Mentor Training for the Yearlong Internship

Objectives for the Training By the end of this training session, participants will be prepared to: Appreciate the purpose and value of the yearlong internship Contrast role of Clinical Instructor vs. Mentor Apply effective characteristics in a Mentor-Mentee relationship Structure a final clinical experience to facilitate professional growth along a continuum Enhance clinical teaching skills using tools for a successful yearlong internship

Yearlong Internship Model Paid Year-long Internship Post-graduation Learning in a “Community of Practice;” Professional Socialization; Proficiency; Self-Efficacy & Confidence Pre-graduation Entry-level competency Structure and Ongoing Mentoring Licensure (Portney and Knab, 2001: Plack, 2011; Black et al, 2011)

Goals & Expectations: Yearlong Internship Entry Level Transition to 1st Year Progression of Responsibility & Skill Continuity of Professional Development Pre-graduation Post-graduation

Prepare Graduates to: Provide Patient-centered Care Utilize Evidence for Clinical Reasoning at a High Level (Moral & Ethical) Be Reflective Practitioners Be Life-long Learners Seek Mentoring

CPI Definition: Entry Level Without guidance or clinical supervision for simple or complex conditions Proficient and skilled in simple and complex pt care Consults with others for unfamiliar or ambiguous situations Capable of maintaining 100% caseload

CPI Definitions ENTRY LEVEL BEYOND ENTRY LEVEL Without guidance or clinical supervision for simple or highly complex conditions Proficient at highly skilled pt care, capable of serving as a consultant Functions in unfamiliar or ambiguous situations Capable of maintaining 100% caseload and seeks to assist others Capable of supervising others Without guidance or clinical supervision for simple or complex conditions Proficient and skilled in simple and complex pt care Consults with others for unfamiliar or ambiguous situations Capable of maintaining 100% caseload

First Year of Practice: Article Highlights Professional Identity and Role Transitions Learning Through Experience Growing Confidence / Self Efficacy Clinical Environment Community of Practice Black, et al, 2010)

Novice to Expert Development in Physical Therapy Fellowship Residency 1st Year of Practice Entry-level Education

Novice to Expert Scale Level / Stage Description / Characteristics Has incomplete understanding; approaches tasks mechanistically; needs supervision 2. Advanced Beginner Has working understanding; tends to see actions as a series of steps; can complete more simple tasks without supervision 3. Competent Good working background understanding; sees action in context; able to complete work independently; still needs refinement 4. Proficient Has a deep understanding; sees actions holistically; can achieve high standard routinely 5. Expert Has an authoritative or deep holistic understanding; deals with routine matters intuitively; goes beyond existing interpretations; achieves excellence with ease (Adapted from Dreyfus, 1981)

Novice to Expert Development: Learning within a Community of Practice Engagement Observation Reflection Discussion  Leads to shared understanding / shared meaning (Plack, 2006)

Necessary Skill Set: Focused Development Clinical Skills Clinical Reasoning Professionalism Self-Reflection & Assessment Lifelong Learning

Necessary Ingredient… Patients Self-Reflection TIME Colleagues

Role Delineation Clinical Instructor Mentor

Role of Clinical Instructor Develop Entry Level Clinician Set Goals & Plan Design Learning Experiences Determine Learning Needs & Continue to Challenge Evaluate Performance & Provide Feedback

Essential Characteristics of CIs Interpersonal Skills / Communication Professionalism Instruction / Teaching Evaluation / Performance Assessment (Recker-Hughes C, et al, 2014)

What is a Mentor? “An experienced and trusted person who gives another person advice and help, especially related to work or school, over a period of time.” (Cambridge Dictionary) “Wise and trusted counselor or teacher.” (www.dictionary.com ) “Someone who guides another to greater success.” (yourdictionary.com)

C I Mentor Clinical expertise Advanced CDM Open communication Constructive criticism Relationship with mentee Skilled at facilitating refection Seek opportunities for student learning Developing colleague life long learning Professional socialization Good communication & Interpersonal skills Professionalism Provide learning opportunities Facilitate CDM Evaluation / Assessment - Provide feedback Developing an entry-level clinician Focus on CDM Challenge students Role model Communication skills Facilitate student learning Feedback Facilitate reflection Professional development

