So You Are a Clinical Instructor—Now What?

TOOLS OF THE CLINICAL INSTRUCTOR

The very first thing that a clinical instructor needs is the term-by-term clinical learning objectives for the program. These spell out expectations on what students should be able to accomplish by the end of each term. Over the course of multiple terms, the outcomes should increase in complexity as students advance from the basics to the higher-level studies and skills such as multitasking and analysis of images and scenarios. Review of the term’s learning outcomes will allow an instructor to shape student activities for maximum benefit.

A second vital resource is the program’s student handbook. This amounts to a contract between the program and the students in a given cohort. From the student handbook, a clinical instructor should be able to learn about the program’s overall structure, including the various didactic courses and how they fit into and around the clinical experiences. The learning outcomes for the clinical terms will be found in the student handbook, as are expectations for student behavior. These can be mundane, such as requirements for attendance and timeliness at the clinical site, or nuanced and situation-specific, such as communications with patients and medical staff. A clinical instructor does not need to know the student handbook in detail but should know how it can be accessed and where to find those parts relevant to clinical education.

Many programs offer training to their clinical instructors. This may be in the form of a 1-d seminar or an in-service session by a program official. The offered training might be spelled out in the documents that are shared with the program’s clinical sites. Some programs have specific recommendations on providing feedback, for example, or preferred ways to handle behavioral issues. The instructor should make good use of these opportunities. The more the individual can learn about what the program prefers, the easier it will be to function as a clinical instructor.

WHAT TO EXPECT FROM STUDENTS

The expectations for student behavior vary to some extent from program to program, but they will in general include the following: functioning as part of the nuclear medicine team; cooperating for the good of the department; showing respect for patients, clinical instructors, and other medical staff; paying attention to their communications; making sure to understand and to be understood; taking initiative; not waiting to be invited to participate; taking responsibility for their own learning; accepting criticism and advice without becoming defensive; and engaging with the clinical department in ways that build trust.

Students often start at very different places in regard to these expectations, and it is the work of the program and of the clinical sites to help them to develop these qualities. It should be obvious that the listed expectations will make the student’s time in the clinical site easier.

What does this mean in real life? One should remember that students work hard just to get into their nuclear medicine technology program, and they want to succeed. They want to do exactly what the instructor wants them to do. But this does not happen instantaneously, it takes work on both sides. It is necessary for the instructor to provide critiques of the student’s work and ask the student to change actions and behaviors. Like a potter manipulating clay, good NMTs come about by being pinched and pulled and molded to acquire the right characteristics.

The presence of a new student will initially slow down the flow of work. It might be necessary for instructors to do some tasks themselves so that the overall patient load for the day gets done. Over time, however, the student will be able to do more tasks independently, and the clinical instructor will be able to step back a bit and enjoy the benefit of the hard work put in during those early days.

THE IMPORTANCE OF THE CLINICAL INSTRUCTOR’S ATTITUDE

A clinical instructor’s attitude plays a large role in making the student experience satisfactory for all sides. This has been documented in several professions, including nuclear medicine (2). Various studies have reported that the best clinical instructors are friendly and approachable, supportive and helpful, accessible and available (3,4). “[I]t is a teacher’s attitude toward students, rather than the teacher’s professional ability, that is the crucial factor in whether the teacher is effective or ineffective” (5).

One might think initially that motivation in a clinical training program is all on the student, such that highly motivated students are more likely to be successful and less motivated students not so likely. This does not fully describe the relationship between motivation and success. A large, multiprofession study found that students’ rating of their engagement directly correlates to their treatment by their clinical instructors (2). In that study, 18% of clinical instructors were identified as exhibiting behaviors that marked them as “demotivators.” Students who identified their clinical instructors as demotivators worked less hard, paid less attention, and felt more frustrated than students who worked with motivating clinical instructors.

The good news is that the shift from demotivating to motivating behaviors is quite simple to make. Self-determination theory provides an easy-to-understand framework (2). This theory posits that people have 3 basic psychologic needs: autonomy, competence, and relatedness. Clinical instructors who behave in ways that support these needs encourage motivation, as is reflected by engagement on the part of the student. Clinical instructors who behave in ways that thwart these needs demotivate their students. Demotivated students in turn demonstrate disinterest, a desire to give up too soon, and minimal effort.

How can instructors act in ways that support autonomy, competence, and relatedness? One suggestion is for them to support autonomy by creating opportunities for student success, by supporting the students’ needs in regard to each learning task, by tapping into the students’ curiosity and need for challenge, and by allowing students the chance to correct their behavior. Another suggestion is for them to support competence by providing structure, by giving consistent guidance, by offering feedback that provides a measure of personal control, and by offering clarity as to way of achieving desired outcomes. Finally, instructors can support relatedness by communicating positively in both verbal and nonverbal ways, by providing a respectful and supportive environment, and by being concerned for the students’ well-being and self-worth (2).

In studies of clinical instructor characteristics, interpersonal relationships are usually at or near the top of the list of characteristics most appreciated by students. These can be as simple as greeting students in the morning, smiling, looking students in the eye, and thanking students for their help (2). On the other hand, students react negatively to intimidation, embarrassment, and humiliation. Who would not?

One of the most deflating moments for students is when they hear, “I do not work with students.” There are times, such as when a tech is new to a department, that are not conducive to a tech’s having a student. But outside those times, techs should not make this their standard line. This immediately cuts off the opportunity for sharing hard-earned wisdom about how to scan, how to interact with patients, and how to think like an NMT. It limits the number and variety of experiences the student will have. This statement is a primary demotivator for students (2).

DISCLOSURE

No potential conflict of interest relevant to this article was reported.