Idiopathic pulmonary haemosiderosis--a case report

Nurse educators regularly develop clinical learning experiences for undergraduate students using the expertise of experienced RNs as preceptors. Preceptors help students develop a knowledge base and clinical skills. This article reports a literature review and summarizes the benefits of preceptorship, outlines preceptor responsibilities and qualities, and discusses the process of preceptor selection and role preparation. Suggestions for collaborative efforts regarding the preceptor experience among staff nurses, nurse educators, and staff development educators are highlighted.     

The relationship between preceptor expectations and student performance on 2 pediatric objective structured clinical examination stations

BACKGROUND: We designed 2 pediatric objective structured clinical examination stations, 1 anemia case associated with lead exposure and 1 failure-to-gain-weight case associated with extended breast-feeding, to evaluate third-year medical students who had studied in pediatric community preceptors' offices as part of a 12-week multidisciplinary ambulatory clerkship rotation. OBJECTIVE: To examine the relationship between preceptor expectations and student performance on these 2 objective structured clinical examination stations. METHODS: To elicit community preceptors' expectations of student performance, we constructed a 46-item survey replicating checklists filled out by simulated patients evaluating student performance on the objective structured clinical examination stations. The percentage agreement among preceptors for each checklist item as well as the percentage agreement between preceptor responses and student responses on each checklist item were calculated. A summary score of preceptor responses across all checklist items and a summary score for student responses across all checklist items on each station were calculated. The correlation coefficients between preceptor and student summary scores were then examined. RESULTS: Fifty-nine preceptor surveys were mailed and 38 were returned (64% response rate). Data were usable from 37 surveys. Eighty-nine percent (33 of 37)of the preceptors agreed that a third-year clerkship student should have the knowledge to care for the patient with anemia and 92% (34 of 37)of the preceptors agreed similarly for the growth-delay case. Agreement among preceptors on individual checklist items varied widely for both cases. Fifty-seven students studied at the anemia station and 34 students studied at the growth-delay station. The mean+/-SD agreement across the 26 items on the anemia case between preceptor responses and student responses was 62%+/-23% and, for the 21 items on the growth-delay case, 60%+/-17%. The mean+/-SD preceptor summary score for the anemia case was 17.4+/-3.8 (maximum, 26) and 16.0+/-3.6 (maximum, 21) for the growth-delay case. The mean student score on the anemia case was 15.5+/-3.7 (maximum, 26) and, for the growth-delay case, 10.0+/-4.5 (maximum, 21). The Pearson correlation coefficient between the preceptor and student scores on the anemia case was 0.19 (P=.15), and for the growth-delay case,-0.41 (P=.06). CONCLUSIONS: These data suggest community preceptors agree on topic areas in which students should be clinically competent. There was, however, considerable variation in agreement among preceptors about what preceptors believe students should be able to do and how the students actually perform. The overall percentage agreement between preceptor expectations and student performance appears to be no better than chance.     

Student and preceptor perceptions of factors in a successful learning partnership

Thirty-two registered nurse preceptors and 42 senior undergraduate nursing students completed a survey ranking factors related to both participants in the clinical learning partnership. Mann-Whitney U-Wilcoxon Rank Sum W tests showed statistically significant differences in the ranking of four factors (the ability to give and receive criticism, knowledge of the preceptoring process, clinical competence, and compatibility) that contribute to successful learning partnerships. Nurse educators and professional nurses should acknowledge these perceptual differences and include these in student and preceptor orientation programs to promote a positive teaching and learning partnership.     

Operation smile: mission to Kisumu, Kenya

With decreased clinical and faculty resources, monitoring students in the clinical area for safety and progress can be difficult. The authors discuss a project that used preceptors for selected beginning students to address issues related to high student-to-faculty ratios, individualized teaching, role modeling, and increased faculty time for scholarship. Based on student evaluation of the pilot project, the authors recommend using nurse preceptors for teaching beginning nursing students.     

Choice of first line treatment for arterial hypertension: should one avoid dihydropyridines in diabetic patients?]

