Learning and Teaching Workshop: Supporting Students in the Workplace - Video Transcript

First of all – welcome. What I’m going to cover today is – more or less the fundamentals around: What is learning? Why is it important to understand how we learn? The different types of learning styles. So then, that in turn, can you recall – how you teach or how you work alongside and the different types of learners that come into your organisation.  For example, as I’m talking today some of you may have to look at me intently, but don’t look too close. Some of you may have to take notes. Some of you may have to listen, so you will all learn in different ways. Many of you may – if I put you on the spot at the end of the session and asked you – what was one aspect, or what was one key point that you learned today? Some of you may not be able to give me that key point, because you don’t learn so well if you feel that I’m interrogating you. I think a lot of the time; it helps that learning takes place at the bed side. The reality is, most of the learning may take place from that student or that learning, when it goes away it really thinks about what happened today in a more meaningful way. So learning for many of us is so vastly different. I’m a list writer. I have to write myself lists, otherwise I’m about to go off track. So it’s very important for me not only to think about why are you all here? But, to set the scene, and that’s why Caroline went around and asked you who you are primarily and how do you supervise? To give us an understanding of your context, so the three or four of us may be here today and we may have a particular program – but it isn’t until we understand the needs of the learner or the needs of the audience that we can really try to tailor the information to use it to make it much more meaningful. So when I see people from Emerton park recently – I think ohh, that’s lovely because Chris is very good friends with my very good friend and I know she’s a pretend sister, so I’m one of those learners who learns by association. I think oh, I remember them now because they are from Spencer and that’s a place that I love to visit. So we all learn in different ways. But what I want you to think about in your tables first is – what do you think learning is? What is your definition of learning? Because it’s very important in terms of the context that we start off on the right path. So if you just have a conversation amongst your four or five – what do you think learning is? What is your definition of learning?

So, I need somebody from each table at one point – not to point anybody out this soon into the session. Who can just give us, maybe, their definition of what they think learning is. Taking on new information. Recognising information – so information is the key word too. It’s around process. We were talking about the fact that you know, the person has to want to learn first to increase their knowledge and skills. The difference between being able to understand it, different people with different styles of teaching to say look – depending on what style they took on. Around motivation, it’s around process and it’s around a want or a desire to learn. Using that information, if you’ve retained it and kept it in there then it’s going to come out somewhere for me, the important part of learning is around application. So that’s good, and we’re all on the same, we all have an understanding now of what we think learning is and are probably a myriad of definitions of what learning is. But around our occupations it’s important that not only we learn for learning’s sake, but that we really learn to understand and especially in health we have to think about learning and learning in context. Because whilst there are so many learning theories and yes we know that from the data that we are born like Prince George and we learn. But when we think about learning in health there are so many other things to think about and that’s why it’s so important to just set the scene. Your all here today, your all health care professionals and yes I know that from the moment you became a healthcare professional you were learning to learn. You were taught and you were thinking about what you learnt and how you were going to apply that to really think about what it is that you’re really doing. So setting the scene is incredibly important.

When we think about learning in health, there are so many things to think about. For example we use our senses, and so if I was to say to any of you which all received hand over on a particular person and the care that’s relevant to that person. Who here might have received a hand over? Who here had to look at the persons notes and look at the patient to find the residents history in the first instance to gain an understanding of the care that they are being provided with for that person? Who looks at the notes first up? Some of you. Who has to go and visually look to the person/patient/client/resident to get an understanding or a deeper understanding of that person? Yes. Who has to have a further conversation with another to gain a deeper understanding of that person or their history? A few of you, so what that demonstrates is that there’s different ways that we take on-board information and I know when I worked in particular environments and I used to sit there after hand over and I used to look at all of my colleagues who rushed up to the files and started pulling them out and reading everything, and think – why are they doing that? Because I was the type of person who had to go and visibly look at the people who I was providing care for. Because as Juliet was saying a minute ago – you receive a hand over, you receive a hand over that somebody has a nasogastric tube inserted and they are in severe pain. There on liquid orally. They have received some bad news overnight. You get a visual picture of the person, and then you go into the environment in which they are situated and they are laughing, smoking and you know having a lovely time. And you think, well the picture that I formed from that person from hand over is not actually the person that I’m visibly seeing.

