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Weekly UpdatesClinical instruction is a vital component of the education process for both radiologic technology and athletic training students. In the clinical setting, students are provided with the opportunity to actively practice skills taught in the didactic environment. Clinical instructors (CIs), as well as the clinical site itself, influence the success of the educational experience for students. Program directors (PDs) are responsibile for ensuring that the clinical sites selected are educationally appropriate. Additionally, they must ensure that the CIs are teaching and evaluating students effectively. (1)
Selection of a clinical site usually is based on factors such as location and willingness to have students; selection is not necessarily based on the quality of teaching opportunities the clinic can provide nor on the staff available. (2,3) However, clinical sites must possess supportive staff and enough patient cases to provide ample learning opportunities for students. (4) In addition, CIs have a responsibility to teach and evaluate students properly in the clinical environment; however, they do not always have the appropriate preparation. (1,3) As with other allied health fields, CIs frequently are chosen based on skill level and years of practice and not on the ability to teach and evaluate students effectively. (1,3)
Limited research related to clinical education for radiologic technology students is available. The literature that is available discusses the need for CIs to be more available and encouraging to students, to have good communication skills and to be able to adjust their teaching styles based on students' personalities. (3-5)
More research is available for athletic training education, which is an allied health program that includes similar clinical education requirements as those of radiologic technology programs. (6) Research about athletic training education could be beneficial to radiologic technology programs and students, especially information on how to select, train and evaluate clinical sites and CIs and how to improve overall clinical education.
The purpose of this paper is to review and compare the literature related to radiologic technology and athletic training clinical education.
Methodology
The research for this paper included a review of literature, published from 1998 to 2006, related to improving the clinical education experience of undergraduate students in the fields of radiologic technology and athletic training. PubMed and ProQuest databases were used to perform a review of the literature. Keyword searches for the literature included "clinical instructors," "clinical instructor evaluations," "athletic training clinical education," "allied health programs and evaluations," "radiologic technology clinical education" and "clinical education evaluation." The final review of the publications included those that specifically discussed either clinical education or clinical instructors in radiologic technology or athletic training education programs.
Literature Review
Clinical Instructors
The clinical instructor is an integral part of the education of allied health students. (7) Moreno et al (7) stated that the relationship between the CI and the student will assist the student with developing good patient care skills. In addition, clinical instructors need to display behaviors that model professionalism and provide a nurturing atmosphere for students. (7) Steves (8) defined the clinical education of radiographers as the time when students gain the necessary tools to become proficient in clinical skills; the CI is a critical link in that development.
According to Laurent and Weidnert (4) a clinical instructor is "a person who provides direct supervision and instruction to students in the clinical aspect of athletic training education." Laurent and Weidnert also stated that clinical instructors have "an important role in the facilitation and integration of athletic training knowledge and skills; thus, it is important to identify and promote helpful clinical instructor qualities." (1) The educational facility, students and CIs all need to have clear definitions of the qualities and responsibilities required to be an effective clinical instructor. Clinical education is an important aspect of many allied health programs; however, the experience can be negative for everyone involved if the program does not have qualified CIs.
Clinical Education in Radiologic Technology
A study conducted by Price et al (3) concluded that site evaluations are essential to ensuring that students receive high-quality education in radiologic technology programs. Even though the study took place in the United Kingdom where clinical structure varies slightly from the United States, the conclusions from the study are applicable to international radiologic technology programs. The structure differs from the traditional U.S. model because, in addition to didactic faculty and a clinical coordinator, the U.K. model also has a clinical lecturer and a scheme tutor. All of these faculty members work to coordinate theory and clinical education.
The study used a questionnaire to evaluate 6 specific areas: clinical experience, clinical assessment, academic support, student welfare, departmental influences, and living and social aspects. (3) The authors concluded that student performance was related directly to the amount of quality time spent with the clinical staff. In addition, a positive, encouraging environment improved student performance. Students reported greater satisfaction with clinical staff when allowed to do work independently under supervision and felt well oriented to the department's structure and procedures. Support from the program's clinical coordinator had a direct correlation with students' satisfaction. The authors concluded that some questions could not be evaluated adequately. Responses for living and social aspects and student welfare lacked adequate answers for analysis. Overall, the authors determined that the success of clinical education is a joint effort between clinical staff and program officials. (3)
To be an effective clinical instructor in the imaging sciences requires that an individual possess exceptional communication skills and the ability to teach and, at the same time, provide quality patient care. (5) Clinical instructors receive little or no formal training on how to be an effective CI. Quite often CIs model their teaching styles and behaviors after their own educational experiences, whether those were negative or positive.
Winn and Grantham (5) performed a study of nuclear medicine technologists to determine whether CIs understand the complexities of teaching students, as well as how student attitudes and personalities influence teaching styles. The authors stated that an effective learning environment for a student must be focused, encouraging and designed around the needs of the particular student. (5) Not all students require the same type of instruction, and being able to recognize different needs results in more effective instruction.
The study examined 4 specific personality domains and determined that these domains influence a student's clinical learning. The domains include focus of energy, organization of facts, response to circumstances and methods of decision making. Each of the 4 domains requires a modification of teaching style. In addition, each domain is associated with certain personality characteristics that also require teaching modifications. The interplay of personality domain and personality characteristics can be complex and sometimes calls for varied approaches to teaching. For example, students in the energy domain might be external learners who need hands-on, verbal instruction. However, other students may be internal learners who also require reflection on information and less verbal instruction.
The authors also concluded that students can possess multiple personality domains and characteristics. (5) For clinical instructors to be effective, they must be able to identify the differences in their students and present information accordingly. Clinical instructors do not need extensive training in personality domains and characteristics to be effective, according to the authors; however, the CIs need to possess a basic understanding of the differences and be able to recognize the obvious traits of each.
Steves (8) defined clinical education as an active experience that involves more than teaching technical skills: The education also involves role modeling and the integration of theory into practice. Students gain more from clinical instruction than just knowing how to be a technologist: They learn how to function as professionals in the clinical environment. Evaluating clinical instruction includes determining whether students are meeting set objectives by the program and whether students are gaining skills required by future employers. (8)
Effective clinical instructors possess certain attributes such as providing excellent feedback and specific, constructive criticism of performance. (8) In addition, clinical instructors need to be knowledgeable about the subject matter. Steves also stated that clinical instructors need to be able to apply different teaching methodologies based on different personality traits that could influence student learning. Specific skills that are important for clinical instructors, in addition to those mentioned, include good planning and implementation skills, accurate performance evaluation and constructive observation, feedback and facilitation skills.
Clinical instructors play a vital role in the education of radiologic technology students. Although it is important to examine what qualities define an effective instructor, it also is important to identify what students perceive to be problems in the clinical environment. (9) A study conducted by Mason (9) surveyed students to determine stressors in the clinical environment that interfered with their clinical education. Students identified 7 clinical stressors; those that pertained specifically to clinical instructors included intimidation by instructors, hurtful criticism, excessive supervision and negative responses to students' questions. The study also asked what clinical sites could do to improve student education, and those items included more positive feedback, greater availability of clinical instructors, support when mistakes are made and the ability to make mistakes as part of the learning process. (9)
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