "A positive tone from the site professionals and staff is imperative from the outset for the student to feel welcome and nurtured." They found that in environments where preceptors and staff valued students, reflective practice increased. Valuing a student enhances a preceptor's openness and respect for the student's perspectives. The more positive that relationship is, the more positive the staff views the student.

We all understand well the importance of staff on practice efficiency. Sometimes staff can make or break an office. Ohrling and Hallberg's (2000) study of nurses' experiences as preceptors revealed several main ideas with "trust" as key. Preceptors needed to value the student's responsibility, and by spending time together they were able to develop the mutual understanding. The preceptors felt that once trust was established, they were able to extend the student's responsibilities. Effective and positive learning climates require trust as well. Most of us learn and perform best when there is an open, honest, respectful, caring and trusting climate. Students also do best when they are able to explore new ideas, and reflect on their work in thoughtful and meaningful ways without fear of judgment of reprisal.

In Reilly and Ormann's text Clinical Teaching in Nursing (1992), they pointed out other qualities of a positive learning environment. They noted that preceptors' demonstration of sensitivity and caring indicated to the student that the preceptor was really committed to helping the student achieve the desired outcomes. They also noted that if a student was fearful in the learning situation, the student became limited in his/her ability to think critically and to communicate well with the preceptor. Yonge and colleagues (2002) discussed that the preceptor's ability to value, work with, and support the student was essential for providing a climate that was conducive to critical thinking and one that promoted the student's inquiry.

The Yonge study also noted that preceptor preparation was the most important factor related to the success of the experience. If we consider our own preparation for taking on the role as a clinical teacher, it probably was not a very formal preparation. Yonge's group found that most preceptors felt unprepared for the role, particularly in the areas of teaching and assessment. This point reminded me of an article I had read a few years ago on new Ph.D's and teaching. The gist of the article was that most new Ph.Ds. hired in academic settings were given the responsibility to teach several new courses, yet most of them had never had any coursework in teaching. It's as if the Ph.D degree alone signified that the individual would be a good instructor. So if selection of preceptors is based solely on availability and education, and not on interest or ability, then the clinical education experience will likely be in jeopardy. Most preceptors are chosen based upon their experience level with the assumption that the individual is knowledgeable, skilled and able to handle the added responsibility. Most of us were not formally trained in supervision, but have learned teaching techniques and strategies through trial and error.

The conference report from the 2006 Audiology Education Summit divided preceptor qualities in the areas of preparation, experience, credentials, skills, knowledge, and personal characteristics (ASHA et al., 2006). These qualities are considered essential for high-quality mentorship. Also, the Summit's clinical education guidelines for audiologic externship discussed the aspects of a preceptor and of a training experience that are critical to a positive learning environment. These aspects included the preceptor's ability to: model best practices, provide timely feedback, uphold legal and ethical practices; facilitate personal and professional growth; promote skill building, and encourage lifelong learning. All of these relate to the clinical teaching goals discussed by Burns and colleagues; namely, that preceptors should assist the student's knowledge and skills, refine their practice efficiency and effectiveness, and promote increasing clinical independence.

Not only is preceptor preparation crucial but the 2005 Education Summit also noted the characteristics of the clinical site that are essential for a student's success (ASHA et al., 2005).

The equipment and physical environment were listed as important characteristics. Yonge, Myrick, Ferguson, and Lughana's article (2005) on promoting effective preceptorship agreed that physical environment is very important. Quiet and private space serves the experience well. Having private space for the student helps to reduce the overall distraction level of the high-paced clinical environment. Students need a place, even if it is a small space, in which to carry out their responsibilities as well as a place to quietly reflect on their clinical work. Remember that students are in a steep learning curve, and while fast-paced testing develops certain types of skills, it is not the best for integration of knowledge with clinical practice. Having private space to provide feedback is also a must. One thing that students do not like is to be called to task in front of others or patients. In addition to the physical environment, the other important characteristics of a quality clinical site noted by the 2005 Education Summit were: evidence-based practice; policies and procedures; adequate staff; site commitment; and diversity of experience.

When I asked a cohort of first-year students who had not begun clinical practicum what they expected from their supervisor, these were a sampling of their comments:

Challenge the student's knowledge

Allow some independence

Allow room for error but expect improvement

Provide encouragement

Communicate with student

Make expectations clear

Show interest in student's growth

Be approachable and not intimidating

Give constructive, specific feedback

Understand that students learn at a different pace and to exhibit patience

Model best practices and be a good role model

Assist student overcome feelings of nervousness, lack of confidence or feelings of being overwhelmed

Develop trust in the student

Some of the expectations listed above mirror Burns' and colleagues' (2006) teaching goals of increasing knowledge and independence as well as allowing for mistakes to occur, but expecting improvement over time. The students also listed feedback as important as well as supervisor understanding that students learn at a different pace. Students noted that developing trust was critical for them. When I asked the students what they would not appreciate from their supervisory experience, these are some of their comments:

Discrepancies across supervisors

Assumption that the student knows something that is beyond what has been taught to date

Supervisor who is distant or unwilling to fully facilitate student's work

Supervisor too quick to correct a mistake or tell me what is the next step

Distant or non-communicative supervisor

Negative feedback discussed in front of a patient

Asking students what they expect from their supervisor and what they prefer not to happen is a good starting point to develop your teaching strategies with any particular student. Burns' group suggested these following teaching principles:

Learning does take time and students, like us, learn at very different rates

Learning is engrained with repetition, reinforcement, and with exposure to a variety of experiences.

The more timely the use of the skills, the better the student's retention

The authors note: "The roles of the student, preceptor, and faculty must be intertwined to ensure for a good learning experience" (p.172-183). The student must also be a committed learner and the preceptor needs to tap into the student's needs and style of learning.

In the 2010 - 2011 Preceptor Handbook from the Department of Nursing at California State University at Fullerton, I found some key adult learning principles documented (California State University at Fullerton, 2011). For effective learning, the authors noted that the student must be ready to learn, involved in the process, and be focused and motivated. Learning must be interactive based upon the individual's needs, organized, and communicated clearly to the learner. Feedback should always be constructive, timely, and integrated with knowledge. The authors recommended that preceptors need to set expectations commensurate with the student's level of learning, use a variety of teaching tools to develop the student's skills, create a great environment for learning, and then constantly reflect on their supervision to determine their effectiveness.

A longitudinal qualitative study by Gray and Smith (2000) in the Journal of Advanced Nursing examined the qualities of an effective mentor from the perspective of student nurses. They noted that there was a scarcity of empirical research that focused on mentorship. This study looked at a 1992 program of education that led to the diploma of higher education in nursing in the United Kingdom. The cohort was 10 students from the Scottish College of Nursing who were interviewed on five occasions over their three-year course of study. There were an additional seven students who volunteered to participate in the study and to keep a diary of their experiences. The focus of this study was to determine changes in the students' perspectives of the mentor over time. The key elements that these students felt good mentors exhibited are shown in Figure 1.

Figure 1. Qualities exhibited by good mentors according to students, as per Gray & Smith (2000).

These qualities not only related to preceptor attributes but also to teaching strategies such as pacing teaching to facilitate the students' progression, setting realistic expectations, and providing regular feedback. Students' reports of what constitutes a poor mentor are found in Figure 2.

Figure 2. Qualities of poor mentors according to students, as per Gray & Smith (2000).

Once again these statements discuss supervisor attributes but also list ineffective teaching strategies such as demonstrating poor teaching skills, having no structure to the teaching, and setting unrealistic expectations. Generally the students with poor mentors coped by taking a philosophical stance by attempting to reduce the time spent with that particular preceptor and/or by discussing this with the educator at the end of their placement. At the end of the study, these same students were asked to reflect and comment on their future roles as preceptors. They were asked what they would do as a supervisor.

Figure 3. List of things students report they would do as a supervisor in the future, per Gray & Smith (2000).

As you can see from Figure 3, this list had less preceptor attributes and more strategies relating to teaching. Recurring themes included developing trust and confidence, determining the student's skill levels early on, setting expectations, and helping a student achieve goals by providing them diverse opportunities. Note that they also wanted "other staff to look out for the student's best interests."

Clinical Teaching

Teaching strategies have to be developed within the context of a given clinical setting as well as adapted to the level of the learner. Burns and colleagues (2006) surveyed a large number of nursing preceptors and these are some of the challenges that they noted.

Rapid pace with multiple demands on the preceptor

Teaching and learning is variable as cases vary in type, number, complexity

Lack of continuity

Limited time for teaching and feedback

Learning may not be collaborative with preceptor

Limited opportunities and time for reflection

Learning may not be at an optimal pace for the student

These challenges seem to be similar to those we experience in audiology clinical practice. Our clinics also have a rapid pace and our cases vary in type and complexity. One of the comments I hear from preceptors, is that with the busy workload, time for teaching and feedback is also variable, which impacts the student's opportunity and time for reflection in learning. I think we would also agree that learning is not always at an optimal pace for students depending on the type of setting and the level of learner.

Categorized Levels of Learners

Burns and colleagues (2006) classified students into three categories - Beginner, Transitional Learner, and Competent Proficient, and noted some key points about each group. The Beginner student may do more observation initially, be given more routine and straight forward cases, and be assigned to prepare the basic components of a given evaluation. Some students will be very tentative at this level and require more nudging. Others may be very assertive even though they have very little experience. At the Transitional Learner stage, the preceptor may step back somewhat, have less need to provide input about the basics, give the student more complicated cases, and allow the student to decide on the key aspects of the evaluation. The Competent Proficient Learner has begun to develop solid skills in many areas, demonstrates improved clinical judgment, and can begin to generalize across patients. They are more flexible and integrative with their thinking and generally more efficient. At this point, the preceptor is allowing for more independence and the teaching strategy is to focus on pattern development and generalization across patients as well as to increase critical thinking.

Teaching Strategies

As we review specific teaching strategies, think about which ones you currently use and with which level of learner.

Modeling. With Modeling, the preceptor demonstrates the skills with patients as the student observes. Less experienced students begin to see the transition of classroom knowledge into the clinical setting. Although this is a strategy used with early students, using Modeling with more advanced students can also be beneficial. Advanced students can develop more integration of complex problems and issues, use critical thinking, and active listening. While this is a relatively passive strategy, it can be very powerful for all levels of learning. Modeling allows the preceptor and the student to act as a team through discussion of the case, development of a differential diagnosis, and making appropriate recommendations.

Case Presentation. Using the strategy of Case Presentation (Burns et al., 2006) allows for the student to obtain crucial information, apply it to the test battery, generate reasonable assumptions about the problem and develop a plan of action. It also allows the preceptor to assess the student's level of critical thinking and the ability to transfer previous experiences into new clinical situations. Case presentations are effective with every level of learner. The level of the sophistication of the presentation increases as the student gains more knowledge and experience. Also, the preceptor's expectation of the information presented will vary according to the level of the learner.