Mentors for the Yearlong Internship: Recommended Criteria Pre-graduation Phase Post-graduation Phase One Year of Clinical Experience All criteria for pre-graduation plus: APTA CI Credentialing Course (basic level) or Equivalent Supervised at least 2 fulltime clinical experiences, preferably with more advanced students (or mentored staff) Strong Clinical Reasoning and Decision-making Evidence of ongoing professional development (e.g., clinical specialist, residency/fellowship training, APTA / professional organization membership Completion of Mentor Training

Mentoring Relationship Mentor’s Roles Mentee’s Roles Teach Learn (with intention) Assess Respond to Feedback Facilitate Communicate Support Motivated for Continual Growth Challenge Take Risks **Mentee (intern) drives the experience

Qualities of a Good Mentoring Relationship Constructive and non-judgmental Positive, facilitative, and developmental Willingness to support the relationship Mutual trust and respect Adequate time

Expectations of Mentees Clarify interests and needs Prepare for role in the mentoring relationship Actively seek feedback Be specific Be receptive to feedback Recognize value and limits of the relationship Be open to information offered Show appreciation for time and assistance given

Skill set – What are we trying to develop through the internship? Clinical skills Reasoning Professionalism Self-Efficacy / Self-Confidence Efficiency / Time Management Teamwork & Collaboration Professional Roles & Responsibilities Leadership

Creating a Structure – “Curriculum” Post-graduation phase Determine Time for Direct Patient Care Block Out Time for Non-direct patient care Suggested: 4-hours per week

Creating a Structure - Curriculum Direct Patient Care Ramp up to 100% Caseload Goals to improve proficiency & efficiency management of caseload Effective team member Non-Patient Care Time Time with Mentor (most valued) Reflection Learning Opportunities Contributions to facility Post Graduation Suggested Allotment: 36 hours patient care 4 hours non-patient care time

Professional Development Plan Development Area Target goals Strategies / Activities Resources Needed Clinical Skills Professionalism Self-efficacy / self confidence Efficiency / Time management Teamwork & Collaboration Leadership

Tools to Facilitate Professional Development Clinical Reasoning Professionalism Reflection Mentor articulates own reasoning Role Model Guiding Questions ICF Worksheet Generic Professional Abilities Planning forms Mind Mapping APTA Core Values Journal / Narrative Clinical Reasoning & Reflection Tool Dreyfus model One-minute CI

Expert Practice in Physical Therapy Expert’s Reasoning Process Patient is central to reasoning process; collaborative problem-solving Intuitive reasoning process Reflection on reasoning (Jensen, G, et al, 1999)

Dreyfus Model of Skills Acquisition – Clinical Reasoning

ICF Reasoning Worksheet

Clinical Reasoning Mind Mapping

Clinical Reasoning and Reflection Tool

Clinical Reasoning and Reflection Tool

One-Minute CI Https://www.youtube.com/watch?v=P0XgABFzcgE Get a Commitment Probe for Supporting Evidence Teach General Rules Reinforce what was correct Correct mistakes

Facilitating Growth in Professionalism: “Generic” Professional Behaviors Critical Thinking Communication Problem Solving Interpersonal Skills Responsibility Professionalism Use of Constructive Feedback Effective Use of Time and Resources Stress Management Commitment to Learning (May, Kontney, Iglarsh, 2009)

Facilitating Growth in Professionalism

Facilitating Growth in Professionalism

Facilitating Growth in Professionalism (APTA, 2007)

Guiding Questions: Judger vs. Learner What went wrong? What did you do wrong? How will this be a problem? Why was that a stupid thing to do? Why did you do it that way? How are you going to fix this? Haven’t I told you this before? Should we bother to discuss it? LEARNER What worked? What can you have an impact on? What did you want to happen? What can you learn? What’s useful about this? What’s the big picture? What’s possible from here? What do you think this pt needs? (Adapted from Adams , Change Your Questions Change Your Life, 2009)

Mechanisms for Reflection

Staying on Track: Performance Measures Pre-graduation Phase Post-graduation Phase Planning Forms Professional Development Plan Monthly Benchmarks Employee Performance Appraisal Clinical Performance Instrument (Mid-term and Final)

Summary / Next Steps Resources and presentation will be posted on CI Community Website www.cuphysicaltherapy.org/clined Password: ClinEd