Rethinking attitudes to student clinical supervision and patient care: a change management success story

Abstract

BackgroundThe aim of this project was to explore the process of change in a busy community dental clinic following a team development intervention designed to improve the management of student supervision during clinical placements.MethodsAn action research model was used. Seven members of a community dental clinic team (three dentists, two dental therapists, one dental assistant and the clinic manager), together with the university clinical placement supervisor participated in the team development intervention. The intervention consisted of two profiling activities and associated workshops spread six months apart. These activities focused on individual work preferences and overall team performance with the aim of improving the functioning of the clinic as a learning environment for dental students. Evaluation data consisted of 20 participant interviews, fourteen hours of workplace observation and six sets of field notes. Following initial thematic analysis, project outcomes were re-analysed using activity theory and expansive learning as a theoretical framework.ResultsAt project commencement students were not well integrated into the day-to-day clinic functioning. Staff expressed a general view that greater attention to student supervision would compromise patient care. Following the intervention greater clinical team cohesion and workflow changes delivered efficiencies in practice, enhanced relationships among team members, and more positive attitudes towards students. The physical layout of the clinic and clinical workloads were changed to achieve greater involvement of all team members in supporting student learning. Unexpectedly, these changes also improved clinic functioning and increased the number of student placements available.ConclusionsIn navigating the sequential stages of the expansive learning cycle, the clinical team ultimately redefined the ‘object’ of their activity and crossed previously impervious boundaries between healthcare delivery and student supervision with benefits to all parties.

Implementing interprofessional learning curriculum: how problems might also be answers

“…With an explicit focus on identifying and challenging underlying fears and assumptions in relation to IPL perhaps these identified contradictions should be highlighted to increase tensions and create an energy and momentum for change. When supported by an environment where innovative thinking and new solutions are entertained and supported, an ELC may be successfully completed [ 33 ].…”

“…While activity theory has been used in considerations of team work in clinical settings [ 32 , 33 , 38 – 41 ] its use in IPL is relatively novel. Activity theory has been applied to communication [ 42 ], student clinical placements [ 43 ], and team debriefings [ 44 ], but not specifically to curriculum development and implementation.…”

“…In previous work implementing change in the management of student clinical placements, the theoretical perspective of activity theory and the associated ELC provided useful insight into why some initiatives succeeded while others did not [ 32 , 33 ]. The aim of this study was to identify tensions associated with implementing IPL curriculum for educators and clinical supervisors, and to examine these findings from the perspective of activity theory and the ELC.…”

Benefits and Challenges of Partner Site Engagement with Community‐Based Dental Education Programs: The Partner Sites’ Perspectives

“…16 Challenges expressed by the participants echoed challenges reported by preceptors in previous research on this topic. 6,17,18 Those we interviewed identiied areas for improvement such as having more information about students prior to their arrival, ensuring that students understood the sites' missions prior to arrival, and reducing the number of short-notice changes in students' schedules. There were also suggestions for improvements in feedback from UIC COD regarding partner sites' impact on learning and possibly working with UIC COD to create guidelines for students' integration into clinics based on best practices among sites.…”

Supervisor expertise to optimise learner : preceptor ratios

“…report that learner : supervisor ratios of 2 : 1 and 3 : 1 resulted in increased ‘overall productivity’ in particular circumstances. This suggests that challenges that have been identified can be overcome and thereby raises the question of how we might optimally develop expertise in supervisors to help them navigate these issues . Further, it suggests that in order to explore aspects such as ratios, expertise in clinical supervision must be developed to provide a skill set that offers a clearer understanding of strategies for navigation through a variety of trials.…”