Teaching the NC Student: Preceptor Check In

Elizabeth AllemangClinical Education Coordinators

Loreto FreireExperiential Learning Coordinator

│March 2019

Welcome

Adobe Connect basics

Introductions

• Name

• Practice

• MEP university affiliation

• Level of preceptor experience – is this your first time as a NC preceptor?

• What issue(s) would you like to discuss today?

Agenda

Preceptor issues for discussion

End of term issues:

• Birth numbers

• Competency standards

• Common gaps and simulated teaching/assessment

• Evaluation and grading

• Assisting the struggling student

MEP student workload policy revisions and impact on placements

Normal Childbearing learning pathway

Start of NC placement

• Student is a beginning clinical learner who has been oriented to NC clinical skills

End of NC placement

• Student is expected to ‘manage’ prenatal, intrapartum and postpartum care in normal situations

Academic component

• Focuses on knowledge to provide care in normal situations

Placement competencies and objectives

Normal Childbearing clinical evaluation form

• Lists clinical placement competencies and objectives

MEP Guide to Teaching, Learning & Assessment

• Provides teaching strategies and competency levels for most clinical skills and abilities, including NC expectations

NC clinical objectives – evaluation form

• Conducts prenatal, postnatal and newborn visits with minimal assistance for normal situations and common variations

• Routinely initiates the planning of visits and debriefs with the preceptor

• Plans and provides intrapartum care and provides labour support in normal labour and common variations

• Seeks advice and consultation from the supervising midwife as needed

• Displays an expanding base of information about maternal and newborn care and provides appropriate information to clients

• Responds to pages and phone calls appropriately and provides clear information with assistance from preceptor

NC clinical objectives – evaluation form

• Establishes effective, professional relationships with clients and other caregivers

• Conducts normal births including 3rd stage and perineal repair

• Demonstrates understanding of the roles of the primary and second midwife

• Documents assessments, plans, and interventions with minimal assistance from preceptor in normal and common situations

• Demonstrates understanding of primary care responsibility, care planning and management in normal and common situations

• Able to assist in common emergency situations with guidance

NC competency standards – the ‘Guide’

Introductory competence

• Abdominal exam by midterm

• Physical assessment by midterm

• Venipuncture by midterm

• Labour support by midterm

• Cervical assessment by final

• Management of first, second and third stage and spontaneous birth by final

• Perineal infiltration and performing episiotomy by final

Intermediate competence

• Abdominal exam by final

• Physical assessment by final

• Venipuncture by final

• Labour support by final

NC competency standards – the ‘Guide’

Introductory competence

• Communication skills by midterm

• Suturing perineal lacerations and episiotomy by final

• Newborn examination by final

• Documentation by final

• Primary care decision making by final

• Care management skills by final

• Professional role and behaviour by final

Intermediate competence

• Communication skills by final

Clinical course ‘benchmarks’

Developed for midwifery clinical courses and pre-clinical midwifery skills course

Provide minimum standards and guidelines for what is needed to achieve a Satisfactory grade

Developed as guideline by Ryerson faculty for faculty to support appropriate evaluation and grading

Developed for midterm and final evaluations

NC clinical skills benchmarks

Midterm Final

• Performs basic clinical skills at NC

level with regular assistance

• Conducts at least 4 births with 4

handed catches*

• At least 10 internal exams with 5

intrapartum*

• Performs tasks of 2nd midwife with

frequent assistance

• Performs basic clinical skills at NC level

with minimal assistance

• Conducts 8 births with at least 4 two-

handed*

• Minimum 10 internal exams with 5

intrapartum*

• Acts as second midwife in normal

situations with regular assistance

*These benchmarks are markers of clinical opportunity rather than student performance and may indicate

the need for placement planning or possible extension

Definitions: frequent = 75-90%, regular = 50-74%, minimal = < 25%

NC assessment skills benchmarks

Midterm Final

• Identifies normal situations with

regular assistance

• Participates in phone assessments and

plans with preceptor (prenatal,

intrapartum, postpartum)