And so there are lots of different ways that we take on-board information and Angela will follow that up when she talks about cues later on when we think – how are we getting the information? How are we using it? And our senses.  How do our emotions come into play when we’re thinking about particular environments? And that’s what students want to know, that’s what learners want to know. They want to know – how would you like them to learn in the environment? I know that Kim works in the community – a lot of community nurses say: Annette, how are we going to teach the learners how to think like me? So what I would say to anybody in the community is, get the students to focus on their senses. Because, and students are lay people, and going into any healthcare environment is sometimes so overwhelming they have no idea what to focus on next. They think about their previous understanding and in terms of health, they think about those television shows that they have watched. Like Doctors, or RPA, or All Saints, or some of those shows. Because they think that’s what happens in health and it’s so overwhelming.

But especially in the community, if you say to a student – today what I want you to focus on is: listening. And at the end of today I want you to tell me, or at the end of going into that person’s environment – when you first walked in, what did you hear? Then we will have a conversation about that. Or when you first walked into that person’s environment what did you see? I don’t want you to say anything. I don’t want you to do anything. I want you to really focus on what did you see? So then what you can do over a period of time is really developing the students, there isn’t an understanding of how in health do we use our senses? Because I know that any of you can walk into any environment and I know it’s an operating room suite nurse. When you greet that person they don’t even have to say anything and you have, I guess, performed the most amazing assessment by using all of your senses.  But the students don’t see that you’ve just done that. So I would be saying to any of you for some students to break things down. Today is the day that we are really going to focus on listening, or today is the day we are going to focus on talking or observing and that becomes so much more powerful to the students. When you think about their particular types of learning styles. And I imagine that as we have just had that conversation you all learn differently, so again if I gave you all your new iPad 4 today for turning up to this environment – so you reach underneath your desk and you’ve got your new ipad 4 so you can all get on Facebook later on.  I want to know, when you rip it out of the box and you realise is it black or is it white – who here has to, or has just been to press every button to make it work? So you learn by doing, you’re a kinaesthetic learner. Who here would have to read the instructions? Some of you. Who here would have to ask somebody or watch somebody next to you so you could learn it that way? So, what you have to appreciate is there the different ways that you learn. Every learner that comes to your environment may not learn like you do. So rather than saying sometimes to Juliet, Angela or myself – oh, the student is just not getting it. Our advice would be try to change the way you’re giving it. Because sometimes it makes all the world of difference.

Question: Just regarding that. Do students have a module where they identify their own learning style? Cause I’ve asked different students – you know, how do you learn the best? What’s your learning style? Clueless. So, and I find that a bit difficult. So, yeah, I was just wondering do you cover that?

Answer: Sometimes students need gentle reminders and sometimes when you’re developing your orientation package, or information, if that’s a particular focus in your environment – I would be saying to students it’s very important in the first instance that you try to understand the best way of learning for you. If I came to your environment and you asked me – Annette we are using a new syringe driver, come here and I’ll quickly show you how to run the line and set it up. I would have to say Kim, can I please have the manual. Because unless I understand how it works, why it works – I can do it, but I’m not really going to be able to understand the intricacies of that piece of equipment.  In health we are so go at ripping things out of the box, tidying up, having the new piece of shiny equipment, putting the manual somewhere in a file that starts with N. That’s not good for people like me who actually need to read the manual. The operating room suite is a great environment for that. There’s so many pieces of equipment that make noises, but not often do we actually get the instruction manual out and find out why are they making those noises. We know how to press the mute, pause or that do not alarm button. But actually understanding why and so what becomes very relevant to students who learn a particular way. So that is what I would put in the orientation manual. It’s very important for all of us to understand – how do we learn? As well as, why do we learn? Potentially, what is the preferred learning style? And there’s so many easy instant tips and tests (on why the students can quickly do for you) to understand your learning.

Don’t ever assume that people learn the way that you teach. I think it is very important, especially in the first instance that we are going to have learners for eight weeks, or eight months it seems in some disciplines that you tack it to the student’s preferred learning style. Because it makes it so much more relevant.  So, does that make sense?



Setting the scene, and understanding learning and learning styles:

Becomes very important, because the research tells us that if people are engaged with the process, they understand the relevance, they understand the context of why they are in a particular position. It becomes so much more meaningful. So, when we think about expectations for example. For all of you who currently have students in practice or you’re going to be having students in practise – what are your expectations of those people when they first come to your environment?

I’ll start with somebody I know – Michael. You have just been told that a student is coming to the ED and they are starting on Monday. What do you expect from that student when they first turn up?

-          That they are willing to learn. 

-          Expect them to be dressed appropriately. I have had a student in tights. I’m amazed how people think that tights are a form of dress. 

-          I think that I would like to have that enthusiasm for the area that they are going into.  A little bit of understanding, of what their role is. 

-          Respect.

-          Learning in terms of the context and the organisation itself.

-          I like to know exactly what they would like to get out of their experience.  Especially in their specialty area.