Collaborative Learning - Simulations. Collaborative Learning through Simulation (Gibbons et al., 2002) can be very effective, particularly with early students. The preceptor develops a case or selects a case, and the student works with the preceptor to discuss a possible case history, evaluation strategy, possible diagnoses, and recommendations. The student and the preceptor share in the decision making. This strategy can be used with all levels of learners, with straight forward cases for early learners, and more complicated cases for advanced learners. I like this strategy with beginners. I tell them that there is no wrong answer, but rather that this is a collaborative, brainstorming exercise. The preceptor may be more involved with the early learner in this strategy and take a step back with more advanced learners. For early learners, this is a positive, confidence-building exercise.

Sink or Swim approach. In Gray and Smith's 2000 article on the qualities of an effective mentor from the student nurses' perspectives, the Sink or Swim approach was criticized by students as suggestive of a poor mentor. However, in this strategy, ultimately the preceptor is responsible for the student's actions and is always available for consultation. This strategy might not be very effective with a beginning student, but would likely work well with a transitional student who needs some nudging to move their skills along, and certainly with a more advanced student. With an early student, the level of anxiety would probably be quite high if the student is given great independence with very little experience. Students who have been involved in this approach, even early students, have told me that while they did not necessarily appreciate the Sink or Swim approach, it did force them to rely upon their knowledge and skills, and to be confident in what they were doing.

Manipulated Structure approach. In contrast, the Manipulated Structure Approach (Gray & Smith, 2000) would be more appropriate for an early student. Here cases or procedures are carefully selected by the preceptor for the student's skill level in an effort to improve basic skills, to give the student early success, and to boost their confidence.

Reflection. Another teaching strategy is Reflection (Arseneau, 1995; DaRosa, 1997; Smith, 1997). As was noted earlier, reflection on one's performance is critical for learning. In a fast-paced environment, there is not much time given to reflection. We often expect students to make sense of everything quickly. Depending upon the level of student, they may need more time to reflect on the clinical details to understand how it all fits. They need to take the information, think about it, integrate it, and apply it to the appropriate patient or scenario. Even very advanced students complain about the lack of time to "make sense of things." Taking time to catch one's breath is important. In giving the student time to reflect it is imperative for them to be able to generalize information and to develop the crucial critical thinking skills necessary for more independent practice.

Self-directed Learning. In Self-directed Learning, the students develop their own goals, their own questions, and likely develop their own plan on how to accomplish these goals and questions. This strategy is likely most effective with transitional and competent proficient learners, those who have had more experience and better developed skills. Those students have a better understanding and judgment of their learning needs. Early students generally need more guidance with their learning. Often when you ask a beginning student what they want to learn, the list is endless, and not always relevant to the most important skill for their point in time of learning.

Self-assessment. Self-assessment is a skill that we begin teaching with early students. While initially, the self-reflection may not be very objective, over time the student learns to assess their strengths and weaknesses in their performance, and to develop their own strategies on how to improve upon them. Late learners do this on a daily and consistent basis, assessing each skill to refine their performance with little prompting from their preceptor.

Direct Questioning. Direct Questioning is an excellent technique to develop critical thinking skills, as long as the questioning is not perceived as a grilling. Questions, such as, "What do you think? What are some possibilities? Why do you think that? Give me an example. How could you handle that differently?" enable the student to share his/her observations and line of thinking. The preceptor can assist the student with formulating information based upon the answers to apply to other cases. This line of questioning also gives the preceptor a guideline about the student's ability to integrate information, formulate concepts, and to look at big picture issues.

Think Aloud method. The Think Aloud method, (Lee & Ryan-Wenger, 1997) as a tool of direct questioning, can be very effective. Both the preceptor and the student can provide rationale for specific questions and techniques that were used or will be used to demonstrate how conclusions were reached. The student basically describes their thought process or technique. This is a good method for developing critical thinking skills and can be used with all levels of learners. It is very effective with early learners as it forces the student to verbalize his/her thoughts and to support the decisions that have been made. The preceptor then has clear understanding of the student's ability to transfer knowledge to the clinical case, and their decision making process.

One-Minute method. The One-Minute method is a technique frequently used in medicine, particularly when time is short, thus the name. This technique has been written about by many authors and validated. In the One-Minute Preceptor Method (Neher, Gordon, Meyer, & Stevens, 1992), the student assesses the patient and then describes to the preceptor what is going on in a very brief time. The preceptor then challenges the student to provide supporting information to defend his/her assessment. The student is able to draw upon all resources and to critically assess the case. The preceptor then provides immediate feedback about what was correct and provides generalized information in which the student can apply to later cases. Here is how the one-minute method works with some learning goals. In this case, the student makes the decision regarding the case and the preceptor says, "What do you think?" Then the preceptor continues to probe for supporting findings and the critical thinking aspects by asking the student a question similar to, "What led you to that conclusion?" You then inform the student what the student was able to do well, followed by you as the preceptor correcting any errors or mistakes that the student did make. One aspect of this method that I use frequently is teaching the general principle by stating, "The key point I want you to remember is...". The last aspect of this method is the preceptor reflection and I use this as well. In addition to the student's thoughts I reflect about what I learned about my own teaching and we talk about what we both learned from this particular case. At the end of each case, I like to say to the student, "What is the most important point that you learned from this particular case?" That point may be different from what I think is the most important point, but it gives me the opportunity to understand what the student is gleaning from that particular experience.

Assigned Directed Readings. Assigning Directed Readings is especially good for early learners given the limited experience with certain kinds of patients, pathologies, and techniques. I like to use this with students both beginning and advanced. For example, you may see a patient with a rare pathology and ask the student to read a particular article, or research the subject and write a short synopsis. This gives an opportunity for the student to teach you, also. Generally later learners will do this on their own without prompting from the preceptor. A few weeks ago, I asked a beginning student to research the topic of hypothyroidism and its effects on hearing and learning in young children. The student needed to be directed to do this review while a fourth-year student would have had the inquisitiveness to do this without prompting

Coaching. With Coaching, the preceptor guides the student verbally through a test or procedure. The intent here is to keep the student safe and efficient with a technique they have not yet mastered. This is a strategy that we use frequently in our clinic as the students follow the clinicians' schedules and therefore may see a test or technique for which they have not yet had coursework. For example, my beginning student is currently enrolled in a vestibular course and is seeing VNG patients with me in clinic. I have done considerable coaching on equipment set up, running the computer, and giving patient instructions as the student does not yet have the knowledge or skill to complete the entire procedure.

Journaling. Journaling is a strategy that I use with my fourth year students as a way to stay informed about what they are doing at their site, and also as a way for them to express their thoughts about the week. Early in the year, the reflections are generally a run-down of the week. Later, their reflections become more of a collaborative thought process of what they have generalized over time and more about the big picture of their clinical work overall.

Feedback. Feedback is the final strategy I will discuss. Feedback is critical to the learning process. If no feedback is given, many students automatically think they he/she has not performed well. Without feedback, it is truly difficult for a student to make constructive change with his/her work. Allowing the student to provide their own self-assessment first is important for the student to learn objective self-assessment (Burns et al., 2006). Feedback needs to be descriptive and specific. Stating "You are doing fine," is not helpful feedback. Reinforce what is positive, discuss any errors or mistakes, and demonstrate to the student where they can improve. Students appreciate feedback that is delivered in a respectful and positive manner just like we like to hear feedback. On a busy day, it is really easy to forget about feedback as we are so focused on our patients' needs. We may sometimes forget that the student needs to hear some specific comments about how he/she has done with a particular patient or with a particular procedure.

Clinical Teaching Strategies Questionnaire

Kathleen Sawin, a Ph.D. nurse, was the lead author on an article entitled "Teaching Strategies Used by Experiences Preceptors" (Sawin, Kissinger, Rowan & Davies, 2001). In this article, they conducted a national survey of 265 experienced preceptors who were primarily nurse practitioners from 18 programs across the country. In the survey, they asked preceptors to identify strategies used frequently in clinical teaching. They used a tool called the Clinical Teaching Strategies questionnaire that was developed and validated in a series of studies by faculty and students in the School of Nursing at Virginia Commonwealth. They found that the preceptors identified a total of 65 total strategies, which were classified by frequency, use, and level of learner. They designated two levels of learners - early advanced beginners and late competent proficients. Almost half of the strategies, 29 or 45%, were used with all levels of learners, both beginning students and more advanced students. However, there were 36 strategies that did differ by level of learner. Strategies were categorized into five different areas: Orientation, History and Physical, Diagnosis and Management, Feedback and Evaluation, and General.

Let me provide a few examples of the 29 strategies used with all levels of students. In the area of Orientation, they assured all levels of students that there were no dumb questions. They also always shared their rationale for how they made a decision about any particular case that they were working on. They wanted to always promote a positive attitude about having students to train in their particular setting. Of the 36 strategies used with different learners, 26 of them were used frequently with both groups of learners. However there were substantial differences in the level of expectation used for each level of learner. For example, in the area of Orientation, advanced learners were expected to have the chart review completed and ready to discuss the case in detail. The advanced students were also held accountable for determining subtle changes during a patient exam and were expected to thoroughly discuss the appropriate intervention. While some of these strategies were used with early learners, the preceptor's level of expectation and sophistication was much lower for the early learners. Overall the study indicated that the 65 strategies were used most or all the time during clinical work. Those that were used less frequently appeared to be those that were more time-consuming or less directly related to the day-to-day practice.

Recommendations for Successful Preceptor-Student Experience

In the article on mastering the preceptor role, Burns et al. (2006) made some final recommendations to ensure for a successful preceptor-student experience. These were:

Develop good pre-planning

Brief interview prior to student's first day

Discuss skill levels, goals, learning style

Share your history and teaching style

Review policies and procedures

Delineate expectations clearly

I'd like to suggest my own list of recommendations based upon the evidence that I have reviewed over time. These are not in any particular order.

Design student time with patients depending upon skill level

Develop case presentation time

Encourage discussion time (even if only a few minutes)

Establish method of communication and regular meeting schedule with student (to discuss performance, learning, difficult cases, etc.)

Develop experiences that encompass entire scope of practice

Establish office space for student to perform duties and to reflect effectively

Appoint lead preceptor who coordinates student learning and provides support

Develop a structure for daily work

Coordinate the student's clinical education with other preceptors

Allow the student to follow through with each patient's entire procedure or treatment plan, if possible

Ask student to establish goals and to self-evaluate during the experience

Include student in continuing education activities

Give student time to reflect on experiences

Review student's evaluation and time lines from the academic training program

Ensure that all preceptors are consistent with the training philosophy and procedures of your site (mixed messages undermine the success of the student's training)

Evaluate your supervision periodically

As a reminder to all of us, students value and appreciate the following:

Clear expectations for performance

Helpful suggestions

Immediate and specific feedback

Honesty about their performance

Praise

Demonstrate respect for them and their value

Encouraged to self-evaluate before the preceptor evaluates

Evaluating Your Own Supervision and the Teaching Strategies You Use

Do you ask the student for feedback about your performance?

Does your student complete a formal evaluation of your supervision?

Does your student feel comfortable in providing feedback about your precepting?

Would your student worry about retaliation if feedback was negative?