The learning experience during a medical school clinical rotation is largely shaped by students' patient encounters. This paper reports on how a log system for recording these encounters can be used for course planning and evaluation. Over the past 5 years, 960 third-year students completed log forms based on their clinical encounters during a required 4-week family medicine clerkship at UT Southwestern. These forms were then optically scanned and the information entered into a computerized database. Log form data revealed that the most common medical problems encountered by students in their ambulatory settings were similar to those reported in the general family practice literature. There was a great deal of consistency in the types of encounters from year to year. The data also showed some differences among clerkship sites in terms of patient demographics and the most frequently reported diagnoses. Information generated from student log forms has been used by the clerkship faculty to determine required readings, prioritize didactic topics and other teaching, adjust curriculum content, prepare support materials and develop examinations. Given the utility of the information obtained and the ease of use of optical mark encounter sheets, we recommend this system for other clerkships.     

The independent study program at the University of Wisconsin Medical School

A program for 30 additional medical students for the first two years of the University of Wisconsin Medical School curriculum has been developed, and two groups of students have advanced to the clinical years. Design included providing modules of course materials to students and utilizing faculty predominantly in the developmental and managerial role. Preliminary results are based on student and faculty opinion of the program in categories of faculty acceptance, faculty-student interaction, certifying examinations, student attitudes, material developed, and course objectives. The course has been accepted as a continuing part of the medical school curriculum and provides a more flexible track for some students. There has been no significant difference in performance on Part I of the examination of the National Board of Medical Examiners for the first two groups. The concepts of individualized medical education have strengthened the basic science and core curriculum of the medical school.     

Integrating electronic conferencing to enhance problem solving in nursing

The authors describe how a computer-mediated conference was integrated into a baccalaureate nursing program clinical course. They discuss methods used in implementing the conference, including a technical review of the software and hardware, and methods of implementing and monitoring the conference with students. Examples of discussion items, student and faculty responses to posted items, and responses to use of the computer-mediated conference are included. Results and recommendations from this experience will be useful to other schools integrating computer-mediated conference technology into the nursing school curriculum.     

Graduate nursing education: developmental disabilities and special health care needs

As children and adults with developmental disabilities and special health care needs are integrated into home, school, and community life, nurses are being required to provide leadership, advocacy, and training in community settings to a much greater extent than in the past. To assess the school and community need for formal graduate preparation for nurses who work with individuals with developmental disabilities and/or special health care needs, 25 nurses in leadership positions representing urban and rural health agencies throughout Minnesota took part in a 5-hour focus group discussion. Analysis of data summarized from this process shows five features of the recommended curriculum necessary for advanced practitioners in this specialty area: (a) discipline-specific core competencies, (b) discipline-specific specialty competencies, (c) genetic competencies not specific to nursing but necessary to function in nursing roles, (d) interdisciplinary and intradisciplinary learning experiences, and (e) clinical experiences with preceptors. The authors recommend the development of interdisciplinary graduate programs designed to prepare nurses to assume leadership roles in school health, public health, home health care, and systems management that will affect public policy and, ultimately, promote change in the systems charged with responsibility to serve this population.     

Resident and faculty perceptions of effective clinical teaching in family practice

Increasing interest in clinical teaching has led to the realization that the unique subset of skills which characterizes effective clinical teaching needs to be identified. Such identification will lead to development of these skills and improvement in the quality of clinical teaching. Family practice faculty are vitally concerned with improving their clinical teaching skills, since clinical teaching is the core of education in family medicine and since many family physicians who become preceptors have had no formal training as teachers. In this investigation of effective clinical teaching behaviors, faculty and residents generally agree in their perceptions of the helpfulness of 58 clinical teaching behaviors. Neither group felt that emphasis on references and research is as important a factor in effective clinical teaching as are residents' active participation in the learning situation and positive preceptor attitudes toward teaching and residents. It was perceived that the ineffective clinical teacher has a negative attitude toward residents, is inaccessible, and lacks skills in providing feedback, while the effective clinical teacher has skills in two-way communication, creates an educational environment that facilitates learning, and provides constructive feedback to residents.     

