Clinical Learning Plans

Students tend to vary in their ability to be self-directed. Entering a new clinical context & being presented with broadly defined course objectives presents an additional challenge to identifying individual learning objectives that will be congruent with expected outcomes. A question that frequently surfaces during tutor meetings is…

What strategies do tutors use to assist students with developing their individual clinical learning plans (CLP)?

General Strategies related to construction of the CLP:

– At the outset students need to have a foundational understanding of how to develop learning plans. The course or programme should provide them with a systematic approach to doing this. In our BScN programme we incorporate acquiring knowledge & skill in developing learning plans as a learning activity, in the first nursing course offered to junior students. These students develop CLP’s & receive ongoing feedback in order to consolidate the concepts related to this process. We also provide students with guidelines for CLP formatting & development in their Programme Handbook, which is their contract with the programme. This information becomes a valuable resource for future use when developing one’s CLP becomes a more autonomous process.

Strategies specific to the clinical placement:

– Tutors might take some individual time to interview each incoming student. The interview gives the tutor an opportunity to emphasize the focus of the course & to review the student’s final evaluation from the prior clinical placement. This creates an overt continuity with the last placement. Enables students to validate what they know & can do well. Helps in setting goals for building on strengths & addressing areas to improve. Students tend to use “catch phrases” when identifying their strengths & limitations. They should be encouraged to describe what they mean in relation to each item you discuss. Through questioning, encourage them to explore how this current clinical placement might help them meet their learning needs. It is useful to have the student articulate what strategies would help them reach their goals. This discussion gives the tutor an idea about the student’s ability to be self-directed and an opportunity to begin to formulate an approach to fostering the student’s learning. This dialogue should be supportive, provide guidance & promote reflective thinking. Hopefully the student will feel some autonomy regarding their learning and also become aware that this new venture into learning is a collaborative effort with the tutor as the quality control guide for meeting course expectations.

– It is important to promote critical thinking about what students need to learn fairly early on in the placement. Often tutors provide some seminal readings related to the client population or have students do a search for one or two relevant articles. After engaging in this activity they return to post conference to discuss a brief summary of the article & identifying some learning issues related to the readings. Through using the group context all students in the placement contribute to the baseline information & benefit from the collective readings. This is a great way to expose students to the literature & move them away from using texts as the major resource for clinical practice. Another approach in keeping with PBL might be to provide some scenarios that are taken directly from the clinical setting or to take the group into meet a client. After the scenario reading or clinical visit ask the students to think about what they need to know in order to effectively; safely & competently, care for the client. Include assessments, medications & procedures specific to the placement. This provides students with some baseline understanding of the placement & client population.

– Review the clinical course objectives. Focus on the verbs used to describe the expected level of learning. Students often need examples of what is meant by each course objective. This can be accomplished during a post conference session where all students can work together to problem solve in order to come up with relevant examples. Here the tutor can challenge the group’s thinking & reinforce examples of objectives & evidences that are congruent with course objectives. Generally students tend to gravitate toward objectives involving acquisition of knowledge or demonstration of psychomotor skills. Higher-order objectives involve providing evidences that demonstrate application of knowledge & integration of relevant data & knowledge (critical thinking) in order to engage in clinical decision-making. These evidences tend to require more complex thinking about the context & client population, the use of discretion and clinical judgment. Students entering a new clinical setting find these difficult to articulate since they have limited knowledge & exposure to the population.

– Applying knowledge gained from other prior or concurrent courses & workshops will assist the student with developing higher order objectives. For example our intermediate students take a critical appraisal course in which they learn to evaluate research studies. This new skill could be reinforced in the clinical setting through a learning objective that examines the effectiveness & efficacy of some nursing practice. This will promote meeting course objectives related to evidence based practice. Another possibility for meeting higher order objectives might be to critique & utilize concepts learned in a nursing theory course. This enables the student to build on prior knowledge by applying what they know to a specific clinical population/client & critiquing the usefulness of the concept in relation to understanding the client &/or with providing nursing care.