Some students will tell you what they need as the experience goes on. Others will not be assertive enough to do so, particularly early on, or will be concerned that the preceptor will take offense. Giving your student the ability and comfort level to provide you with feedback will enhance your mutual relationship.

Clinical Teaching Effectiveness Inventory

The Clinical Teaching Effectiveness Inventory is a tool that may be helpful for evaluating clinical supervision. Copeland and Hewson, physicians from the Cleveland Clinic, developed this theory-based clinical teaching inventory to rate clinical teaching effectiveness (2000). The goal was to provide both positive and negative feedback to clinicians and educators in an effort to improve their teaching. This institution-wide instrument was designated to routinely evaluate all clinical faculty. It was tested for validity, reliability, and usability. The inventory has 15 items (shown in Figure 4) and uses a five-point Likert scale.

Figure 4. Items on the Clinical Teaching Effectiveness Inventory (Copeland & Hewson, 2000).

This seems to be a fairly easy and efficient tool that could be used in our settings in both a formal and informal manner. These are questions that you might ask of yourself informally or have the student complete the inventory. Many of these questions focus on key learning principles, for example, establishing a good learning environment, and stimulating independence and autonomy. Others focus on specific teaching strategies, such as allowing sufficient time for teaching and clinical work, giving feedback, asking questions, and adjusting your teaching style to the learner's needs. This tool or other similar tools can assist preceptors in focusing their attention on key issues that are necessary for an excellent clinical experience.

In my opinion, being able to objectively evaluate one's supervisory performance is as important as evaluating the student's performance. Allowing the student to provide you feedback without fear of reprisal will enhance the clinical education experience for the student and improve your teaching style. In the end, an excellent clinical experience benefits the student, the preceptor, and our patients.

Thank you for your attention.

How do we determine which of our staff would be good preceptors? Some people have an interest, but do not necessarily have the skills or experience, where others seem like they would be good preceptors and are not interested.

Generally I like to tell sites that determining who is really interested is key, and then determine what types of skills they have for precepting. Some preceptors, who may be earlier in their career, may feel that they do not have preceptor skills, but I think asking some of the questions that we have reviewed about their styles of teaching could be very helpful. Also I think since we do not have formalized training in clinical preceptorship taking extra courses in preceptorship or reading some of these articles that I have referenced can be helpful. I have provided these types of articles to sites that have been considering student supervision and also to sites that want to develop fourth-year externship programs. After reviewing some of the skills and strategies that preceptors need to have, people innately start to determine if they have those types of skills and abilities. For individuals that may have the skills and are not interested, I think it would be good to determine why that person or persons are not interested. It may be surprising to the administrator to find what those issues are. The number one thing I hear is that people do not have time with the demands on them in the health care environment now. I would counter that with a discussion about the fact that yes, students do take more time, but there are ways to work with students while maintaining our level of productivity.

Can you discuss the Audiology Education Summit? I have heard about it but do not know much of the details.

There were two Audiology Education Summits. They were held in 2005 and 2006. The 2005 Summit was sponsored by the American Speech, Language and Hearing Association (ASHA), the Council on Academic Accreditation (CAA) and the Council of Academic Programs in Communication Sciences and Disorders (CAPCSD). The 2006 Summit had these sponsors as well as the American Academy of Audiology. In attendance were invited academic and clinical educators from audiology doctoral programs as well as guests from clinical facilities and related professional organizations.

The goals were to look at what types of things were needed to develop clinical experiences for students in four-year Au.D. academic training programs. At the time of these summits, on-campus Au.D. programs were very new, and obviously the clinical education piece is a very important part of these training programs. Out of the summits came some wonderful reports on what we would expect to see in a preceptor as far as qualities and attributes, as well as what qualities were important for clinical sites such as depth and breadth of experiences covering the scope of practice, and sufficient space and resources for students. These reports were fairly comprehensive documents and if you have not had a chance to read them, I encourage you to do so. You can access them online: 2005 and 2006. They provide the nuts and bolts of criteria, A to Z, of what needs to happen to provide for a good learning environment for students in training. They cover not only what should happen on a short-term basis such as for second and third-year students that may be off campus two or three days a week, but also guidelines for developing long-term relationships with a student in your site, as with fourth year students.

From a clinical perspective, is there a tool or process used to validate that supervisors and preceptors are meeting the six characteristics described by the Summit?

I do not think that I have seen a tool or a checklist that would list all of those characteristics. Certainly the Summits made some recommendations about the preceptor needing to have between three to five years of clinical experience, a high level of skill, and high level of knowledge, and other characteristics but I am not sure that we have tools to actually measure that. As I said in my comment about PhDs . teaching courses but never having any coursework in teaching, the assumption is that we all have the knowledge and the ability to be a preceptor. The question we need to ask is, do we have the other characteristics and more formalized preparation to go down the path of being a preceptor and then to becoming a good preceptor? In my experience as an audiologist and over the years in my role at the university, I have learned a great deal about myself as a preceptor and how to change my teaching style based on the level of the learner or the student's needs. I don't think I have ever seen a tool that would help us ensure that all preceptors have these key components or even certain types of characteristics.

On average, how much time should preceptors expect to dedicate to a student including administrative activities?

Time can mean how often the student is at a particular site and the amount of time you spend with your student in a given day or period of time. The amount of time you spend with a student will be based upon the level of the learner. Also, when the student is new to your site and you do not know his or her skill level, initially you will spend more time with the student. Initially, you will want to see how the student works, not only performing test techniques and interacting with patients, but you will also want to determine their level of ability to critically think, integrate information and generalize. Some of our preceptors know that they can be committed to a student two days a week versus others who can handle students full-time and are best prepared to handle a fourth-year student.

If you were to be a site or a preceptor who said you had a student two days per week and you were the only preceptor, in early learners, the goal is that you are with the student most of the time. Early learners will follow your schedule of patients. As the student becomes more skilled and knowledgeable, and is able to become more independent, you can step back a bit and not spend quite as much time in direct supervision. I have talked with many preceptors over many years and find the amount of time spent depends upon the preceptor and the student. Some preceptors like to spend more time in direct supervision, even with students who are more advanced. Some preceptors like to step back more once they have seen the student has achieved a certain skill level with a particular technique or has abilities to work with certain types of patients.

Regarding your point about lack of training for preceptors, should Au.D. programs have coursework in supervision? Currently only University of Pittsburgh does.

I do agree that Au.D. programs should have coursework on supervision. Our university is in the midst of a curriculum review and is seriously considering a course to look at all aspects of supervision such as supervision of students, but also administrative supervision such as supervision of other personnel. I think it is critical that we receive some kind of formalized training in supervision if the expectation is that we as clinicians will be asked to train students. The starting point needs to be at the university. We need to be committed to the fact that training students on how to become future excellent preceptors is critical to their education. In an education setting, trying to add coursework into a program means that you have to take away some hours in other coursework. This is always a difficult challenge for universities.

Apart from specific skills and experiences, what guidance can you provide on matching students to preceptors?

When we talk about matching, we can talk about matching personalities as well as matching a student who has less experience in certain areas with someone who is an expert in that area. When I place students in off campus sites or even on campus, I might decide a particular first-year student needs to work with a particular supervisor first. This could be due to the experiences the student will get, or because of personalities. In the end, I like to take personality out of the picture. We all have very different personalities and trying to match people's personalities may not accomplish anything. The key point is having a preceptor that is willing, excited, and looking out for the student's best interests. There have been some cases where I have had sites who have said that they have designated a preceptor next quarter for a student, but the person is not really happy about being a preceptor. I say to the site that is probably a disaster waiting to happen. Everyone has to be onboard and excited about the relationship, in order for the experience to be successful.

How do you reconcile differences in practice techniques for procedures for which there are no standards, but preferences, such as masking?

I think you have to look to the evidence of what is best practice. As preceptors we all have different ways of doing things. Truly this is not a bad thing. Students learn a great deal from that. In a setting where there are several audiologists, a student may have three preceptors who do things three different ways. It can be confusing, however, if the student is told one day it is okay to do a technique one way, and the next day with the next preceptor that it is not okay. When it comes to procedures where there is no standardization, I think we have to look for best evidence for best protocol. When we have looked at our protocols, which we do usually every two years, we go back to the literature and review what is the highest level of evidence and then develop our protocols based on that. In your particular setting, one of the best things you could do is to develop your own protocols so that all your staff are on the same page. I have had sites ask if I would send them our protocols which I gladly do, but I always say that they are based on the evidence and the research that we have done. This can be a starting point for you, but it is in everyone's best interest to have best-evidenced protocols set your standards for your particular site. When there is no specific protocol, this becomes very confusing for the student.

Arseneau, R. (1995). Exit rounds: A reflection exercise. Academic Medicine, 70, 684-687.

American Speech-Language and Hearing Association (ASHA), Council on Academic Accreditation in Audiology and Speech-Language Pathology, & Council of Academic Programs in Communication Sciences and Disorders. (2005, January). Audiology education summit: A collaborative approach. Conference report from conference presented in Ft. Lauderdale, FL. Retrieved from: www.asha.org/uploadedFiles/events/audsummit2005.pdf

American Speech-Language and Hearing Association (ASHA), Council on Academic Accreditation in Audiology and Speech-Language Pathology, American Academy of Audiology, & Council of Academic Programs in Communication Sciences and Disorders. (2006, January). Audiology education summit II: Strengthening partnerships in clinical education. Conference report from conference presented in Ft. Lauderdale, FL. Retrieved from: www.asha.org/uploadedFiles/events/audsummit2006.pdf

Burns, C., Beauchesne, M., Ryan-Krause, P., & Sawin, K. (2006). Mastering the preceptor role: Challenges of clinical teaching. Journal of Pediatric Health Care, 20, 172-183.

California State University-Fullerton Department of Nursing. (2011). Preceptor handbook, 2010 - 2011. Retrieved from: nursing.fullerton.edu/

Copeland, H. & Hewson, M. (2000). Developing and testing an instrument to measure the effectiveness of clinical teaching in an academic medical centre. Academic Medicine, 75(2), 161-166.

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DaRosa, D., Dunnington, G., Stearns, J., Ferenchick, G., Bowen, J., & Simpson, D. (1997). Ambulatory teaching "lite": less clinic time, more educationally fulfilling. Academic Medicine, 72, 358-361.

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Sawin, K. , Kissinger, J., Rowan, K. & Davies, M. (2001). Teaching strategies used by expert preceptors. National Academies of Practice Forum: Issues in Interdisciplinary Care, 3(3), 197-206.Smith, I. (1997). The roles of experience and reflection in ambulatory care education. Academic Medicine, 72, 32-35.

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Yonge, O., Krahn, H., Trojan, L., Reid, D., & Haase, M. (2002). Being a preceptor is stressful! Journal Nurses Staff Development, 18, 22-27.

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Joanne E. Schupbach, MS, MA Manager Audiology Clinical Education, Assistant Professor, Rush University Medical Center Joanne Schupbach, M.S., M.A.  is an Assistant Professor at Rush University and a clinical audiologist at Rush University Medical Center in Chicago, Illinois. She is also the Manager of Audiology Clinical Education for the Department of Communication Disorders and Sciences. Her interests are in the areas of student mentoring and clinical teaching. She has served on various university, hospital and professional organization committees.

