Better Approaches to Clinical Education

Providing quality clinical education in a dynamic environment is challenging. The laboratory environment has changed significantly since the inception of clinical placement in medical and clinical laboratory programs. Clinical education should be consistently reviewed to meet current standards in the lab, but as labs continue to develop and grow, clinical education is often left behind. Consider the next cycle of students as an opportunity to restructure your lab’s approach to clinical education. Completely changing your approach to the student rotation in your lab can help reduce the burden on bench technologists and technicians, and allow you to continue providing quality education.

The purpose of clinical placement is for students to apply the foundations and knowledge they learned in school and to practice and grow their skills to entry-level competence. Typically, educational institutes provide clinical sites with competencies students must meet to be successful in their clinical placement. Competencies are created to encompass the teaching capability of all clinical sites, and they should reflect both theoretical and practical application. However, they will not tell you how to determine competency, nor how long a student should practice certain skills. It is the technologist’s or technician’s job to determine and gauge the student's competency level. David Kolb's Experiential Learning cycle is a great framework for establishing a clinical education model.¹ There are four parts to the cycle:

• Concrete Experience: The student learns through practical experience.
• Reflective Observation: The student reflects on their experiences.
• Abstract Conceptualization: The student connects theory to practice and develops critical thinking.
• Active Experimentation: The student practices and applies their knowledge and skills through tasks, exercises, and simulation.

As the student rotates through the lab, they will naturally meet the stages of Concrete Experience and Reflective Observation through their observation and experiences at the bench. However, adding structure to this idea will improve student learning and help staff guide the student through the overwhelming amount of information in the lab. This can be done by creating specific learning objectives for students to complete as they rotate through. 

Developing learning objectives

There are two ways to approach learning objectives for clinical education in the lab. The first is to take each competency and divide it into tasks or skills that are relevant for each bench. This would be preferred for smaller core labs that have a rotating bench or “float” benches. It helps ensure that each competency is covered with a smaller number of tasks or skills.

For example, in a core lab, if the competency is “student applies principles of microscopy,” you can break this down into the following learning objectives:

• The student will be able to clean and perform basic maintenance and troubleshooting on the brightfield and the inverted microscopes.
• The student will successfully identify microscopic elements in routine urine microscopy, such as cellular elements, casts, microorganisms, and crystals.
• The student will use their professional judgment to determine and report significance of findings as per the standard operating procedures.
• The student will be able to analyze samples with the inverted microscope for positive DAT, rouleaux formation, confirming a mixed field, and postnatal rosette testing.

With these specific learning objectives, it will be easier for the technologist to not only assign tasks, but understand and focus on what to teach the student to cover this competency.

The second way to create learning objectives is to create a list of skills and tasks from each bench, then find competencies that align with each one. This way is best used for larger labs that have multiple benches like a microbiology lab. Each bench will be able to have individual and specific skills and tasks designed for students. It also allows students to experience a larger variety of specimens under each competency.

For example, in microbiology on the urine bench, a couple of learning objectives may be:

• The student will be able to identify common clinically significant pathogens in urine specimens, including S. saprophyticus, Gram-negative bacilli, and pure growth of yeast.
• The student will be able to perform and analyze basic biochemical tests for identification including PYR, LAP, catalase, oxidase, and latex agglutination.

In this example, the learning objectives are specific but also apply to broader competencies, such as “student applies biochemical and serological methods to confirm microorganism identification” and “student identifies clinically significant microorganisms from multiple specimens and source types.” With these developed learning objectives, students will have a more streamlined approach to meeting the Concrete Experimentation stage.

Connecting theory to practice

"Developing relevant and clear learning objectives that are applicable and specific to your lab is the key to strong clinical education."

Finally, to help solidify their understanding, develop some questions for each bench or use previous case studies or scenarios. Have the students complete this during their time on the bench. This follows the Abstract Conceptualization stage from the Experiential Learning cycle where students will connect their experiences to other examples and problems encountered in the lab. Then, after observing and learning on the bench, students should have the opportunity to apply their knowledge independently. 

After completing their time at a bench, provide students with samples they might encounter at that bench. Ask them to perform the appropriate workup, then either compare their results to the released results or review their results with a clinical preceptor. These simulated exercises would satisfy the Active Experimentation stage where they are able to apply their knowledge and skills in practice.

By restructuring education in your lab, it will be easier for both students and staff to navigate the clinical learning and teaching experience. Use this article as a guide for implementing some or all of the stages of the Experiential Learning cycle. These steps may be introduced one at a time or all together, depending on what works best for your lab. Developing relevant and clear learning objectives that are applicable and specific to your lab is the key to strong clinical education.

References:

1. Kolb, David A. Experimental Learning: Experience as the Source of Learning and Development. Prentice-Hall, 1984.