IMPLEMENTING A STUDENT-CENTERED APPROACH IN CLINICAL COURSES: CHALLENGES AND SOLUTIONS

S. Peleg¹, L. Lotan¹, O. Divon-Ofir², L. Pesach-Gelblum², R. Pelleg-Kallevag¹

Background: Integrating theory and sensory-motor skills into clinical teaching in physiotherapy is a challenging task. In addition, the collaborative nature of teaching with colleagues requires coordination regarding explanations and demonstrations presented to the students. Finally, it is imperative that we reflect on the complexity of processes related to adult-learning and comprehension limits of the student. Therefore, we developed a model for teaching based on adult learning theories.

Purpose: To familiarize the academic staff and clinical instructors with adult learning theories, to apply these theories to teaching clinical skills, and  to shift to student-centered teaching.

Methods: The new “student-centered approach in clinical courses” was developed in collaboration with the Center for Medical Simulations, Sheba Medical Center (MSR), Israel. The model focused on: 1. Collaboration between the clinical instructors, 2. Structured demonstration of a clinical skill (sequential and followed by concrete explanations), 3.Principles of intervention using clarifying, promoting or correcting interventions in order to close students’ gap in knowledge or skills and promote student performance.
 The new program was implemented in three stages:

1. Preparatory stage: A model for clinical skills instruction was developed whereby the clinical class is divided into three groups for demonstration, with a ratio of one lecturer to every 15 students. Each demonstration is to last up to 10 minutes, followed by student practice for 30 minutes, during which students receive feedback.
2. Initial training stage: Initial training of the staff of the Department of Physical Therapy (n=12) included a two-day workshop, led by the clinical skills division staff of MSR, focusing on concepts from adult learning theory and preparation of a clinical skill demonstration. Key concepts that were introduced included: continuous as opposed to disassembled demonstration; situational awareness; and single versus double loop learning. To promote coordination between the lecturers and standardization of instruction, a 'skills-station' form was introduced. 
3. 'On the Job Training' stage: A clinical evaluator (from MSR) entered each course and gave detailed feedback to the clinical instructors (individually and as a team) while the clinical instructors reflected on their own performance. 

Results: The model of teaching in small groups in a student-centered way was implemented in all clinical courses. Each clinical instructor reflected on his/her performance after receiving detailed feedback, for example on the balance between the theoretical explanations on the one hand and the demonstration of the clinical skill on the other. Both clinical instructors and students reported high satisfaction rates.

Conclusion(s): Teaching in small groups, ensuring double-loop learning and avoiding theoretical discussions during the demonstration improved acquisition of clinical skills.

Implications: Training programs adapted to courses of clinical skills, followed by on the job training, are efficient tools for creating a change in the class environment, both in the academic part and clinical field of physical therapy.

Funding, acknowledgements: This study was funded by the Russel Berrie Foundation.

Keywords: adult learning, student-centered teaching, simulations

Topic: Education: methods of teaching & learning

Did this work require ethics approval? Yes

Institution: Zefat Academic College

Committee: Ethical Committee of Zefat Academic College

Ethics number: 42917