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Strategies for Clinical Teaching Joanne E. Schupbach

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Editor's note: This text-based course is a written transcript of the live seminar, "Strategies for Clinical Teaching," presented by Joanne Schupbach, M.S., M.A., Manager Audiology Clinical Education, Assistant Professor, Rush University Medical Center. The course handout is available here (PDF) - it is recommended to download the course handout prior to reading the text course.

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April 2018 Vol. 13 No. 4

Author(s): Melinda Bowman, MSN, RN, CNE, CMSRN

Organize, communicate, and document for a successful clinical nursing instructor experience.
Takeaways:

The transition from expert clinician to novice clinical instructor requires a shift in thinking.

Today's nursing programs are placing more emphasis on critical thinking and safe patient care using current best evidence.

By Melinda Bowman, MSN, RN, CNE, CMSRN

Congratulations! You've completed your master of science in nursing (MSN) and you're about to accept your first position as an adjunct clinical nursing instructor. You'll transition from being an expert clinician to a novice educator. This may seem intimidating, but don't worry, many of your patient care skills-organization, patience, clear communication, and thorough documentation-will easily transfer. And familiar concepts, such as legal considerations and your role at the bedside, just require a shift in thinking. Because the more knowledge you have, the easier the transition will be, use these tips to get a successful start.

Organization: Before you begin

Ideally, you'll be given a comprehensive orientation to the nursing program and access to all the course materials and resources that the students have, and you'll be assigned to a seasoned faculty member to mentor you into your new role. If you're not, don't panic. Here's a list of the minimum resources you'll need and questions you'll want answered. (See Before you get started.)
School policies
You should have access to all of the school's policies for students in the clinical area. Make sure you know how many patients to assign and what the students can and can't do under an RN's supervision. You'll also need a copy of the written objectives for the students' clinical experience so you understand what the focus should be. Be aware that programs are placing less emphasis on tasks like bed baths and more emphasis on critical thinking.
Syllabus
To help you tie the students' clinical experiences to class content, ask for the syllabus so you know what they're learning in class each week. Note that the best time to link classroom concepts to the clinical area is the week after students have covered the content in class. You'll want to know the theoretical content of the students' classes, which should reflect current best evidence, so get copies of the main textbooks and ask the publishers for the digital editions.
QSEN competencies
If you're not familiar with the six Quality and Safety Education for Nurses (QSEN) competencies, visit qsen.org. Review the knowledge, skills, and attitudes that should be instilled in undergraduate nursing students to improve the quality and safety of healthcare systems. Many nursing programs incorporate these competencies into their student learning outcomes and evaluation tools. Even if you haven't heard of QSEN, you'll already be familiar with the concepts the competencies cover.
Make a visit
Arrange to visit the unit where you'll be working with students, preferably at change of shift so you can see how hand-off report is done. Shadow a staff nurse for a few hours to get a sense of the unit and its workflow.

Meet with the nursing manager to review the written objectives for the students' clinical experience and ask for copies of the clinical policies for students. Discuss the best way to choose patient assignments and how they'll be posted on the unit.

You'll also want to ask for access to all systems and secure rooms before you begin. Other practical questions include where to find space for pre- and post-conferences, where students park, and whether the unit has a dedicated space for the students' coats and notebooks.

Legal considerations

Your state nurse practice act, the school of nursing's policies, and the clinical site's policies will dictate what the students can and can't do in the clinical area. Be sure you're knowledgeable about each. Students aren't practicing under your license, but they are practicing under your supervision for tasks that fall within the scope of practice for the degree that they're seeking. They're held to the same standard of practice as those with a license. Your job is to determine when students can safely function independently.

Consider an addition to your professional liability insurance that indicates you're now teaching. Keep detailed written records, give timely feedback, and follow all policies so you can defend your professional decisions if a student sues.

Be aware of the Family Educational Rights and Privacy Act (FERPA), which protects students' educational records. It also prohibits you from discussing a student's progress with anyone who doesn't play a role in that student's education. Think of it as education's Health Insurance Portability and Accountability Act.

Clear communication, thorough documentation

Everyone-you, students, nurse managers, and staff-must understand all requirements and expectations of the clinical experience. Be sure the manager and staff are aware of the students' focus each week of clinical, and clearly communicate assignments and paperwork the students must complete, including how they're submitted, who's responsible for reviewing them, and the penalty for late submissions. Learn how you're to give feedback to the students on their weekly performance, and consider keeping a written anecdotal record of each student's clinical experiences and progress, even if it's not required by the program. This record will be an invaluable resource when it's time for formal evaluations.

Make sure you know how and when students are to be formally evaluated. Ask to see completed examples of the evaluation tool, so you know how to structure your own evaluations. Understand what you're to do if a student is unsafe or in danger of failing clinical, and communicate regularly with your lead course faculty about student progress.

Clear communication with the students is equally important. Be clear about the learning objectives for each clinical day, and give students immediate feedback about how they're meeting them. Remember to be respectful; feedback should be constructive and delivered in private.

Your new role at the bedside

One of the biggest role adjustments to make as you move from clinician to educator is to shift your thinking at the bedside. You're a guest on the unit, there to guide the students' learning. Resist the urge to step in and "do" if the patient deteriorates or the student stumbles. The primary RN is ultimately responsible for the patient's care. Allow the student to struggle (safely) on his or her own to manipulate a piece of equipment or to come up with the answer to a patient's question. Have patience. Remember, students are learning and it will take them what seems like a long time to complete tasks or make connections between theory and a patient's presentation.

The transition from being an expert clinician to a novice educator may seem daunting. Many of the skills you already possess-organization, patience, and the ability to communicate clearly and document thoroughly-will serve you well. With these tips in mind, you'll soon become as comfortable in your new role as you were in your old one.
Melinda Bowman is a nursing instructor at Our Lady of Lourdes School of Nursing in Camden, New Jersey.
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From expert RN to novice clinical instructor: Tips for success

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April 2018 Vol. 13 No. 4 Author(s): Melinda Bowman, MSN, RN, CNE, CMSRN Takeaways: The transition from expert clinician to novice clinical instructor requires a shift in thinking. Today's nursing programs are placing more emphasis on critical thinking and safe patient care using current best evidence. By Melinda Bowman, MSN, RN, CNE, CMSRN Congratulations!

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Using EBN in classroom based courses

EBN can be used in nursing foundation courses to introduce students to pre-appraised clinical evidence early in their nursing studies and to show them how textbook information can be enhanced by current clinical research findings. When students learn about the nursing process, they can read relevant synopses or abstracts from EBN. For example, an EBN abstract describes a study that showed that telephone assessment and teaching by nurses improved glycaemic control in clinic patients with diabetes. Just 6 minutes of nurse telephone contact each month, in addition to automated assessment and self care education phone calls, resulted in improved patient outcomes. These patients had fewer problems with medication adherence, fewer diabetic symptoms, and a lower mean serum glucose concentration than similar patients who did not receive this intervention. The accompanying commentary stressed the exciting possibilities the technology offers for enhancing nursing assessment and patient education.

Another abstract describes a systematic review of nursing interventions for smoking cessation. This abstract could be used to provide students with a positive example of how nursing interventions can affect unhealthy patient behaviours. The accompanying commentary discusses other important considerations, such as the need for nurses to time interventions to coincide with patient readiness and the prudence of eliciting support from patients' partners or family members. The online version of this EBN abstract contains a link to a clinical practice guideline on smoking cessation. This acquaints students with a guideline that includes practical, empirically based recommendations to assist nurses and other healthcare providers in their efforts to help patients stop smoking.

The concept of advanced directives or "living wills" is a common topic of introductory nursing courses in the US, and several EBN abstracts summarise studies of the effectiveness of advanced directive programmes and seminars. One abstract summarises the findings of a study that showed that an advanced directive programme in nursing homes resulted in fewer hospital admissions and hospital days and lower hospital and healthcare costs than control nursing homes without such programmes. The accompanying commentary describes findings from other related studies, and the online version provides links to the abstracts of these studies in Medline.

Another abstract describes a study that found that a brief group seminar with written documents was more effective than mailed information in increasing the number of advanced directives among medical outpatients. The accompanying commentary includes suggestions for the types of healthcare settings where the study findings might be most relevant and the online version provides a link to the abstract of a related study in Medline. All of this information would enrich classroom discussion and enhance students' learning about advanced directives.

Using EBN abstracts and commentaries and the links on the online version to augment student learning in nursing foundation courses provides the dual benefit of stimulating interesting classroom discussion and promoting research utilisation behaviours that may later become habitual.

EBN content can also be useful in more advanced nurse education. For example, EBN includes several abstracts of studies focusing on elements of cardiovascular nursing. One such summary concerns a systematic review of the effectiveness of psychoeducational programmes in reducing the incidence of recurrent myocardial infarction, cardiac risk factors, and cardiac mortality. Cardiac patients who attended psychoeducational programmes had better outcomes than similar patients who did not participate in such programmes. The commentary contrasts these findings with those from 2 other reviews on the same topic, helping students to gain a better perspective of the overall state of research in this area. EBN online provides a link to the full text of one of these reviews, which gives students immediate access to detailed information.

Several abstracts of studies examining the care and treatment of children with asthma could be assigned as readings for students taking paediatric nursing courses. One abstract presents the findings of a study that examined the effectiveness of a clinical pathway for children admitted to hospital with asthma exacerbations. Findings showed that when a clinical pathway was used to guide care, children needed less frequent treatment with nebulised β agonists and had shorter hospital stays than similar children who did not receive care guided by the pathway. Similar findings from other studies are discussed in the commentary, with a direct link to the full text report of one of these studies.

If the assigned reading for nursing courses regularly included abstracts and commentaries from EBN, the habit of using research evidence is more likely to become established in students before they graduate and enter into nursing practice.

Using EBN in clinically based courses

EBN is an excellent resource for teaching students about research findings that enhance their understanding of clinical experiences. Nurse teachers could have students use EBN to identify studies of relevance to patients in their clinical area. Each week, students could pick one abstract and commentary to discuss during a clinical tutorial. These discussions would allow everyone in the clinical group to learn new evidence-based information on a regular basis. Nurse teachers could help students to identify the nursing implications of study findings and consider how they might use the findings in their practice. One example is an abstract and commentary about a large cohort study that found that the risk of fracture markedly increased immediately after a stroke. Another abstract and commentary present the findings of a qualitative study of patient perceptions of stroke rehabilitation. Both studies have important implications for students and other clinicians who care for stroke patients. Using research findings to enhance students' understanding of their clinical experiences helps to solidify their commitment to evidence-based practice.

Using EBN in a nursing research course

Finally, EBN publishes a great deal of material that would be useful in nursing research courses. The abstracts themselves provide clear examples of focused clinical questions, the use of various research designs, and appropriate samples; they describe interventions, outcomes, and statistical findings that are meaningful to practitioners and their patients. The commentaries can help students to identify the nursing implications of study findings and begin thinking about research utilisation in practice. The online version links with other citations, including many full text articles, to offer students greater detail about specific research studies. Additionally, the editorials (particularly the EBN Notebooks and Users' Guides) describe and explain various research concepts, including how to find and select valid research for application in practice. These editorials use papers abstracted in EBN as illustrative examples.