The development of a course in basic physical examination skills

Basic clinical skills of most medical school undergraduates continue unobserved and deficiencies have been detected in a significant number of physicians during residency. Nevertheless, our health care system is calling for competent graduates with solid basic clinical skills and a larger representation of qualified generalists in the increasingly important managed care environment. The need for a better introduction to Clinical Skills course was identified by students and clinical faculty at Ponce School of Medicine. In response to these concerns a new curriculum was developed with clear objectives, effective instructional strategies, and performance-based evaluation, with adult learning principles as its framework. The musculoskeletal examination unit of the curriculum was pilot tested and the course evaluation strategies revealed satisfaction with objectives, instructional and evaluation strategies, as well as improved confidence, and sense of usefulness for the learned skills. A curriculum in basic clinical skills that incorporates adult learning principles with solid instructional strategies can increase the confidence and skills of the learners and should lead to improved outcomes.     

Mutation in the prion protein gene at codon 232 in Japanese patients with Creutzfeldt-Jakob disease: a clinicopathological, immunohistochemical and transmission study

The societal and economic forces driving change in medical education are affecting communities as well as universities. Each of the four authors of this paper is deeply involved in one of the components of their locale's well-developed community-based medical educational system, and each describes how change is influencing his role in that system, whether the role be managing a community hospital, directing a local Area Health Education Center, participating as a family medicine faculty member, or being a community preceptor. They agree on some common themes: (1) that it is good that medical students' education is moving into the community (e.g., this validates the importance of the community hospital to medical education, is an acknowledgment of the importance of generalism, and provides students invaluable learning experiences); (2) that educating medical students in the community is expensive, and more funding and resources are needed so that the area's hospitals, community faculty, preceptors, and support services can be fairly compensated for their commitment; and (3) that their community-based education system can no longer absorb the costs of training more medical students. This is not a criticism of academic medical centers, which are under tremendous financial pressures themselves, but is simply to state the community perspective and to urge fairness in the distribution of resources for medical education. Community institutions and academic medical centers will work individually to create their own integrated health care systems but must work together to create a better, more cost-effective system for educating medical students.     

A creative clinical education model: three views

To effectively educate nurses who are able to meet changing health care needs, new models for clinical experiences must be considered. Collaborative arrangements between practice and education are particularly useful. The preceptor approach is used widely for seasoned students in senior experiences nearing graduation. The "paired" model, a variation on the preceptor model, has worked well in one setting for beginning students. It needs to be tried in other settings with different faculty and perhaps in other types of courses, and it needs to be tested. Collaboration between education and practice not only benefits education, but lays the groundwork for shared scholarly endeavors. Ultimately these relationships have a positive impact on patient care.     

Preparation for an online asynchronous university doctoral course. Lessons learned

This article addresses the development of the initial course in the first completely online doctoral program in nursing. Synchronous and asynchronous methods of distance education were assessed. Planning focused at the university, school, and course levels. University planning involved the technical infrastructure, registration, student services, and library services. School planning examined administrative commitment and faculty commitment and willingness. Course planning focused on marketing, precourse information, time frame, modular design, planned interaction, and professor availability and support. Implementation issues centered on getting students connected, learning the software, changing instructional methods, and managing chats. Traditional methods of evaluating student learning and course evaluation were supplemented with the development of qualitative and quantitative tools to gather data for making administrative decisions. The Dean and faculty agreed that the internet was an effective method of delivering content in the initial Health Policy course. The Dean and faculty agreed to continue the PhD program online for one cohort and continue to evaluate student progress and faculty and student satisfaction.     

Development and testing of the Clinical Post-Conference Learning Environment Survey

Clinical postconference is an integral component of the required laboratory hours in undergraduate baccalaureate nursing education. Empirical evidence supporting the educational benefits of this activity are nearly nonexistent. This article describes the development and psychometric testing of a self-report instrument designed to measure clinical postconference learning environments as perceived by undergraduate nursing students and faculty. The Clinical Post-Conference Learning Environment Survey (CPCLES) consists of 54 items and has been tested with more than 500 participants in three schools of nursing in the Midwest. Based on theoretical support and comprehensive review of the literature, six components of the learning environment are measured in two forms of the instrument; an actual scale and an importance scale. Content validity, internal consistency, and test-retest reliability are discussed. Using the CPCLES, perceptions of undergraduate nursing students and faculty were measured. Significant differences between the actual components of the learning environment and the correlated ratings of the importance of these components were found. Faculty perceived a significantly greater amount of teacher support, task orientation, and innovation in the postconference learning environment than did undergraduate students. No differences were noted between faculty and students regarding the importance of the learning environment components. This study presents findings with the use of the first instrument developed to measure clinical postconference learning environments. The congruence and discrepancy among and between learning groups' perceptions carry implications for educational practices in this setting. Subseqent investigations using this tool may be able to link the perceived learning environment to valued cognitive, affective, and behavioral learning outcomes.     