• Identifies normal situations with

minimal assistance

• Takes first call in normal situations

(prenatal, intrapartum, postpartum)

with minimal assistance

Definitions: regular = 50-74%, minimal = < 25%

NC care management skills benchmarks

Midterm Final

• Conducts normal prenatal and

postnatal care with regular assistance

• Manages care in normal labour birth

with regular assistance

• Conducts normal prenatal and

postnatal care with minimal assistance

• Manages normal labour and birth with

minimal assistance

Definitions: regular = 50-74%, minimal = < 25%

NC communication skills benchmarks

Midterm Final

• Communicates assessments and care

plans in normal situations with

occasional prompting

• Conducts ICDs in NC curriculum with

regular assistance

• Conducts normal prenatal and

postnatal care with minimal assistance

• Manages normal labour and birth with

minimal assistance

Definitions: regular = 50-74%, occasional = 25-49%, minimal = < 25%

NC pharmacology skills benchmarks

Midterm Final

• Has drug file/sample prescriptions for

NC content

• Administers common medications

with regular assistance

• Prepares prescriptions with regular

assistance

• Administers common medications with

minimal assistance

• Writes prescriptions for NC content

with minimal assistance

Definitions: regular = 50-74%, minimal = < 25%

NC professional skills benchmarks

Midterm Final

• Regularly participates in professional

activities of practice

• Consistently on time, reliably on call

and integrates feedback professionally

• Regularly participates in professional

activities of practice

• Consistently on time, reliably on call

and integrates feedback professionally

Definitions: consistently = > 90%, regularly = 50-74%

NC overall benchmarks

Midterm Final

• Regularly systematic in skills,

assessments and plans at NC level

• Regularly uses organizational skills for

follow up

• Frequently systematic in skills,

assessments and plans at NC level

• Consistently uses organizational

systems in follow up

• Consistent in final benchmark areasDefinitions: consistent(ly) = > 90%, frequently = 75-90%, regularly = 50-74%

Common gaps and simulated assessment

Common areas where skills may take more time to reach expected level of competency and that may be carried into next clinical courses as learning needs:

• Pelvic exam

• Accuracy of cervical effacement and dilation

• Venipuncture and IVs

• Suturing and episiotomy

• Assisting in NRP and emergency skills

Many of these can be assessed in skills drills and role plays if limited clinical opportunity

Effective feedback and evaluation

Use MEP materials (clinical evaluation form, ‘Guide’) to set expectations and goals

Identify where students are doing well and areas for improvement

Coordinate feedback from other preceptors

Work together with student to identify learning needs and plans

Seek assistance from the tutor as needed

If a student is not at the level they should be, make a clear plan for remediation with the student and tutor

Evaluation meetings

Follow MEP policy for evaluation procedure – preceptor and student complete forms independently, meet together to review, then meet with tutor to report and discuss

Evaluate at appropriate level and be clear about learning needs to be addressed – see clinical evaluation form and ‘Guide”

Roles re: evaluation and grading

• Student self evaluates

• Preceptor recommends grades

• Tutor assigns grade

Tutor can assist preceptor and student with appropriate grading

Grading

Midterm grade options – Satisfactory or Unsatisfactory

Final grade options – Satisfactory, Unsatisfactory, Provisional Satisfactory

Provisional Satisfactory – 4 week remedial placement with objectives and goals, suitable for discrete ‘gaps’

Placement extension – up to 4 weeks if learning opportunities have been limited and/or fall below minimum clinical experience standards

Unsatisfactory – identifies areas where performance falls below expected level; at final evaluation, student will fail and repeat the course when it is next offered

When learning challenges arise

Identify issues early

Notify tutor and seek assistance ASAP

Document your feedback and evaluation in relation to competency expectations

Set goals and depersonalize – use the ‘Guide’ and clinical evaluation form

Make a remediation plan with tutor assistance

Create an appropriate time frame for improvement

Facilitate clinical/simulation learning opportunities

Plan for extra tutor check in meetings with preceptor and student

When challenges are significant

Adjust expectations to where a struggling student is at rather than where they should be and assist them to progress from that point

Break down skills and abilities into steps, have student work to their level of competency, and add new step as previous step is mastered

Some students may require more placement time, e.g. provisional placement, failure and repeat course

Learning challenges may signal a need for ‘clinical accommodations’

Students are sometimes assigned to another preceptor or practice for reassessment or if conflict arises that is not resolved

MEP workload policy revisions

Birth numbers: maximum planned births increased, minimum established for primary attended births, maximum established for attended second births

Average prenatal and postnatal visits per week: increased to 20

Birth numbers: balance of primary/second births defined

Time off call per month: reinforced 4 days/month is a minimum

Study time: 24 hour off call ‘academic day’ Thurs 5pm-Fri 5pm

Safety policy: off call time increased to 12 hours and clarified after 24 hours awake

Have these impacted your student’s progress?

Thank you for your participation

Ryerson MEP Faculty Clinical Education Coordinator:

Elizabeth Allemangealleman@ryerson.ca

Ryerson MEP Experiential Learning Coordinator:

Loreto FreireL2freire@ryerson.ca