Managing difficult situations - tools for supervisors

Many organisations and learning institutions have their own frameworks in place to assist clinical educators in taking action to identify and manage students in difficulty.  The following strategies and considerations are suggested by The Queensland Occupational Therapy Fieldwork Collaborative (2007) when addressing concerns that are impacting on a student’s ability to perform on placement:

Identify the problem

• Raise the concerns you have early and provide the student with specific examples of the behaviour you have observed.  This includes providing timely feedback throughout the placement.

Explore the background to the problem

• ­Provide opportunity for the student to reflect on the feedback provided and discuss the background and contributing factors to any difficulties.  Use of active listening and open questions are useful skills to demonstrate in discussion with the student.

Be Supportive

• ­Provide the opportunity for the student to explore solutions to the issues raised before problem solving for the student.
• Consider the student’s preferred learning style and any fears or anxiety they may have.
• Direct the student to formal counselling support through their university if the need is identified and the student expresses readiness for this support.  Contact the specific university placement coordinator for guidance.

Develop a strategy

• ­Once the issue has been isolated, brainstorm solutions with the student.
• Strategies and outcome measures should be established so the student has clear expectations and opportunity to gain competency in the desired skill.

Maintain confidentiality

• ­Universities require that confidentiality relating to academic and clinical performance, university grades and personal issues raised during supervision is protected while on placment.

Document the process

• ­Include all important observations, discussions and decisions in minutes of the supervision sessions ensuring the supervisee and clinical educator have a copy of the documents including agreed strategies and timeframes.

Seek support

• ­Clinical educators can seek the support of other clinicians or the supervisor at their workplace regarding their concerns, being mindful of confidentiality.
• Throughout the process of working with a student in difficulty, it is vital to remain in contact with the placement coordinator at the university. The clinical educator may feel the issues can be remediated during the course of the placement, however, communication with the university can assist the placement coordinator in planning subsequent placements and ensure the student has demonstrated their ability to implement the skills they have been taught (Nemeth, E and McAllister, L. 2013).

Review and evaluate outcomes

• ­Ensure that dates for review and final evaluation are agreed on with the student and that feedback regarding the specific issue is provided in a timely manner.  Strategies may require review and modification depending on the student’s progress.

 If the student continues to underperform and not implement the agreed strategies, the clinical educator may need to fail the student.  Failing a student is difficult for the student and the clinical educator and the response from the student may vary depending on their readiness to learn from the experience.  Nemeth and McAllister (2013) describe readiness to learn as a student’s “readiness to use the experience of failure in fieldwork placement as a catalyst to alter perceptions of themselves and their worldview… The experience of failure … can become a transformative learning experience” (p 117).  Students who are not ready to learn from the experience and accept the failure can become angry, depressed or remain in denial and blame their clinical educator (Queensland Occupational Therapy Fieldwork Collaborative, 2007; Nemeth & McAllister, 2013). Intervention from the university placement coordinator is required to ensure supports and strategies are put in place to provide the student with their options, and support the clinical educator.

Troubleshooting

Preventing observed difficulties becoming a crisis is key to the management of a challenging clinical education experience. The Griffith University Physiotherapy Clinical Education Resource Manual (2013) lists some advice gathered from students on ways for clinical educators to troubleshoot difficulties with students including:

• Be friendly.
• Be approachable.
• Let students know from day one that you want questions to be asked.
• Let students know they are there to learn, not be examined.
• Find out what the student wants from the placement.
• Make sure the student knows that it does not matter if they answer a question incorrectly.
• Do not be intimidating.
• Give positive feedback as well as constructive criticism.
• Find out the way the student likes to learn – if they need observation first or if they like to get in and try first.
• When possible, give tutorials.

(Griffith University, 2013, p 68).

Barriers to supervision by the clinical educator are outlined by the Health Education and Training Institute (2012) and include being absent, ridged, intolerant or irritable, telling instead of coaching and exhibiting a ‘blaming’ attitude. These behaviours can lead to student avoidance, anxiety, poor performance and impact on patient care and safety.

Clinical education frameworks recommend that an agreement or preventative plan is made between educator and student at the commencement of placement on how conflict will be resolved if it arises (Cunningham Centre, 2011).  Including the opportunity to discuss conflict on the agenda for supervision sessions keeps communication open (Western Australian Country Health Service, 2009).

Siggins Miller (2012) outlines a list of enablers to successful placement. A clinical educator can ask themselves the following questions before and during a placement to enable a successful experience for both the student and themselves:  

• Does the placement provide a culture of quality (quality relationships, learning and best practice)?
• Am I providing effective supervision?
• Is the placement providing the student with learning opportunities that include direct patient care in a supportive environment?
• Is there effective communication and collaboration between students, the academic institution and placement site?
• Are there adequate resources and facilities to conduct placement activities?

Asking these questions prior to the commencement of the student placement can assist the clinical educator in identifying areas for their own professional development in clinical education.  In addition, Siggins Miller (2012) identifies that occupational stress and workplace incivility and aggression are shown to have a significant impact on the quality of a student placement and can lead to underperforming due to stress and anxiety.  A clinical educator can assist in preparing the student for workplace factors in the initial stages of the placement, monitor the impact on the student and provide opportunity to debrief.

Summary statement

Managing a student in difficulty is one of the most challenging situations a clinical educator can encounter.  The types of difficulties encountered by the student can be as a result of multifaceted internal or external factors.  A level of empathy and commitment from the clinical educator and university to work with the student is required to achieve the goals of placement.  Successful negotiation through the difficulty requires early identification, open communication, skilled reflective practice and development of a clear plan of action with regular reviews between the student and clinical educator.

We also advise the Clinical Educator to refer to the Maintaining Emotional Wellbeing section of this website when Managing a Difficult Situation.

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Queensland Health have produced a fact sheet for Occupational Therapists working with students who are having difficulties

References:

Please Note: References remain valid until superseded by later research. The resources referenced here are regularly reviewed and are considered current and relevant to the topics presented.

• Occupational Therapy Practice Education Collaborative-Queensland (OTPEC-Q) (2018). The clinical educator’s resource kit Retrieved from:  https://otpecq.group.uq.edu.au/resources-publications/clinical-educators-resource-kit.
• Nemeth, E., & McAllister, L. (2013). Learning from failure. In Stagnitti, K., Schoo, A., & Welch, D., Clinical and fieldwork placement in the health professions (2nd Ed) (pp. 115 – 127). Melbourne, Australia: Oxford University Press.
• Griffith University (2013). Physiotherapy clinical education resource manual. School of Rehabilitation Sciences. Gold Coast, Australia: GU.Australian Learning and Teaching Council (2010). A guide to supervision in social work field education (revised edition). Retrieved from: http://socialworksupervision.csu.edu.au/.
• Health Education and Training Institute (2012). The learning guide: A handbook for allied health professionals facilitating learning in the workplace. Sydney: HETI. Retrieved from: http://www.heti.nsw.gov.au/Global/HETI-Resources/allied-health/allied-health-learning-guide.pdf
• Siggins Miller Consultants (2012). Promoting quality in clinical placements: Literature review and national stakeholder consultation. Adelaide: Health
• Health Workforce Australia (2013). Enabling Clinical Supervision Skills. Griffith University, Gold Coast Australia.
• Western Australian Country Health Service (2009). Foundations to supervision. Perth: Combined Universities Centre for Rural Health and Western Australian Department of Health:  http://www.wacountry.health.wa.gov.au/fileadmin/sections/allied_health/WACHS_G_AH_FoundationsToSupervision.pdf