This post was inspired in part by this article on the 10 skills that every student should learn. These are some of the skills that we’re intentionally trying to help our students develop, as a way of integrating them into the culture of professional clinical practice.
- Reading carefully. If you can read you can learn anything, it is the gateway to all knowledge.
- Touch type. Not being able to type is the modern equivalent of not being able to write.
- Write persuasively by developing and supporting arguments with evidence. Our students must develop the skill of communicating in the language of the profession. Writing also means being able to structure their work, because there is meaning in structure. It helps to develop logical thinking, beginning with an introduction, developing the argument, and concluding it. Drafting is an important means of refining their understanding, and discarding ideas that don’t fit. Simplify the sentence so that it conveys only what is necessary. Being concise and clear in presenting their thoughts.
- Conduct research. Identify missing knowledge or information. Question everything. For everything that they do or say, they need to have a reason. Why do a grade 3 and not a grade 4 mobilisation? Why at L3 and not at L5? Why stretch the soleus and not the gastrocnemius? A healthy skepticism should inform their learning. Think like scientists. Be comfortable saying: “I don’t understand, can you explain that again?”. Developing their own questions as a way of finding answers to fill in gaps in their own knowledge. Challenge authority. Question the way that the world is (or the way it is presented to you) with the intention of figuring out ways to make it better.
- Use technology as part of their learning environment. Developing skills in managing information. Searching, filtering, aggregating, summarising, synthesising, and sharing information. Identifying credibility in a source. Know when to stop looking.
- Collaborate. Working together to solve complex problems.
- Accountability. Make a statement of belief, backing it up with evidence. Stand by your statement. Commit to it.
- Care. Care about what you’re learning. Care about doing your best.
I’m sure that I could carry on with this list, seeing that there are clearly many other skills that we aim to develop. But for now, I think that this is a useful point at which to pause and reflect.
I’ve recently finished the analysis of the first round of the Delphi study that I’m conducting as part of my PhD. The aim of the study is to determine the personal and professional attributes that determine patient outcomes, as well as the challenges faced in clinical education. These results will serve to inform the development of the next round, in which clinical educators will suggest teaching strategies that could be used to develop these attributes, and overcome the challenges.
Participants from the first round had a wide range of clinical, supervision and teaching experience, as well as varied domain expertise. Several themes were identified, which are summarised below.
In terms of the knowledge and skills required of competent and capable therapists, respondents highlighted the following:
- They must have a wide range of technical and interpersonal skills, as well as a good knowledge base, and be prepared to continually develop in this area.
- Professionalism, clinical reasoning, critical analysis and understanding were all identified as being important, but responses contained little else to further explain what these concepts mean to them.
In terms of the personal and professional attributes and attitudes that impact on patient care and outcomes, respondents reported:
- A diverse range of personal values that they believe have relevance in terms of patient care
- These values were often expressed in terms of a relationship, either between teachers and students, or between students and patients
- Emotional awareness (of self and others) was highlighted
In terms of the challenges that students face throughout their training:
- Fear and anxiety, possibly as a result of poor confidence and a lack of knowledge and skills, leading to insecurity, confusion and uncertainty
- Lack of self-awareness as it relates to their capacity to make effective clinical decisions and reason their way through problems
- A disconnect between merely “providing a service” and “serving”
- They lack positive and supportive clinical learning environments, have poor role models and often aren’t given the time necessary to reflect on their experiences
- The clinical setting is complex and dynamic, a fact that students struggle with, especially when it comes to dealing with complexity and uncertainty inherent in clinical practice
- Students often “silo” knowledge and skills, and struggle to transfer between different contexts
- Students struggle with the “hidden culture” of the professional i.e. the language, values and norms that clinicians take for granted
These results are not significantly different from the literature in terms of the professional and personal attributes that healthcare professionals deem to be important for patient outcomes.
The second round of the Delphi is currently underway and will focus on the teaching strategies that could potentially be used to develop the attitudes and attributes highlighted in the first round.