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Procedure
The accreditation process is based on adult learning principles1 and experiential learning. Adults learn by:
- knowing why they should learn something and considering it important to acquire the new skill, knowledge or attitude
- being self-directing and deciding for themselves what they want to learn
- having had far more experience than young people and different kinds of experiences, so that connecting the learning experiences to past experiences can make the learning experience more meaningful and assist them to acquire new knowledge
- becoming ready to learn when they experience a life situation where they need to know
- entering the learning process with a task-centred orientation to learning
- having both extrinsic and intrinsic motivation to learn.
The process of clinical competency accreditation has three distinct stages:
- Orientation
- Clinical skills accreditation and formative review
- Summative review.
At each of these stages the clinical teacher and the learner undertaking accreditation have objectives and outcomes that need to be met.
Orientation
Clinical teacher Learner - Establish recognition of prior experience
- Orient learner to clinical areas, client files, clinic forms and appointment system
- Demonstrate clinical skills and clinical decision making with reference to clinic-based guidelines and the standard operating procedure
- Provide information on evidence-based resources for use in the clinic setting and for self-directed learning
- Observe client consultations
- Commence supervised clinical skills
- Engage in reflective practice during and after client consultation
Clinical skills and formative review
Clinical teacher Learner - Base skill review on clinical practice wherever possible
- Observe client consultations to ensure skills are performed in the clinic context and continuity of care is maintained
- Provide specific, timely and constructive feedback based on observations
- Refer to clinic-based guidelines and the standard operating procedure when teaching
- Meet with learner regularly to review file documentation and participate in reflective practice and planning for skill development
- Provide opportunities to role play skills and attributes
- Perform client consultations with observation
- Provide rationale for any variations in client consultation
- Perform client consultations independently once accredited for each skill
- Continue to observe client consultations and actively reflect on attitudes, knowledge and skills demonstrated
- Follow clinic-based guidelines and the standard operating procedure
- Ensure a safe client environment by working within own scope of practice
Summative review
Clinical teacher Learner - Provide feedback on clinical skills accreditation and clinical practice
- Develop action plan for skills not yet accredited
- Review after three months with line manager
- Undertake a clinical session with a senior clinician utilising feedback and reflection skills
- Demonstrate ability to apply knowledge within the context of sexual health clinic practice
- Demonstrate critical thinking and clinical decision-making skills appropriate to the speciality and scope of practice
- Perform client consultations independently for accredited skills
- Within multidisciplinary framework consult with senior colleagues in accordance with delegation of clinical practice
- Commence medications package for standing order accreditation
- Continue clinical supervision and skills accreditation as negotiated with line manager
Clinical teaching skills
Feedback
Feedback is a means of communicating thoughts and feelings about the performance and competence of another person. It is central to sharing ideas, information and skills, as well as being vital for establishing and building relationships.
Helpful feedback makes a conscious distinction between the person—who is always valued—and particular acts or specific work—which may be subject to critical comment. The most important characteristic of constructive feedback is the way it is given. The tone, the style and the content should be consistent and provide the message that the person is valued.2
Skills for giving and receiving feedback are learnt. They are an essential element of lifelong learning. Feedback provides information that the learner can use to make changes to their practice.
Guide to helpful feedback (based on Boud2):
- Be realistic—direct comments towards things that the person can act on
- Be specific—base your comments on concrete observable behaviour
- Be sensitive to the goals of the person—link your comments to their intentions
- Be timely—select a time appropriate to timing of the event you are giving feedback on
- Be descriptive—describe your own views; it is up to the person to accept or reject them
- Be consciously non-judgmental—offer your personal view
- Don’t compare—treat each person’s work as their own
- Be direct—say what you mean
- Be positive—say what you appreciate
- Be aware of your own emotional state and focus on the other person.
Reflective practice
Reflection is an intentional process of examining experience to help people understand the action and the reasoning behind their thoughts and actions.
There are two main types of reflection: reflection in action (during the event) and reflection on action (after the event). The retrospective action of reflecting on a prior experience or action aims to promote one’s thoughts and judgments, attitudes and actions in the context of a particular experience. The knowledge gained cannot affect the past event but it can be used in future events.
David Kolb articulates the experiential learning cycle that shows how the learner plans, acts, observes and, through understanding, plans for the next encounter.3
Through reflection, it is possible for the learner and teacher to accumulate knowledge about and become familiar with sexual health practice. The result is that the learner not only changes their practice (learns from experience) but the teacher can also impact in a co-participatory way on the learner’s practice.
During the reflective process the clinical teacher will use listening techniques:
- recognising areas that need further reflection
- using questioning techniques to guide the learner’s reflection
- sharing both experience and reflective insight
- supporting the learner’s reflective practice
- guiding and supervising the learner’s journal writings.
Figure 7.1: The cycle of reflective practice. (Adapted from Kolb and Fry 1975)
Self-directed learning
It is the responsibility of the clinician to maintain and update their professional knowledge relating to sexual health in order to provide a high-quality service for clients and to develop case-related experience. Time may be allocated within the roster for self-directed learning. There are also many online learning packages with topics on HIV, sexual health, history taking, and women’s and men’s health.
In relation to nursing, the clinical competency assessment tools are based on the scope of practice as outlined in the Delegation of Clinical Practice.
The Mini-clinical evaluation exercise from the Royal Australasian College of Physicians is a useful tool.
Professional relationship issues
If the learner experiences difficulty in their relationship with the clinical teacher, all possible attempts should be made to ensure that a professional, constructive and supportive relationship is maintained. If this cannot be managed on an individual level, consultation with the line manager to develop a plan is recommended.