-          Ask questions.

-          Able to listen and take instructions.

-          Expectation, especially in third year, that they have a certain level of capability. That their learning so far has got to a certain level. Sometimes we find that that isn’t so.

-          Confidence.

-          I expect that they are prepared to reflect back on what they have done.

-          Time management.

-          Punctuality.

So in terms of expectations and one reason that I don’t use PowerPoint, I like to use colour. The only reason that I will write things up on the boards is as a form of clarification. Because sometimes, I’m like sunrise and the conversation may not be correct. So another handy hint, as you’re having a conversation with somebody to potentially write it down or to speak it back so the person can add – no I didn’t mean that, I meant this. So that’s a sort of important teaching and learning tool. So when we think about expectations it is very important from a learner’s perspective and a teacher’s perspective – to name it up front.  Because to fit in, to feel valued, to set the scene we need to know the ground rules. We need to know really, not what would you want. But most importantly when we are thinking about learning it’s about the why, it’s about the rational. It’s about, as Julie was saying, It’s about the application. So I need to know that if you want me to listen – what’s the relevance of listening in this organisation for me? Well you need me to listen, and you need me to follow instructions because that demonstrates for me the capacity to be a safe practitioner.

If you are ill informed or you incorrectly hear the information potentially you could harm people. So it’s very important that when you are setting out the ground rules or having a conversation around your expectations that you provide a rational as to why would you like this set of behaviours? Does that make sense? Because we understand health, we understand the domain; you understand your clinical context. But what happens is – it’s like me walking here today with a 1000 piece jig saw puzzle, tipping it upside down on the floor, taking away the picture and saying – go do that! There’s all these little pieces, but you have no idea about what the big picture looks like. That’s how students feel; they don’t know what you want them to look like. They don’t know how you would like them to behave. They know they want to be Mel, they know they want to be a social worker. But they don’t really know what a beginning level social worker looks like. Or how they behave, because they are not there yet. But they certainly want to get there. They want you to show them the big picture. And then incrementally show them how to get there. We sometimes don’t do that, they have visions from the television and from the media what they think your profession may look like. But they don’t know how they can do it. And that’s why providing these small incremental steps as opposed to bombarding people with information sometimes works better for some people.

When it comes to initiative, again, it’s hard to use your initiative if you don’t know what your initiative in this context means. Because we sometimes know in health, using initiative could be dangerous. Again it’s spelling out what does initiative mean. Yes I want you to question, but I might be quite shy or I might be quite timid or I’m actually not sure what types of questions you want me to ask. So it’s spelling out what it is that you want and why. Does that sound reasonable? Most students want to do well; most students want to be you. Most students want to provide safe care. They just need to know what are the ground rules. And what is it that you expect from them. Yes we provide them with the theory. Yes they have a list of learning outcomes or goals. They know what they have to do, but they need assistance in how to navigate that within your healthcare space, because they are not being there before. They are almost like lay people and they really don’t have any understanding of your particular context.

If I said to Judy, Judy you’re on the Mersey campus today – I think you can go and work with Lindy in the operating room suite. You would feel good about that wouldn’t you? Or I said Elisa – you’re going to go and work with Michael today in ED. Think about how you would feel. I’m going to say Shan – I want you to go up to the hospital today in Smithton because there’s a crisis. We sometimes get this feeling and even though we are very good at what we do within our own context sometimes being placed outside our comfort zone we doubt our own capacity. That’s how students feel on most days. They know they’ve learnt the information, they know they can apply the information. They know that given the chance they can demonstrate to you an understanding of what it is that you would like them to do. But doubt their own capacity. So how I would equate that is if you were redeployed to another work place every single day. And how does that make you feel? That’s usually how students feel on any given day.

So we have had a think about your expectations. What do you think the students expectations are of you? Or of your work environment on their first day?

-          They want you to be informative.

-          Friendly.

-          Approachable.

-          Respectful.

-          Professional.

-          Patient.

-          Accessible.

-          To listen.

-          To provide feedback.

-          To have knowledge.

-          Be intuitive.

-          Be a good role model.

-          Support.

-          Be there.

