Teaching methods for enhancing and supporting clinical performance across the educational continuum : book to bedside and beyond.

Background: Health professional education is a continuum, beginning on the first day of an undergraduate degree and concluding only when the individual leaves the profession. The challenges for improving clinical performance are trans-disciplinary and international. Improving clinical performance is imperative for improving the quality of our health service delivery. It is a core-business of universities and other educational institutions. Improved education can impact on student and clinician behaviours. Aim: This collection of research aimed to investigate what teaching methods enhance and support clinical performance across the educational continuum. The studies were applied to the contexts of undergraduate education, the transition from campus to clinic, and post-graduate educational settings. Method: The research began by conducting a systematic review of the literature to determine the existing evidence for differentiating which educational methods have the ability to enhance clinical skill learning outcomes in health professional education. Gaps in the literature identified from the review were then combined with topical issues facing the candidates health professional department, determining the type and sequence of the studies that followed. The departmental needs included facilitating student feedback on performance, flexibility in resource utilization, supporting the transition of student performance from campus to clinical education environments, supporting multidisciplinary and interprofessional education, diversifying our educational interests into post-graduate continuing professional development opportunities, and developing efficiencies to protect against financial restraints. Qualitative, quantitative, and mixed method research designs, including audits, multi-centre and inter-disciplinary trials, five randomised controlled trials, and an economic evaluation, were utilised to explore the research aims. Results: The results have progressed our understanding of teaching methods for clinical performance and informed the development of departmental and faculty activities. Key study outcomes included; 1) Providing evidence that students supplementing their learning by undertaking self-video of their clinical performance can have significantly increased learning outcomes measured through objective structured clinical examination (OSCE) scores, 2) That innovative web-based practical skill teaching methods can produce comparable clinical skill learning outcomes in comparison to traditional live tutoring, offering flexibility in teaching resource utilization, 3) Informing guidelines for the implementation of student self-video of performance into modern practicum, 4) Using digital repositories of teaching and learning resources can improve the efficiency of data retrieval, supporting clinical skill performance of both on-campus students and those in clinical education, 5) Development of guidelines for facilitating genuine critically-reflective practice to maximise self-improvement from clinical encounters, 6) Identification of the degree of variation that exists in the clinical-educators perceptions of what constitutes competent clinical-performance; fuelling the discussion for equity in assessment and the expectations of student workplace performance, 7) Web-based and face-to-face education delivery can produce equivalent learning outcomes for the domains of participant attendance, adherence, satisfaction, knowledge, and self-reported change in practice, and; 8) Although Web-based education is robustly superior within breakeven analysis from the perspective of the education provider, cost-effectiveness from the perspective of the health service, and cost-benefit from the perspective of the student, vary in their results of the favoured delivery method depending on the sensitivity analysis applied. Conclusions: The choice of teaching methods and educational supports can influence clinical performance. In large, practical considerations should drive delivery selection choice. Innovative Web-based learning activities can be appropriate for education of clinical-based skills, and not just for knowledge transfer. However, care must be taken in the design and implementation of the Web-¬based activities to ensure optimal student engagement and educational value. In the presence of equivalent learning outcomes from differing teaching methods, decision-makers should focus on questioning the efficiency of the delivery methods. The studies have combined to further the evidence base for the field of clinical education research across the educational continuum -book, to beside, and beyond.