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What are we trying to achieve?

One of the main tasks of the clinical teacher is to support the learner in raising their awareness of their own strengths and areas for further development. One widely used model which helps develop self-knowledge and insight is the Johari window (1955).

 

 

Known to self

Unknown to self

Known to others

Open arena

 

Blind spot

 

Unknown to others

Hidden (façade)

 

Unknown

 

 

The task of the clinical teacher (through feedback, formative (developmental) assessment, support and a combination of ‘asking’ and ‘telling’) is to help the learner expand the ‘open’ arena (in which a person feels able to ‘be themselves’, is authentic and behaviours are routinised) so that they start to become aware of or feel able to reveal those aspects that fall in the other three areas:

 

  • ‘blind spot’ – i.e. where others can see their deficiencies or gaps but the learner cannot.  This is where formative assessment techniques (such as 360 feedback) and a trusting relationship can help the learner become aware of learning needs. The teacher needs to be able to tell the learner about aspects of their performance or behaviours that may be difficult.
  • ‘hidden’ or ‘façade’ – those aspects where the learner is aware of needs, gaps or deficiencies but others are not. This requires trust to be developed between the clinical teacher and the learner. The teacher needs to ask sensitive questions of the learner so the learner feels able to admit weaknesses or deficiencies or reveal anxieties or fears.
  • ‘unknown’ – this is where the teacher and learner work together to identify areas for development through a combination of asking and telling.

 

Those assessing educational needs can help the learner to move through the stages in the

‘competency model’ of professional development (Proctor, 2001, Hill, 2007) as shown in the

table below.

 

 

Unconscious

incompetence

Conscious

incompetence

Conscious

competence

Unconscious

competence

Learner

Low level of competence.

Unaware of failings

Low level of competence. Aware of failings but not having full skills to correct them.

Demonstrates competence but skills not fully internalised or integrated. Has to think about activities.

Carries out tasks with conscious thought. Skills internalised and routine. Little or no conscious awareness of detailed processes involved in activities.

Clinical teacher: assessing learning educational needs

Supportively helps learner to recognise weaknesses, identify areas for development and become aware of learning / development needs and thus conscious of ‘incompetence’.

Uses range of skills and techniques to assess learner’s development in relation to defined expectations for the level and stage of learning. Helps learner to develop and refine self-assessment skills. Reassures and supports.

Helps learner to develop and refine skills, reinforces good practice and competence through positive regular feedback and a focus on areas for development and refinement of skills, additional knowledge required and an integration of competences.

Raises awareness of detail and unpacks processes for more advanced learning. Helps learner to identify any areas of weakness/bad habits that they may not be aware of.

 

 

Let’s take an example of a second year undergraduate nursing student who is in the third week on an acute medical ward placement. Being a second year, they are very much in the early stages of the ‘novice to expert’ trajectory. You notice that they are very good at the practical procedures you have observed, but they seem a bit shy and reticent with patients’ relatives, especially those who are very unwell. You ask the student to meet up with you in the afternoon of the late shift when there is time to have a conversation. Starting with asking how they are finding the ward and how things are going, the student tells you that she is enjoying the ward, particularly being able to practice a wide range of practical skills. You share with them that you have noticed their proficiency and agree some further procedures which the student can observe with a view to practising these before the next placement, which is surgery. So you have reassured the student that they are on track and established where the student feels they are in terms of competence and also agreed some further development towards ‘conscious competence’.

 

Thinking points

Taking this example further (based on your own role), how might you approach the issues around communication skills? Specifically:

What would you ask?

What would you tell?

What development activities might you put in place?

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