Summary and conclusion

The movement towards evidence-based practice encourages practitioners to use research evidence to guide their clinical decisions and challenges nurse educators to cultivate, in their students, the habit of using research evidence. To accomplish these goals, educators must go beyond teaching research in a formal course or assigning research articles as reading material. New tools and teaching strategies are required to help students develop the habit of regularly using research to guide practice. Because nursing practice in current times can be energy draining and time constraining, students need to learn ways of quickly and efficiently locating and digesting current research findings, and they need guidance to comprehend the implications of research findings for nursing practice. EBN is a practical and effective tool that can help meet these needs. The online version offers users the advantage of being searchable across all issues of the journal. Additionally, readers who subscribe to EBN can use the email alert system on the web version to keep apprised of new research in their specific areas of interest. In summary, both the print and online versions of EBN offer many exciting possibilities for nurse educators to enhance student learning using current clinical research.

View Abstract

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Print and online versions of Evidence-Based Nursing: innovative teaching tools for nurse educators

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The availability of Evidence-Based Nursing ( EBN ) online to institutions that currently subscribe to the print version is good news for nurse educators. EBN online offers educators an innovative way to use the journal's resources and the internet to teach students about evidence-based practice (EBP).

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Clinical Evaluation Tools

This module provides an overview of a variety of typical clinical evaluation tools that the new clinical educator may use for student evaluation. Through discussion and a small-group activity, participants are exposed to the major evaluation tools. Depending on when and where the participants attended nursing school, the concept map and other tools may be new to them. The hands-on activity in using a clinical performance rubric helps build participants' skills and prepares them for their first clinical rotation with students. This session is the practical application of the previous module, Clinical Evaluation: Concepts and Processes.

Objectives:

1. Discuss various Clinical evaluation tools

2. Discuss the development and use of a clinical performance rubric

3. Discuss methods of providing feedback to students

4. Compare the traditional nursing care plan with the concept map

5. Discuss how to develop positive student-faculty relationships

Materials Needed

Powerpoint Slides 6-1 through 6-23
Examples of concept care maps that students have created
Clinical Evaluation Activity Handouts
Student Scenario and Clinical Evaluation Rubric
Patient Assessment Tool
Nursing Care Plan
Concept Care Map

Conducting Pre-Clinical and Post-Clinical Conferences

The purpose of this module is to present strategies, techniques, and tips for effective clinical pre- and post- clinical conferences.

Objectives:

1. Explain the purposes of pre-clinical and post-clinical conferences

2. State the benefits of clinical conferences

3. Discuss strategies to promote student participation in clinical conferences

4. Describe ways to prepare for clinical conferences

Materials Needed

Powerpoint Slides 8-1 through 8-29
One squeeze ball per participant
3 x 5 or 4 x 6 note cards

Creating a Positive Learning Environment

The module provides a conceptual approach for reviewing various strategies to enhance active learning and critical thinking for clinical students. This conceptual approach also helps to summarize many of the points made during the Clinical Faculty workshop.

Objectives:

1. Describe how active learning practices facilitate students' critical thinking

2. Describe how active learning practices stimulate student learning

3. Describe how active learning practices create a positive learning environment

Materials Needed

Powerpoint Slides 10-1 through 10-27
Small pad of paper or sticky notes for students to use for group exercises

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This module provides an overview of a variety of typical clinical evaluation tools that the new clinical educator may use for student evaluation. Through discussion and a small-group activity, participants are exposed to the major evaluation tools. Depending on when and where the participants attended nursing school, the concept map and other tools may be new to them.

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Toolbox of teaching strategies

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The Clinical Nurse Educator (CNE) wears many hats in the organization. The CNE's role, integral to the success of the healthcare organization and the nursing staff, includes a varied and extensive list of critical responsibilities, including:

Onboarding and orientation of new staff

Providing training and continuing education

Updating policies and procedures

Working with hospital management to develop and meet strategic organizational goals

Because the CNE has a wide range of responsibilities, they need tools to effectively address the demands of the role and create efficiencies wherever possible.

The CNE faces daily challenges such as extreme changes in healthcare regulations, the need to evaluate the evidence that supports clinical practice, and a reduction in resources. It is important that they leverage solutions that help them meet these challenges while cost-effectively ensuring that the clinicians at their organization consistently deliver safe patient care.

Challenges Faced

In confidential research conducted by Elsevier, a world-leading provider of nursing and medical information products and services, key information was uncovered about the demands placed upon CNEs' time and the factors that hamper their overall efficiency and effectiveness. The following list captures the critical challenges they face:

Ensuring staff competency. The CNE is key in helping to ensure that staff members at all levels are competent in their role and documented as such. However, achieving this goal in an efficient and effective manner depends on the quality of the systems and processes that a hospital has in place. Otherwise, the work at hand becomes arduous and overwhelming.

Meeting multiple demands for educational materials. CNEs often are bombarded with a high volume of requests for educational information that may or may not be readily available. In many cases, the requested information requires extensive research to find content that is current, accurate, authoritative, and evidence-based.

Resolving conflicting resource information. Information that is made available to nurses and other health- care professionals is likely to have been derived from various sources. CNEs are responsible for ensuring that this information does not conflict with hospital policies and procedures, best practices, and standards, as well as the latest evidence.

Addressing unique learning styles. To be effective, a CNE needs to educate based on an individual's unique learning style and ensure that the information is geared toward his or her level of education and expertise. Developing targeted educational programs and resources can be time-consuming and complicated.

Updating policies and procedures. A CNE plays an essential role in helping to keep hospital policies and procedures up to date on an annual basis and as practice, standards, and regulations change. Efficient resources are not always available to ensure that this process goes as smoothly and efficiently as possible.

Depending on generic search engines. Unfortunately, CNEs often have to depend on Google and other generic search engines to find needed information. The search results are not vetted in a manner that ensures the delivery of accurate and current information from reliable sources. This effort is further complicated because the CNE must sort through volumes of search results that do not match nursing and medical terminology.

Wading through dense on-line resources. Text-heavy, web-based materials hinder the CNE in quickly retrieving information.

Conducting offline research. On occasion, CNEs need to go beyond traditional research, that is, calling drug companies or other hospitals or posting queries on association forums to find information.

In one scenario reported by a CNE respondent, she said it took her four days to adequately answer questions the pediatric oncology unit had about intravenous (IV) chemotherapy and related skin complications. She used available search tools to try to identify the latest evidence and practice standards but was unable to pinpoint what she needed. And she conducted this research while trying to meet the other daily demands of her role as a CNE.

In confidential research conducted by Elsevier, a world-leading provider of nursing and medical information products and services, key information was uncovered about the demands placed upon CNEs' time and the factors that hamper their overall efficiency and effectiveness.

When evaluating web-based products, healthcare administrators should focus their efforts on a variety of factors during the decision-making process.

The solution also should incorporate convenient competency management system functionality to form one single, yet comprehensive, resource for healthcare professionals.

Other features to look for include:

Convenient online access to evidence-based skills and procedures

Content adapted with insight from leading nursing and other healthcare associations and societies

Continuous updates to reflect the latest in evidence-based practice

Built-in administrative functionality that enables assignment, management, and validation of skills competency

The ability to customize content to align with an institution's specific protocols, processes, vocabulary, and workflow

The ability to establish specific learning criteria for the entire staff and to evaluate and deliver information appropriate for individual learning styles and needs

The ability to monitor progress and generate reports to measure staff competency against established standards and identify learning gaps

Ease of integration with a learning management system to coordinate and track education and competency

A user-friendly interface that expedites access to information

The pace of medical innovation and regulatory changes is dizzying, with new information continuously coming to light that could affect clinical decisions. With so much on the line, it is critical for healthcare organizations to have confidence in the informational resources upon which they depend.

Point-of-Care Reference Tool
Among the CNE's most critical tasks is answering immediate needs for information at the point of care. This requires instant access to trusted and authoritative information to quickly answer pressing clinical questions and bring evidence-based best practices directly to the bedside.

To find an appropriate solution, decision makers should evaluate both the technology and the content. The reference solution should integrate powerful search technology to streamline workflow, along with trusted content. Having this solution will help build the confidence of the staff in decision making and the application of knowledge in their practice.

Clinically focused, evidence-based nursing monographs

Renowned nursing and medical reference texts

Leading nursing journals

Peer-reviewed clinical updates

The latest drug information and calculators

Patient education handouts

Continuing education programs are expensive and can demand a great deal of time. Having online programs available at the healthcare organization offers convenience and helps offset an individual's expense.

Among the CNE's most critical tasks is answering immediate needs for information at the point of care. This requires instant access to trusted and authoritative information to quickly answer pressing clinical questions and bring evidence-based best practices directly to the bedside.

Continuing Education
Nurses and other healthcare providers are responsible for continuing their education. They can seek continuing education (CE) opportunities at conferences, at seminars, through journals, and through online sources. The CNE plays a major role in developing programs that are offered in house and in supporting nurses and others to participate in off-site CE activities and programs. However, CNEs can provide these activities and programs through an online format. This promotes convenient access for the learner and helps free up the CNE to spend more quality time in the clinical setting.

Online continuing education programs are growing at an exponential pace. Decision makers need to be cautious when evaluating programs to ensure that the content and delivery mode meet some basic requirements. Programs should:

Provide CE credits from an accredited organization, such as the American Nurses Credentialing Center (ANCC)

Provide high-quality, current, evidence-based content developed in conjunction with key nursing associations

Provide programs that are specific to their needs, including orientation and certification preparation

Offer guidance on integrating online learning with traditional education to provide an effective blended-learning approach

Offer a delivery platform that allows for tracking, reporting, and managing of eLearning courses and other education

The right eLearning courses delivered the right way at the right time can help promote best practices, ensure optimal patient outcomes, and provide the educational opportunities nurses need to advance in their careers.

Conclusion

There is no doubt that the role of the CNE is both critical and complex. However, with the right tools in place, he or she can contribute even more to a facility's informational and educational needs. With immediate access to authoritative sources and up-to-date content through technology that is built strictly for healthcare, today's Clinical Nurse Educators can use their time more effectively and work more efficiently for enhanced job performance and satisfaction.
Learn more about our Nursing Suite of solutions to enhance staff knowledge and competency

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Empowering Clinical Nurse Educators With Tools To Drive Efficiency

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The Clinical Nurse Educator (CNE) wears many hats in the organization. The CNE's role, integral to the success of the healthcare organization and the nursing staff, includes a varied and extensive list of critical responsibilities, including: Onboarding and orientation of new staff Providing training and continuing education Updating policies and procedures Working with hospital management to develop and meet strategic organizational goals Because the CNE has a wide range of responsibilities, they need tools to effectively address the demands of the role and create efficiencies wherever possible.

