Session 4A – Lärande i kliniken

Moderator: Matilda Liljedahl

Experiencing authenticity – The core of student learning in clinical practice

Learning in clinical education is complex including both organizational and pedagogical challenges. One way to meet these challenges are clinical education wards. This research project explored students’ learning, from students’ patients’ and supervisors’ perspectives, at a clinical education ward with an explicit pedagogical framework.
Semi-structured individual and group interviews of 38 students were analyzed using qualitative content analysis. An ethnographic study with participant observations and follow-up interviews of 11 students, 10 patients and 5 supervisors and a group interview of the supervisors was also conducted.
The core of student meaningful learning is the experience of both external and internal authenticity. External authenticity refers to being at real clinical settings. Internal authenticity is about the feeling of belonging and really contributing to patients’ well-being. Students in early stages created mutual relationships with patients who became active participants in student learning. Students experienced immediately both external and internal authenticity. Students nearing graduation experienced only external authenticity, ambivalence and self-centredness. Caring for patients in need for extensive care helped students to experience internal authenticity as well. The challenge for supervisors was to balance patient care and student learning; both equally important. Supervisors worked as a team, supporting students and allowing them independence.
Students need to experience both external and internal authenticity to make learning meaningful. Supervisors need to challenge and support students by allowing them to take care of their own patients together with peers. Patients can be active participants, not just training objects.  An explicit pedagogical framework based on patient-centeredness, peer-learning and teamwork creates the prerequisites for experiences of external and internal authenticity.

Name: Manninen, Katri
Working title: Senior clinical lecturer
University/Hospital: Karolinska Institutet/Karolinska University Hospital
Department: LIME/Department of Infectious Diseases
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CKU Studentenhet med peer learning

Syftet med projektet var att utveckla, implementera och utvärdera Studentenhet med peer learning som handledningsmodell på sex vårdenheter vid Karolinska Universitetssjukhuset. Målet var att förtäta antalet studenter under verksamhetsförlagd utbildning och att utveckla studentens lärmiljö genom att ge stöd till handledning av studenter samt att bidra till att utveckla pedagogiska metoder för handledning.
Projektet initierades av Karolinska Universitetssjukhuset, FoUU i samarbete med Centrum för Klinisk utbildning (CKU).  Projektet startade under höstterminen 2014 och handledningsmodellen implementerades vårterminen 2015. Projektet riktades specifikt till vårdenheter där sjuksköterskestudenter från grundutbildning, termin 3, placeras. Nio enheter på sex kliniker vid Karolinska Universitetssjukhuset kom att ingå i projektet. Utvärdering av studentens upplevelse av lärmiljön vid de aktuella enheterna genomfördes samt handledande sjuksköterskor och adjungerade kliniska adjunkter (AKA) upplevelse av implementering av handledningsmodellen. Utvärderingen visade att majoriteten av studenterna ansåg att det rådde en god pedagogiska atmosfär på avdelningen samt att de haft en god relation med handledare. Handledarna uppfattade att peer learning som pedagogisk metod underlättade studentens utveckling av självständighet, problemlösande förmåga, samverka med andra professioner samt att uppnå lärosätets kursmål. Handledarna upplevde ett gott stöd från AKA och över lag ett visst stöd från chefssjuksköterska. Majoriteten av handledarna såg framemot att handleda studenter enligt handledningsmodellen även nästa gång. Utvärderingen visade att majoriteten av AKA höll med om att framtagna stöddokumenten för handledningsmodellen var relevanta samt att implementering av peer learning och schemalagd återkoppling fungerat övervägande väl. Kommentarer visade även att AKA fått mer kunskap om handledning men ansåg sig behöva mer tid och träning i att ge pedagogiskt stöd till handledare.

Name of the authors: Tomaszewski, Camilla (1); Brochard, Katarina (2)
Working Title: Adjunkt (1, 2)
University/College/Hospital: Sophiahemmet Högskola (1), Röda Korsets Högskola (2)
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Evaluation of a student-run clinic in primary health care

Background: Student-run clinics (SRCs) offer realistic learning environments and stimulate a wide range of professional skills. At the SRC in Gustavsberg students in medicine, nursing, physiotherapy and psychology manage their own patients, under supervision. Our aim was to evaluate of one of the first SRCs in primary health care in Sweden from the perspective of students, supervisors and patients. Methods: Students filled in evaluation questionnaires by the end of their rotation. Clinical supervisors in medicine, nursing and physiotherapy were interviewed about differences with tutoring in the SRC as compared to their general practice. Interviews were thematically analysed. Patients filled in an evaluation questionnaire following their visit or a planned series of visits. Results: Students reported a very high degree of satisfaction with the learning environment and the relationship student-supervisor. Interviews with supervisors showed that the organization of the SRC provided time and administrative support for supervisors to focus on supervising. At the SRC the supervisor’s pedagogical role become more visible, since it was clearly separated from routine work. The tuition became more targeted towards the student’s individual needs and increased independence. Trust between supervisor and the student was an important factor to enable enhanced student autonomy. Patients were overall very positive about the care they received. Conclusion: Students and patients were satisfied with their experience of the SRC. The setting and organization facilitated and clarified the pedagogical role of the supervisors. We believe that such settings have a great potential for enhanced student-centred learning and increased student autonomy.

Name of author/athors: Fröberg, Maria (1,2); Leandersson, Charlotte (2,3); Fläckman, Birgitta (4); Hedman, Erik (1,5); Björklund, Karin (3); Nilsson, Gunnar (2); Stenfors-Hayes, Terese (3)
Working title: MD, PhD

1 Gustavsberg Primary Health Care Centre
2 Department of Neurobiology, Care Sciences and Society, Karolinska Institutet
3 Department of Learning, Informatics, Management and Ethics
4 Department of Care Sciences, Ersta Sköndal University College
5 Department of Clinical Neuroscience, Karolinska Institutet

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