Overwhelmingly, when students return from their first stay in a particular environment they very rarely speak about the people they provided care to. They speak about the people they were working alongside. Did they feel welcomed? Did they feel valued? Did anybody remember their name? We often have this conversation that we can go into an environment and months after the students been there and we say – has anybody seen Judy? And they say – who? Oh the student! The students are called the students, regardless of their length of time in the environment. So important in terms of the fundamental skills of communication – to try to remember someone’s name.  You might not have to remember how many L’s does Alison have or Michelle. Sometimes it is important for your colleagues who you have been working with for 10 years and you still can’t remember how many L’s their name has. But it is important to try to remember people’s names in terms of feeling valued, feeling respected and feeling welcomed. And I think sometimes we forget the little things make such a huge difference. Then there’s the old adage about sometimes we might not remember the person’s name, but we never forget how they make us feel. Some students have stories that make us feel quite sad in terms of were they welcomed, or did they feel valued. Cause you can never underestimate how an environment makes you feel and if we don’t make sure that the environment is conducive to learning then the cleverest people may not be successful. You don’t necessarily have to share your stories, but I’m sure that some of you may be like me and when you go into a particular environment – you look on the roster to see who you might be working with on the next shift. Because that could determine what your day might be like. That’s no different for students. A particular type of environment may make them behave in a particular way. Students overwhelmingly have conversations around – they just wanted you to know that you were coming. They want to feel welcome. They want to feel valued. Then usually if we can provide that type of environment most of the time things go swimmingly. Does that make sense? It is no different than if someone came to this environment today and Caroline didn’t know they were coming. And when they all walked in, we were like – oh, who’s that!? Straight away it sets the scene for that person and potentially the outcome is not going to be positive.

Whilst we think about what we would like as supervisors, on the flip side it’s very important to think about what are the expectations of learners. Again I advise on the first day, in terms of orientation of the student to your environment, is to name up front – what are the expectations.  What are your expectations? What are the expectations of learners? It is no different to having a conversation where the patient client resident or relative around learning a new procedure. You really need to understand the ground rules to think about the context and is this environment conducive to learning?  If we are placed in a very noisy environment, when I’m in here I can hear sounds behind me and if I’m the type of person who is very easily distracted – I’m not going to be able to focus. So again really thinking about context – is important if you want someone to retain a particular type of content and then apply that later down the track. So expectation is important.

We have to think about the process; with the process of learning we can set the scene. You understand people style, or their style of learning, you all have an understanding of what the outcome is going to be. Then have a think about how is that person going to demonstrate to you their knowledge acquisition or process of – there is an outcome. So again you then think about well how were you going to work alongside this learning? Kim working within the community is working alongside a student on a daily basis and somehow Kim wants me the student to demonstrate to her that I’ve learnt something. How do you think that students ordinarily demonstrate to their supervisor learning? How do you know that someone has learnt something? When you observe they are competent – so observation.

Reflect – so if we were going to ask: what did I just say to you? What would you say to me Juliet? If I wanted Juliet to provide me with a deeper understanding of what it is that I just asked her to do I would think about my questioning technique and I know that you will be getting another hand out that you don’t have yet.  Which is all around questioning technique – so if you want someone to elicit a particular response, you have to think very carefully about how you’re going to ask the question.  It’s like saying to someone at the end of the day – thanks very much for all your help, I’ll see you tomorrow. Then Juliet will see the student the next day and ask Talia – how do you think you went? She will say, well they thanked me for everything I did today and said come back tomorrow so I must be doing really well. So sometimes the conversations that we have aren’t that explicit. So when we think about questioning students we think about what kind of response to we want. So for example if I want a student to demonstrate to me their problem solving skills, their decision making skills or their critical thinking skills I might say – could you list and prioritise. For example, so Chris might say to me – Annette today we are going to be caring for a person who has been diagnosed with Parkinson’s related to a medical patient. Can you quickly list for me, what are the side effects of that particular medication that we have been giving to that person? Ok, I can go off and do that. Or another one that Michael might say to Caroline who’s working in the ED department – we are expecting a relative to come in now to ask about a particular patient who is not progressing well. Caroline, what do you think you could say to that relative? And why? Does that make sense? Or you can say – if you want to develop somebodies skills. For example, somebody down the back was saying – if you really want the student to demonstrate their capabilities, so the types of questions that you could say to that student – what are our options here? Kim could say, look we have had a referral and we are going to see a person today who has a wound that is not healing, we know that they have been seen by the repair specialist yesterday. What do you think our options are here? You have been working with me now for four weeks. You have seen how I operate – what would you do if you were the community nurse? So you’re very specific in the types of questions that you’re asking of a student and then you are trying to elicit a particular response. As opposed to saying, we have just received all this information – what are we going to do? So try to be much more specific. 