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Abstract

Critical thinking is defined as the mental process of actively and skillfully perception, analysis, synthesis and evaluation of collected information through observation, experience and communication that leads to a decision for action. In nursing education there is frequent reference to critical thinking and to the significance that it has in daily clinical nursing practice. Nursing clinical instructors know that students face difficulties in making decisions related to clinical practice. The main critical thinking skills in which nursing students should be exercised during their studies are critical analysis, introductory and concluding justification, valid conclusion, distinguish of facts and opinions, evaluation the credibility of information sources, clarification of concepts and recognition of conditions. Specific behaviors are essentials for enhancing critical thinking. Nursing students in order to learn and apply critical thinking should develop independence of thought, fairness, perspicacity in personal and social level, humility, spiritual courage, integrity, perseverance, self-confidence, interest for research and curiosity. Critical thinking is an essential process for the safe, efficient and skillful nursing practice. The nursing education programs should adopt attitudes that promote critical thinking and mobilize the skills of critical reasoning.

Keywords: critical thinking, nursing education, clinical nurse education, clinical nursing practice

1. INTRODUCTION

Critical thinking is applied by nurses in the process of solving problems of patients and decision-making process with creativity to enhance the effect. It is an essential process for a safe, efficient and skillful nursing intervention. Critical thinking according to Scriven and Paul is the mental active process and subtle perception, analysis, synthesis and evaluation of information collected or derived from observation, experience, reflection, reasoning or the communication leading to conviction for action ( 1).

So, nurses must adopt positions that promote critical thinking and refine skills of critical reasoning in order a meaningful assessment of both the previous and the new information and decisions taken daily on hospitalization and use of limited resources, forces you to think and act in cases where there are neither clear answers nor specific procedures and where opposing forces transform decision making in a complex process ( 2).

Critical thinking applies to nurses as they have diverse multifaceted knowledge to handle the various situations encountered during their shifts still face constant changes in an environment with constant stress of changing conditions and make important decisions using critical thinking to collect and interpret information that are necessary for making a decision ( 3).

Critical thinking, combined with creativity, refine the result as nurses can find specific solutions to specific problems with creativity taking place where traditional interventions are not effective. Even with creativity, nurses generate new ideas quickly, get flexible and natural, create original solutions to problems, act independently and with confidence, even under pressure, and demonstrate originality ( 4).

The aim of the study is to present the basic skills of critical thinking, to highlight critical thinking as a essential skill for nursing education and a fundamental skill for decision making in nursing practice. Moreover to indicate the positive effect and relation that critical thinking has on professional outcomes.

2. CRITICAL THINKING SKILLS

Nurses in their efforts to implement critical thinking should develop some methods as well as cognitive skills required in analysis, problem solving and decision making ( 5). These skills include critical analysis, introductory and concluding justification, valid conclusion, distinguishing facts and opinions to assess the credibility of sources of information, clarification of concepts, and recognition conditions ( 6, 7).

Critical analysis is applied to a set of questions that relate to the event or concept for the determination of important information and ideas and discarding the unnecessary ones. It is, thus, a set of criteria to rationalize an idea where one must know all the questions but to use the appropriate one in this case ( 8).

The Socratic Method, where the question and the answer are sought, is a technique in which one can investigate below the surface, recognize and examine the condition, look for the consequences, investigate the multiple data views and distinguish between what one knows and what he simply believes. This method should be implemented by nurses at the end of their shifts, when reviewing patient history and progress, planning the nursing plan or discussing the treatment of a patient with colleagues ( 9).

The Inference and Concluding justification are two other critical thinking skills, where the justification for inductive generalizations formed from a set of data and observations, which when considered together, specific pieces of information constitute a special interpretation ( 10). In contrast, the justification is deduced from the general to the specific. According to this, nurse starts from a conceptual framework-for example, the prioritization of needs by Maslow or a context-evident and gives descriptive interpretation of the patient's condition with respect to this framework. So, the nurse who uses drawing needs categorizes information and defines the problem of the patient based on eradication, nutrition or need protection.

In critical thinking, the nurses still distinguish claims based on facts, conclusions, judgments and opinions. The assessment of the reliability of information is an important stage of critical thinking, where the nurse needs to confirm the accuracy of this information by checking other evidence and informants ( 10).

The concepts are ideas and opinions that represent objects in the real world and the importance of them. Each person has developed its own concepts, where they are nested by others, either based on personal experience or study or other activities. For a clear understanding of the situation of the patient, the nurse and the patient should be in agreement with the importance of concepts.

People also live under certain assumptions. Many believe that people generally have a generous nature, while others believe that it is a human tendency to act in its own interest. The nurse must believe that life should be considered as invaluable regardless of the condition of the patient, with the patient often believing that quality of life is more important than duration. Nurse and patient, realizing that they can make choices based on these assumptions, can work together for a common acceptable nursing plan ( 11).

3. CRITICAL THINKING ENHANCEMENT BEHAVIORS

The person applying critical thinking works to develop the following attitudes and characteristics independence of thought, fairness, insight into the personal and public level, humble intellect and postpone the crisis, spiritual courage, integrity, perseverance, self-confidence, research interest considerations not only behind the feelings and emotions but also behind the thoughts and curiosity ( 12).

4. IMPLEMENTATION OF CRITICAL THINKING IN NURSING PRACTICE

In their shifts nurses act effectively without using critical thinking as many decisions are mainly based on habit and have a minimum reflection. Thus, higher critical thinking skills are put into operation, when some new ideas or needs are displayed to take a decision beyond routine. The nursing process is a systematic, rational method of planning and providing specialized nursing ( 13). The steps of the nursing process are assessment, diagnosis, planning, implementation, evaluation. The health care is setting the priorities of the day to apply critical thinking ( 14). Each nurse seeks awareness of reasoning as he/she applies the criteria and considerations and as thinking evolves ( 15).

Problem Solving

Problem solving helps to acquire knowledge as nurse obtains information explaining the nature of the problem and recommends possible solutions which evaluate and select the application of the best without rejecting them in a possible appeal of the original. Also, it approaches issues when solving problems that are often used is the empirical method, intuition, research process and the scientific method modified ( 16).

Experiential Method

This method is mainly used in home care nursing interventions where they cannot function properly because of the tools and equipment that are incomplete ( 17).

Intuition

Intuition is the perception and understanding of concepts without the conscious use of reasoning. As a problem solving approach, as it is considered by many, is a form of guessing and therefore is characterized as an inappropriate basis for nursing decisions. But others see it as important and legitimate aspect of the crisis gained through knowledge and experience. The clinical experience allows the practitioner to recognize items and standards and approach the right conclusions. Many nurses are sensing the evolution of the patient's condition which helps them to act sooner although the limited information. Despite the fact that the intuitive method of solving problems is recognized as part of nursing practice, it is not recommended for beginners or students because the cognitive level and the clinical experience is incomplete and does not allow a valid decision ( 16).

Research Process / Scientifically Modified Method

The research method is a worded, rational and systematic approach to problem solving. Health professionals working in uncontrolled situations need to implement a modified approach of the scientific method of problem solving. With critical thinking being important in all processes of problem solving, the nurse considers all possible solutions and decides on the choice of the most appropriate solution for each case ( 18).

The Decision

The decision is the selection of appropriate actions to fulfill the desired objective through critical thinking. Decisions should be taken when several exclusive options are available or when there is a choice of action or not. The nurse when facing multiple needs of patients, should set priorities and decide the order in which they help their patients. They should therefore: a) examine the advantages and disadvantages of each option, b) implement prioritization needs by Maslow, c) assess what actions can be delegated to others, and d) use any framework implementation priorities. Even nurses make decisions about their personal and professional lives. The successive stages of decision making are the Recognition of Objective or Purpose, Definition of criteria, Calculation Criteria, Exploration of Alternative Solutions, Consideration of Alternative Solutions, Design, Implementation, Evaluation result ( 16).

The contribution of critical thinking in decision making

Acquiring critical thinking and opinion is a question of practice. Critical thinking is not a phenomenon and we should all try to achieve some level of critical thinking to solve problems and make decisions successfully ( 19 - 21).

It is vital that the alteration of growing research or application of the Socratic Method or other technique since nurses revise the evaluation criteria of thinking and apply their own reasoning. So when they have knowledge of their own reasoning-as they apply critical thinking-they can detect syllogistic errors ( 22- 26).

5. CONCLUSION

In responsible positions nurses should be especially aware of the climate of thought that is implemented and actively create an environment that stimulates and encourages diversity of opinion and research ideas ( 27). The nurses will also be applied to investigate the views of people from different cultures, religions, social and economic levels, family structures and different ages. Managing nurses should encourage colleagues to scrutinize the data prior to draw conclusions and to avoid "group thinking" which tends to vary without thinking of the will of the group. Critical thinking is an essential process for the safe, efficient and skillful nursing practice. The nursing education programs should adopt attitudes that promote critical thinking and mobilize the skills of critical reasoning.

Footnotes
CONFLICT OF INTEREST: NONE DECLARED.
REFERENCES

1. Scriven M, Paul R. (n.d.). Defining critical thinking. Retrieved February 23 2013, from //www.critical-thinking.org/University/univclass/Defining.Html .

3. Papathanasiou I, Kotrotsiou S, Bletsa V. Nursing documentation and recording systems of nursing care. Health Science Journal. 2007;1(4)

4. Facione P. Millbrae, CA: California Academic Press; 1990. Critical thinking:A statement of expert consensus for purpose of educational assessment and instruction.

5. Facione P. Milbrae CA: California Academic Press; 1998. Critical Thinking:What it is and why it counts.

6. Alfaro-Lefevre R. 2nd ed. Philadelphia: W.B. Saunders; 1999. Critical Thinking in Nursing:A practical approach.

7. Bandman EL, Baundman G. East Norwalk. CT: Appleton &Lange; 1998. Critical Thinking in Nursing.

8. Paul R, Elder L. Santa Rosa, CA: Foundation for Critical Thinking; 1999. The miniature guide to critical thinking:Concepts and tools.

9. Paul R, Elder L. Upper Saddle. River. NJ: Prentice Hall Health; 2000. Critical thinking:Tools for taking charge of your learning and your life.

10. Lunney M, editor. Philadelphia: North American Nursing Diagnosis Association; 2001. Critical Thinking and Nursing Diagnoses:case studies &analyses.

11. Schuster PM. Philadelphia: F.A. Davis; 2002. Concept mapping:A critical thinking approach to care planning.

12. Paul RW. Santa Rosa, CA: Foundation for Critical Thinking; 1995. Critical thinking:How prepare students for a rapidly changing world.

13. Wilkinson JM. 3rd ed. Upper Saddle River. NJ: Prentice Hall Health; 2001. Nursing process and critical thinking.

14. Kourkouta L, Papathanasiou IV. Communication in Nursing Practice. Mater Sociomed. 2014;26(1):65-67. [ PMC free article] [ PubMed]

15. Benner PE, Hooper-Kyriakidis PL, Stannard D. Philadelphia: W.B. Saunders; 1999. Clinical wisdom and interventions in critical care:A thinking-in-action approach.

