Clinical instruction and instructors.

Whether academicians care to admit it or not, the classroom is NOT the appropriate place for real learning. Real learning connotes use. If information isn't going to be immediately used or applied in some practical way, it simply doesn't get learned. That's why the real cornerstone of allied health education lies in the clinical experience. Unfortunately, constraints in allied health education often result in theory being presented long before practice, with clinical experiences lagging behind lecture and lab. If our ultimate goal is patient care, the education community should bring clinical to the forefront as the students' most important learning environment. It's those clinical rotations that provide students with the skills and comfort level that can't ever be achieved in a college classroom or lab. Over 25 years of teaching Respiratory Care has brought me to the unwavering belief that the quality of our product lies in the quality of our clinical instruction.

Clinical instructors and preceptors are the professionals who take on this critically important responsibility. It is to them that academic programs entrust the formation of the psychomotor skills and affective behaviors that will characterize the next generation of practitioners. Clinical instruction is provided by a number of human resource approaches. Instructors may be program faculty themselves or instruction may be provided through the use of paid clinical adjuncts. These instructors are responsible for a group of students and dedicated only to student instruction while they are in the learning site. In many other cases however, contracts with affiliates may call for clinical instructors to be provided by the learning site, with students being assigned to staff therapists who have offered to share their expertise. This is the one-on-one clinical "preceptor" approach. It is a voluntary effort. Preceptors are not paid by the academic institution. The advantages to this approach are very real, especially for students' second-year or specialty clinical rotations. These clinical preceptors often provide the most valuable experiences for students. Because they're working on their home turf, important lines of communication are in place. Their familiarity and acceptance in their respective clinical or specialty areas pave the way for students to get maximum clinical opportunities and exposure. Students also tend to relate well to clinical preceptors who, unlike their academic faculty, they perceive to be "real world" practitioners. Benefits come to the preceptors as well. Precepting is an important source of professional stimulation and those who do it like having an association with an academic institution. The literature is full of studies that show that preceptors teach because of the intrinsic rewards they receive. Regardless of compensation arrangements, how well students fare and how well prepared they are to enter the workplace depend heavily on the mentoring skills of the individuals who directly guide their clinical development.

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But make no mistake about it. Mastering the art of clinical instruction doesn't come easily. Clinical instructors and preceptors need all the help we can give them. It's ironic that, given the importance of the job assigned to them, most clinical instructors have not had the benefit of formal coursework in teacher education. They've probably come to realize by way of their own workplace experiences, that they have a fondness for students or a natural knack for hands-on teaching. Then through a process of trial and error, they develop teaching skills on their own. But without a formal understanding of the academic process, they often lack knowledge of learning domains or feel ill-equipped to write a meaningful clinical evaluation.

Every allied health program has a Director of Clinical Education (DCE) whose job is dedicated to administering and improving clinical instruction. It's this DCE who fills the role of instructional leader and has the responsibility of supervising and acting as "consultant" to instructors. But this leadership is, by necessity, "hit or miss" often leaving clinical instructors and preceptors to fend for themselves.

Efforts to improve the quality of clinical instruction are important. Not just because of the significant resources poured into providing a clinical experience that is conducive to learning, but because the quality of the profession literally depends on it. Most programs report that their greatest needs and anxieties lie in the area of clinical instruction. Of primary concern is the preparation of future teachers. The current academic shortage makes it crucial that we start cultivating the next generation of educators, both clinical and academic. Formal programs for the purpose of elevating the skills and status of clinical educators are limited and have been confined to better-established disciplines such as Nursing and Physical Therapy. Aside from local efforts, they have been largely lacking in the RC academic environment.

Thankfully, there is now an emerging recognition that as a profession, Respiratory Care would be well served to provide assistance to aspiring educators. To that end, the AARC has launched a project to address the cultivation of both classroom and clinical educators. Named the Educator Academy, its express purpose is to assist rookie or aspiring teachers to move forward in the area of respiratory care education. Now the Education Section of the AARC is discussing possibilities for staff development specifically for RC clinical instructors. Its initial step was the convening of a working group. The ultimate goal is to develop a program that would address a wide range of clinical education competencies, such as concepts of adult education, learning domains, and clinical performance evaluations. The vision is that of a prepackaged educational seminar that would be accessible to any and all therapists responsible for the teaching of RC students in the clinical settings. A nationally standardized and sponsored program of this type would surely elevate the status of clinical preceptors and instructors as well as make them better appreciate the complicated nature of the learning. In the meantime, the AARC extends a standing invitation to all clinical educators to enhance their organization membership by joining the specialty Education Section. That membership offers periodic newsletters, access to current issues in education, and an on-line list serve for communication with other interested and education-minded RCPs.

Successful clinical teaching requires the participation of a talented and committed corps of clinical instructors and preceptors. In my book, they are the unsung heroes of RC education. Let's all recognize, celebrate and provide support to this most important and often forgotten segment of teaching professionals.

by Sandra McCleaster RRT