Bridge to the future: nontraditional clinical settings, concepts and issues

Healthcare restructuring in the wake of healthcare reform places greater emphasis on primary healthcare. Clinical education in acute care settings and existing community health agencies are not compatible with teaching basic concepts, principles and skills fundamental to nursing. Problems of clients in acute care settings are too complex and clients in the community are often too dispersed for necessary faculty support and supervision of beginning nursing students. Nontraditional learning settings offer the baccalaureate student the opportunity to practice fundamental skills of care and address professional skills of negotiation, assertiveness, organization, collaboration and leadership. An overview of faculty designed clinical learning experiences in nontraditional sites such as McDonald's restaurants, inner city churches, YWCA's, the campus community and homes are presented. The legal, ethical and academic issues associated with nontraditional learning settings are discussed in relation to individual empowerment, decision making and evaluation. Implications for the future address the role of the students and faculty as they interact with the community in which they live and practice.     

Myopic shift after cataract removal in childhood

This article describes the experience of a team of nursing educators who, over the course of 2 years, redesigned the delivery of an undergraduate nursing clinical course to reflect the changing face of mental health care near the turn of this century. Case studies of student learning experiences show the value of nontraditional clinical settings such as homeless shelters to the professional growth and training of nursing students. Recommendations offer practical advice for combining nontraditional community-based clinical experiences with critical thinking exercises as key components of the mental health clinical course delivery.     

A curriculum based on systems theory

This paper describes an entry-level curriculum based on systems theory that was designed to promote integrated thinking and a shared image of practice among all of the members of an educational community that included students, faculty, and clinicians. Initiated in 1983, the program integrates occupational therapy theory, critical thinking, and knowledge about person-environmental transactions with traditional medical, biological, psychological, and sociological course work to create a unique educational experience. The curriculum model is based on a spiral learning process that encourages integrated thinking. Furthermore, all concepts are systematically tied to the occupation core, the central theme of the program. Fieldwork is used to reinforce ideas presented in the classroom and features discrete learning experiences where students demonstrate their integration of knowledge and skills. In an evaluation of the program, responses from 78 clinician, 51 alumni, and 132 student questionnaires; feedback from 132 fieldwork supervisors; and longitudinal data from 33 alumni confirmed that graduates are critical thinkers who appreciate the diverse needs of clients while demonstrating an appreciation for the curative effect of meaningful, goal-directed activities.     

Implementing problem-based learning in a family medicine clerkship

BACKGROUND AND OBJECTIVES: Problem-based learning (PBL) has been implemented in the curriculum of many medical schools, but limited information is available about the outcome of this learning technique. The educational intervention presented in this paper implemented a PBL learning component in our third-year family medicine clerkship and measured the outcomes of this curricular change. METHODS: One third of the curricular time devoted to didactic teaching in our family medicine clerkship was replaced with PBL activities. Simulated cases were developed and presented to students who, with the aid of faculty facilitators, studied the cases, gathered information about the cases, and developed diagnostic and management plans for the cases. The outcome of the intervention was measured by a) comparing students' scores on the National Board of Medical Examiners (NBME) family medicine clerkship examination to scores achieved by students in the year before PBL was introduced and b) students' evaluations of the relevance and success of PBL in the clerkship curriculum. RESULTS: Students' NBME clerkship examination scores increased from a mean of 66 the year before PBL began to 73 after PBL was implemented. More than 80% of students reported that PBL was a good way to learn family medicine, and 85% reported that the PBL technique provided sufficient information to formulate learning issues. CONCLUSIONS: PBL can be introduced into a third-year family medicine clerkship curriculum with general acceptance by students. Students rated the technique highly, and their examination scores improved.