Another good approach is to say to Elisa – how would you handle that situation? So the student would really think about what it is. Now a very good example was, there was a student in a surgical ward the other day and she came up to her supervising registered nurse and went – Uh, I think we need to give the person some pain relief.  Then the registered nurse said, why? Obviously the student said, well the person is in pain. The person was written up as a green zone, with about 5-10mg. So the student was encouraged to think about – should he give 5mg or closer to 10mg, or 15mg and by being given the opportunity to speak out loud, given the time to think about – is the person constipated? No they are not. What’s their pain scale? It’s 8. You know – that student could ascertain that the person needed 15mg. But often students just give 5 and say the other person gave you 5 it seems like the right thing to do. So we need to allow people time to learn, time to think, time to speak out aloud as opposed to just watch me – let’s see how I go and we will have a conversation about that tomorrow.

So if you would like someone to demonstrate their capability – it’s about setting the scene to insure that the person is able to demonstrate their capability in a comfortable and safe environment.  Does that sound reasonable? So, questioning, how you question a learner is very important if you would like the person to demonstrate to you a particular response. When we think about putting all of that together and thinking about how the students learn in healthcare environments again it becomes quite fraught – what you’re so used to, I’m not used to. If I had to go and work in the emergency department today, I had to go into the operating room suite today – there’s so many areas that I would be focusing on because of my heightened sense of anxiety. When we feel anxious as learners or focus, potentially, isn’t what your focus is. And that’s what we have to think about in health.  You’re so familiar with your environment, but the lay person isn’t, the student isn’t.  I think especially when there are students like – and I’m just thinking about in social work. I imagine there are many different types of placements social work students have. I imagine they could be placed in emergency departments, the paediatric environments, community environments. And depending on people previous understanding or previous history – then their focus points may be different to our focus points. So please don’t ever underestimate your own capacity and your own knowledge when thinking about working alongside a learner and trying to focus on the incremental steps – so that person can be you. Because I know that when I, if I was to work in the emergency department, I want to pick someone like Michael to model particular behaviours. Because I want to be him, but I need to know – how did he become like he is. In terms of the behaviours that he’s exhibiting, how did he learn all of that? How does someone like Louise know all of that? How did she learn that? That’s what the student’s want to know, and it’s quite difficult sometimes for you to take a step back and go – I don’t know, I just learnt it. You have to become clever at articulating how you became who you are. Because these students, they want to be you.

They don’t really want to be us do they? No, but they do go into practise, because that practise is about application of knowledge and they want to be you. So, that’s my parting point. How do the students be you? You are safe practitioners, you are very good at what you do, you are knowledgeable and your levels of communication are phenomenal and the students need to know that. I think sometimes we focus so much on content that we forget about the process, and for me it’s all about the process. Because if the students can learn the process, if the student midwife can learn the process of learning in midwifery they should be able to transfer that process to any healthcare environment, and function safely.

One parting point, for all of those that have competence or competence based assessment – competence is around knowledge, skill, attitude and behaviour. We so often focus on skill acquisition – that’s the skill of priming the line, the skill of undertaking a comprehensive assessment, the skill of communication. But sometimes we may not focus on the knowledge required to undertake that particular task. We may not focus on the attitude or behaviour that is associated with that particular procedure. Though competence, knowledge, skill, attitude and behaviour it is so important. Because more often than not its people like me that get called about a particular student and their behaviour – I need your help, I don’t think the student is progressing satisfactorily. I will say I need more detail.  Julie will say, as far as knowledge base is concerned that student is phenomenal. As far as their skill, you know their skill around manual dexterity and technology far surpasses my own. However, I’m getting comments that they are rude, they are disrespectful, they are not engaged, they are not punctual and they are definitely not demonstrating any behaviour around enthusiasm. We need to have a conversation around that because competence is knowledge, skill, attitude and behaviour. Sometimes it isn’t until we point it out to the student or the learner that whilst you have been focusing on these two elements. You really need to now focus on your attitude and behaviour. By that I mean this, this and this. Because sometimes people have never received feedback about their attitude and behaviour. We are too worried, because we think that someone might think we are picking on them. We are only ever commenting on performance improvement practise and in health competency is around skill, knowledge, attitude and behaviour. So that’s one thing that we know we have to get better at. We know that we need to be providing supervisors with much more information about how do we provide people with feedback. But in particular feedback around attitude and behaviour and it is no different from being an emergency healthcare professional and working alongside a colleague for a very long time who you wish you could provide them with feedback around their attitude and behaviour. There’s people in your environment who are – their communication skills do require some enhancement.  They do require information about the importance of being punctual and being professional, but we need to become cleverer at giving that feedback. Because it is, as healthcare professionals we do sign off on a regular basis that we are competent.  And attitude and behaviour is one third of that. Our professional sense of responsibility and behaviour.

Any questions?

So it’s around the process, it’s around thinking about what is learning? Why are people here? If we would like them to acquire information – why? How are they going to apply that information? And why?