18. Dillon Beach, CA: Author: 2001. Foundation for Critical Thinking. Critical thinking:Basic theory and instructional structure.

20. Green CJ. Upper Saddle River. NJ: Prentice Hall Health; 2000. Critical thinking in nursing :Case studies across the curriculum.

21. Pesut D.J, Herman J. Albany, NY: Delmar; 1999. Critical reasoning:The art and science of critical and creative thinking.

22. Raingruber B, Haffer A. Philadelphia: F.A. Davis; 2001. Using your head to land on your feet: A beginning nurse's guide to critical thinking.

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Critical Thinking: The Development of an Essential Skill for Nursing Students

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Critical thinking is defined as the mental process of actively and skillfully perception, analysis, synthesis and evaluation of collected information through observation, experience and communication that leads to a decision for action. In nursing education there is frequent reference to critical thinking and to the significance that it has in daily clinical nursing practice.

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You tube video explaining concept mapping

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Understanding the important differences between a fixed mindset vs growth mindset from the book, Mindset_ The New Psychology of Success by Carol Dweck

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Nurse.com digital guides and publications

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Tech and teaching tools are changing nurse education

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This nursing continuing education program fills nurses in on changes in nursing education, such as technology's role and new teaching methods.

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Check out this comprehensive, easy-to-read summary of the best-selling book, _The 7 Habits of Highly Effective People

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With the patient care and hospital industries evolving so quickly, the way we approach nursing education and classroom learning styles should adapt and grow, too - right? A singular approach of teaching concepts and theories, or the "old school" way, still has its place, but the benefits of implementing active learning strategies in nursing education are impossible to ignore.

The benefits of using active learning strategies in nursing education

Simply presenting course material may provide short-term value, but physical practicing, experiencing, and learning through active engagement helps the roots of that material grab hold. Today's nurses are tasked with effectively communicating with multiple departments through different technology platforms while making critical decisions across a spectrum of patient scenarios. It's not an easy job!

Educators who use active learning strategies in their nursing programs are able to teach to a variety of learners: visual learners, auditory learners, tactile learners, and yes, even those learners who have difficulty remaining seated. But what's more, students are able to learn in a way that most closely simulates real, on-the-job nursing situations, making for a more seamless transition into the workforce.

Try these active learning strategies in your nursing classroom

Okay - so now that you understand the benefits of using active learning strategies in nursing education, try implementing some of the following activities to encourage active learning among your students:

1. Pre-class assignments

Prior to teaching a concept in class, ask your students to research key terms, review patient assessments, required medications or drug classes, and exemplars related to the concept. This will not only help students feel more prepared during class, but it typically leads to a more involved and engaging class discussion.

2. Unfolding case studies

Repetitive Powerpoint presentations can be dry. Try incorporating case studies that include visual cues, lab tables, and patient quotes to encourage discussion among students. This keeps those "necessary evil" slideshows engaging and forces students to apply "book knowledge" and think critically about real-life examples.

3. NCLEX practice questions

Working NCLEX practice questions throughout your curriculum will have amazing long-term benefits on your nursing students when it comes time to buckle down and study leading up to the big exam. Have students answer example NCLEX questions individually and then guide and encourage a larger class debate on correct and incorrect answers. Adaptive learning systems like Lippincott's adaptive learning system, PrepU, is jam-packed with NCLEX practice questions and gives students a unique learning experience based on their level on knowledge. It also gives teachers the ability to see exactly where each student in the class is at in the course.

4. Role play

This is a fun one that gets students up and moving around! Have your nursing students act as patients, nurses, family members, and technicians in a skit presentation that reveals a deeper learning point for the rest of the class. For example, the skit could reveal the importance of good and poor therapeutic communication.

5. Concept maps

Use concept maps to cover content acquisition, student assessment, or knowledge applications and then encourage them to take pictures of them on their phones to use as study tools. This style of active learning strategy is great for visual learners. Sometimes seeing a concept laid out and then being able to refer to it again later can make all the difference.

6. Simulation activities

Here's where things can get interesting. Break students into groups and allow them to practice more hands-on interventions and procedures, like a code blue scenario, and use their critical thinking skills to react quickly and efficiently. You, as the educator, can participate and guide as necessary, but take a smaller role and encourage students to do the heavy lifting.

7. Brain drain

This is a rapid-fire exercise where students shout out 5-10 concept-related terms that the instructor lists on a whiteboard. Then, as you work through and discuss each term, the instructor erases them one by one, enhancing students" recall capabilities.

8. Mystery/patient/drug in a box

Here's an effective way to implement a hands-on active learning strategy for your nursing students. Place a number of boxes around the classroom with items and pictures related to that day's concept. Students will then use that to build a patient story and present it to the class. The class then brainstorms how a nurse might treat the hypothetical patient. Students will appreciate being able to associate experiences and stories with concepts.

9. Gallery walk

For a gallery walk, scatter pictures and artifacts related to the day's concept around the classroom. Break students into small groups and have them wander throughout the room identifying each item and its relevance to the concept in terms of interventions, patients, and procedures. Use this style of activity to get the blood flowing again after a PowerPoint or to break up a long class - the student who can"t stay seated will appreciate it!

10. Compare & contrast

Compare and contrast scenarios really fuel class discussion. As an example, faculty could create two (or more) scenarios of patients with the same symptoms and conditions, and students must discuss how they would treat the patients differently or similarly. This includes medication interventions, recommendations, diagnosis, etc.

11. What if?

Use 'what if" scenarios to transition between concepts or to review theories at the end of a class. Pose various 'what if?" questions to individuals or small groups on a clinical situation to force their critical thinking skills. For example, in a discussion of the concept of Perfusion, you could ask questions like: what if a patient is cold and blue? Complains of dizziness? Develops crackles in the lungs?

Moving forward

Active learning strategies in nursing education is all about empowering students to actually remember the large amount of information they face throughout nursing school. Many nursing students achieve success in their program by memorizing terms and concepts long enough to spit them back up on a test. Don"t let those be your students! Help them retain knowledge and graduate with the skills required to be an effective nurse in today's high-intensity, patient care settings through engaging, active learning strategies.

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11 Active Learning Strategies to Engage Active Learning

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With the patient care and hospital industries evolving so quickly, the way we approach nursing education and classroom learning styles should adapt and grow, too - right? A singular approach of teaching concepts and theories, or the "old school" way, still has its place, but the benefits of implementing active learning strategies in nursing education are impossible to ignore.

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Digital resources

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Bruner's Theory

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A major theme in the theoretical framework of Bruner is that learning is an active process in which learners construct new ideas or concepts based upon their current/past knowledge. The learner selects and transforms information, constructs hypotheses, and makes decisions, relying on a cognitive structure to do so. Cognitive structure (i.e., schema, mental models) provides meaning and organization to experiences and allows the individual to "go beyond the information given".

As far as instruction is concerned, the instructor should try and encourage students to discover principles by themselves. The instructor and student should engage in an active dialog (i.e., socratic learning). The task of the instructor is to translate information to be learned into a format appropriate to the learner's current state of understanding. Curriculum should be organized in a spiral manner so that the student continually builds upon what they have already learned.

Bruner (1966) states that a theory of instruction should address four major aspects: (1) predisposition towards learning, (2) the ways in which a body of knowledge can be structured so that it can be most readily grasped by the learner, (3) the most effective sequences in which to present material, and (4) the nature and pacing of rewards and punishments. Good methods for structuring knowledge should result in simplifying, generating new propositions, and increasing the manipulation of information.

In his more recent work, Bruner (1986, 1990, 1996) has expanded his theoretical framework to encompass the social and cultural aspects of learning as well as the practice of law.

Application

Bruner's constructivist theory is a general framework for instruction based upon the study of cognition. Much of the theory is linked to child development research (especially Piaget ). The ideas outlined in Bruner (1960) originated from a conference focused on science and math learning. Bruner illustrated his theory in the context of mathematics and social science programs for young children (see Bruner, 1973). The original development of the framework for reasoning processes is described in Bruner, Goodnow & Austin (1951). Bruner (1983) focuses on language learning in young children.

Note that Constructivism is a very broad conceptual framework in philosophy and science and Bruner's theory represents one particular perspective.

Example

This example is taken from Bruner (1973):

"The concept of prime numbers appears to be more readily grasped when the child, through construction, discovers that certain handfuls of beans cannot be laid out in completed rows and columns. Such quantities have either to be laid out in a single file or in an incomplete row-column design in which there is always one extra or one too few to fill the pattern. These patterns, the child learns, happen to be called prime. It is easy for the child to go from this step to the recognition that a multiple table , so called, is a record sheet of quantities in completed mutiple rows and columns. Here is factoring, multiplication and primes in a construction that can be visualized."

Principles

1. Instruction must be concerned with the experiences and contexts that make the student willing and able to learn (readiness).

2. Instruction must be structured so that it can be easily grasped by the student (spiral organization).

3. Instruction should be designed to facilitate extrapolation and or fill in the gaps (going beyond the information given).

References

Bruner, J. (1960). The Process of Education. Cambridge, MA: Harvard University Press.

Bruner, J. (1966). Toward a Theory of Instruction. Cambridge, MA: Harvard University Press.

Bruner, J. (1973). Going Beyond the Information Given. New York: Norton.

Bruner, J. (1983). Child's Talk: Learning to Use Language. New York: Norton.

Bruner, J. (1986). Actual Minds, Possible Worlds. Cambridge, MA: Harvard University Press.

Bruner, J. (1990). Acts of Meaning. Cambridge, MA: Harvard University Press.

Bruner, J. (1996). The Culture of Education, Cambridge, MA: Harvard University Press.

Bruner, J., Goodnow, J., & Austin, A. (1956). A Study of Thinking. New York: Wiley.

Related Websites

More about Bruner can be found at:
http://www.infed.org/thinkers/bruner.htm

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A major theme in the theoretical framework of Bruner is that learning is an active process in which learners construct new ideas or concepts based upon their current/past knowledge. The learner selects and transforms information, constructs hypotheses, and makes decisions, relying on a cognitive structure to do so.

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Learning Theories

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APA Format

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You can also watch our APA vidcast series on the Purdue OWL YouTube Channel .

General APA Guidelines

Your essay should be typed and double-spaced on standard-sized paper (8.5" x 11"), with 1" margins on all sides. Include a page header (also known as the " running head") at the top of every page. For a professional paper, this includes your paper title and the page number. For a student paper, this only includes the page number. To create a page header/running head, insert page numbers flush right. Then type "TITLE OF YOUR PAPER" in the header flush left using all capital letters. The running head is a shortened version of your paper's title and cannot exceed 50 characters including spacing and punctuation.

Font

The 7th edition of the APA Publication Manual requires that the chosen font be accessible (i.e., legible) to all readers and that it be used consistently throughout the paper. It acknowledges that many font choices are legitimate, and it advises writers to check with their publishers, instructors, or institutions for guidance in cases of uncertainty.

While the APA Manual does not specify a single font or set of fonts for professional writing, it does recommend a few fonts that are widely available. These include sans serif fonts such as 11-point Calibri, 11-point Arial, and 10-point Lucida Sans Unicode as well as serif fonts such as 12-point Times New Roman, 11-point Georgia, 10-point Computer Modern.

Major Paper Sections

Your essay should include four major sections: the Title Page, Abstract, Main Body, and References.

Title Page

Note: APA 7 provides slightly different directions for formatting the title pages of professional papers (e.g., those intended for scholarly publication) and student papers (e.g., those turned in for credit in a high school or college course).

The title page should contain the title of the paper, the author's name, and the institutional affiliation. A professional paper should also include the author note. A student paper should also include the course number and name, instructor name, and assignment due date.

Type your title in upper and lowercase letters centered in the upper half of the page. The title should be centered and written in boldface. APA recommends that your title be focused and succinct and that it should not contain abbreviations or words that serve no purpose. Your title may take up one or two lines. All text on the title page, and throughout your paper, should be double-spaced.

Beneath the title, type the author's name: first name, middle initial(s), and last name. Do not use titles (Dr.) or degrees (PhD).

Beneath the author's name, type the institutional affiliation, which should indicate the location where the author(s) conducted the research.

A professional paper should include the author note beneath the institutional affiliation, in the bottom half of the title page. This should be divided up into several paragraphs, with any paragraphs that are not relevant omitted. The first paragraph should include the author's name, the symbol for the ORCID iD, and the URL for the ORCID iD. Any authors who do not have an ORCID iD should be omitted. The second paragraph should show any change in affiliation or any deaths of the authors. The third paragraph should include any disclosures or acknowledgements, such as study registration, open practices and data sharing, disclosure of related reports and conflicts of interest, and acknowledgement of financial support and other assistance. The fourth paragraph should include contact information for the corresponding author.

A student paper should not include an author note.

Note again that page headers/page numbers (described above for professional and student papers) also appear at the top of the title page. In other words, a professional paper's title page will include the title of the paper flush left in all capitals and the page number flush right, while a student paper will only contain the page number flush right.
Student APA title page

Professional paper APA title page

Abstract

Begin a new page. Your abstract page should already include the page header (described above). On the first line of the abstract page, center and bold the word "Abstract" (no italics, underlining, or quotation marks).

Beginning with the next line, write a concise summary of the key points of your research. (Do not indent.) Your abstract should contain at least your research topic, research questions, participants, methods, results, data analysis, and conclusions. You may also include possible implications of your research and future work you see connected with your findings. Your abstract should be a single paragraph, double-spaced. Your abstract should typically be no more than 250 words.

You may also want to list keywords from your paper in your abstract. To do this, indent as you would if you were starting a new paragraph, type Keywords: (italicized), and then list your keywords. Listing your keywords will help researchers find your work in databases.

Abstracts are common in scholarly journal articles and are not typically required for student papers unless advised by an instructor. If you are unsure whether or not your work requires an abstract, consult your instructor for further guidance.

APA Abstract Page

Please see our Sample APA Paper resource to see an example of an APA paper. You may also visit our Additional Resources page for more examples of APA papers.

How to Cite the Purdue OWL in APA

Individual Resources

The page template for the new OWL site does not include contributors' names or the page's last edited date. However, select pages still include this information.

In the absence of contributor/edit date information, treat the page as a source with a group author and use the abbreviation "n.d." for "no date":

Purdue Online Writing Lab. (n.d.). Title of resource. Purdue Online Writing Lab. http://Web address for OWL resource

Purdue Online Writing Lab. (n.d.). General Writing FAQs. Purdue Online Writing Lab. https://owl.purdue.edu/owl/general_writing/general_writing_faqs.html

The generic APA citation for OWL pages, which includes author/edit date information, is this:

Contributors' names. (Last edited date). Title of resource. Site Name. http://Web address for OWL resource

Note: This page reflects the latest version of the APA Publication Manual (i.e., APA 7), which released in October 2019. The equivalent resource for the older APA 6 style can be found here.

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You can also watch our APA vidcast series on the Purdue OWL YouTube Channel . General APA Guidelines Your essay should be typed and double-spaced on standard-sized paper (8.5" x 11"), with 1" margins on all sides. Include a page header (also known as the " running head") at the top of every page.

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Knowles Andragogy

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Knowles' theory of andragogy is an attempt to develop a theory specifically for adult learning. Knowles emphasizes that adults are self-directed and expect to take responsibility for decisions. Adult learning programs must accommodate this fundamental aspect.

Andragogy makes the following assumptions about the design of learning: (1) Adults need to know why they need to learn something (2) Adults need to learn experientially, (3) Adults approach learning as problem-solving, and (4) Adults learn best when the topic is of immediate value.

In practical terms, andragogy means that instruction for adults needs to focus more on the process and less on the content being taught. Strategies such as case studies, role playing, simulations, and self-evaluation are most useful. Instructors adopt a role of facilitator or resource rather than lecturer or grader.

Application

Andragogy applies to any form of adult learning and has been used extensively in the design of organizational training programs (especially for "soft skill" domains such as management development).

Example

Knowles (1984, Appendix D) provides an example of applying andragogy principles to the design of personal computer training:

1. There is a need to explain why specific things are being taught (e.g., certain commands, functions, operations, etc.)

2. Instruction should be task-oriented instead of memorization - learning activities should be in the context of common tasks to be performed.

3. Instruction should take into account the wide range of different backgrounds of learners; learning materials and activities should allow for different levels/types of previous experience with computers.

4. Since adults are self-directed, instruction should allow learners to discover things for themselves, providing guidance and help when mistakes are made.

(See computers for further discussion of this topic).

Principles

1. Adults need to be involved in the planning and evaluation of their instruction.

2. Experience (including mistakes) provides the basis for learning activities.

3. Adults are most interested in learning subjects that have immediate relevance to their job or personal life.

4. Adult learning is problem-centered rather than content-oriented.

References

Knowles, M. (1975). Self-Directed Learning. Chicago: Follet.

Knowles, M. (1984). The Adult Learner: A Neglected Species (3rd Ed.). Houston: Gulf Publishing.

Knowles, M. (1984). Andragogy in Action. San Francisco: Jossey-Bass.

Related Website

For more about Knowles and his work, see:
http://www.infed.org/thinkers/et-knowl.htm

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Knowles' theory of andragogy is an attempt to develop a theory specifically for adult learning. Knowles emphasizes that adults are self-directed and expect to take responsibility for decisions. Adult learning programs must accommodate this fundamental aspect. Andragogy makes the following assumptions about the design of learning: (1) Adults need to know why they need to ...

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The benefits of a flipped classroom

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Flipped Classroom Model: Why, How, and Overview

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Poster

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Florence Nightingale
(full text, 96 pages)

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Notes on nursing : what it is, and what it is not : Nightingale, Florence, 1820-1910 : Free Download, Borrow, and Streaming : Internet Archive

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The appearance of this facsimile reprint is the culmination of an initial suggestion from Helen G. McClelland, Director of Nursing of the Philadelphia...

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Jeopardy games etc.

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Classroom Jeopardy Review Game | Buzzer Mode | Factile

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The #1 Jeopardy-style classroom review game now with Buzzer Mode. It’s Free, Easy and Loads of fun! Create engaging Jeopardy-style quiz games in minutes or choose from millions of existing Jeopardy game templates.

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Classroom Assessment Techniques

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Print Version
What Are CATs?

Classroom Assessment Techniques (CATs) are generally simple, non-graded, anonymous, in-class activities designed to give you and your students useful feedback on the teaching-learning process as it is happening.

Examples of CATs include the following.

The Background Knowledge Probe is a short, simple questionnaire given to students at the start of a course, or before the introduction of a new unit, lesson or topic. It is designed to uncover students' pre-conceptions.

The Minute Paper tests how students are gaining knowledge, or not. The instructor ends class by asking students to write a brief response to the following questions: "What was the most important thing you learned during this class?" and "What important question remains unanswered?"

The Muddiest Point is one of the simplest CATs to help assess where students are having difficulties. The technique consists of asking students to jot down a quick response to one question: "What was the muddiest point in [the lecture, discussion, homework assignment, film, etc.]?" The term "muddiest" means "most unclear" or "most confusing."

The What's the Principle? CAT is useful in courses requiring problem-solving. After students figure out what type of problem they are dealing with, they often must decide what principle(s) to apply in order to solve the problem. This CAT provides students with a few problems and asks them to state the principle that best applies to each problem.

Defining Features Matrix: Prepare a handout with a matrix of three columns and several rows. At the top of the first two columns, list two distinct concepts that have potentially confusing similarities (e.g. hurricanes vs. tornados, Picasso vs. Matisse). In the third column, list the important characteristics of both concepts in no particular order. Give your students the handout and have them use the matrix to identify which characteristics belong to each of the two concepts. Collect their responses, and you'll quickly find out which characteristics are giving your students the most trouble.

Why Should I Use CATs?

CATs can be used to improve the teaching and learning that occurs in a class. More frequent use of CATs can...

Provide just-in-time feedback about the teaching-learning process

Provide information about student learning with less work than traditional assignments (tests, papers, etc.)

Encourage the view that teaching is an ongoing process of inquiry, experimentation, and reflection

Help students become better monitors of their own learning

Help students feel less anonymous, even in large courses

Provide concrete evidence that the instructor cares about learning

How Should I Use CATs?

Results from CATs can guide teachers in fine-tuning their teaching strategies to better meet student needs. A good strategy for using CATs is the following.

1. Decide what you want to assess about your students' learning from a CAT.

2. Choose a CAT that provides this feedback, is consistent with your teaching style, and can be implemented easily in your class.

3. Explain the purpose of the activity to students, and then conduct it.

4. After class, review the results, determine what they tell you about your students' learning, and decide what changes to make, if any.

5. Let your students know what you learned from the CAT and how you will use this information.

Where Can I Find More CATs?

The standard references on CATs is Classroom Assessment Techniques: A Handbook for College Teachers, 2nd edition, by Thomas A. Angelo and K. Patricia Cross (Jossey-Bass, 1993). This book includes 50 CATs, indexed in a variety of useful ways. The book is available at the Center for Teaching library. See its ACORN record for call number and availability.

A number of web sites also feature information on and examples of CATs, including the following.

This teaching guide is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

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Print Version What Are CATs? Why Should I Use CATs? How Should I Use CATs? Where Can I Find More CATs? What Are CATs? Classroom Assessment Techniques (CATs) are generally simple, non-graded, anonymous, in-class activities designed to give you and your students useful feedback on the teaching-learning process as it is happening.

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Puzzlemaker
(from Kim K.'s toolkit)

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Create Your Own Criss Cross Puzzle | Discovery Education Puzzlemaker

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Create your own cross word puzzles with Discovery Education’s Puzzlemaker.

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Chest tube video

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Bloom's Taxonomy

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Bloom's Taxonomy - UCF Faculty Center for Teaching and Learning

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Taxonomies are developed to provide a framework for organizing a continuum along an underlying structure. For example, languages may be classified as Romantic, Germanic, etc. based on their underlying grammatical structure and origin. Bloom's taxonomy primarily provides instructors with a focus for developing their course learning objectives.