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mentor education: A world of possibilities through e-learning technology
Nurse Education Today 31 (2011) 263–267
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Nurse Education Today j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / n e d t
Preceptor/mentor education: A world of possibilities through e-learning technology Florence Myrick a,⁎, Wendy Caplan a, Jayne Smitten a, Kerry Rusk b a b
3rd Floor, Clinical Sciences Building, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada Faculty of Nursing, Ed N2-111, University of Alberta, Canada, Edmonton, Alberta T6G 2G5
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Article history: Accepted 18 October 2010 Keywords: Preceptor Mentor e-Learning technology Support Teaching and learning
s u m m a r y Preceptorship/mentorship is designed to socialize students into the nursing profession, promote their confidence/competence and foster their critical thinking ability. In today's global context, opportunities exist for local, rural, national and international student placements which provide exciting and mutually rewarding preceptorship experiences. Despite the recognized value of those involved in preceptorship/mentorship, however, little progress has been made regarding the development of an infrastructure that effectively supports their ongoing education. This project, piloted from October 2008 to February 2009, leveraged our established research and teaching experience in preceptorship with technologies that allowed us to create an accessible and engaging e-learning space designed to support preceptors in a seamless fashion, improve the quality of the student preceptorship and enhance professional teaching capacity. A purposive sample of 25 preceptors was selected with a total of 18 preceptors successfully completing the five month program. Upon completion, participants were surveyed and individually interviewed. Data analysis revealed the program to be informative, supportive and highly valued. Knowledge derived from this study can: a) further enrich the substantive nature and infrastructure of online preceptor education; and b) contribute to clarifying best practices for preceptor support, facilitation, and ongoing professional development with a view to enhancing the preceptorship experience. © 2010 Elsevier Ltd. All rights reserved.
Introduction For facilitation of discussion, the authors use the term preceptorship and its derivatives (preceptors and preceptee) to describe the process of pairing a student in the clinical area with an experienced nurse on a one-to-one basis to engage in clinical practice. The authors acknowledge that in countries such as the United Kingdom, the term preceptorship is analogous to and used interchangeably with the term mentorship and its subsequent derivatives (mentor and mentee) and is used to describe the same process (Andrews and Wallis, 1999; Kaviani and Stillwell, 2000; Neary, 2000; Sword et al., 2002; Watson, 1999). Opportunities for rural, national and international student placement are exciting and mutually rewarding and rely heavily on faculty accessibility. The Faculty of Nursing in which this study was conducted currently partners with agencies throughout Canada and the world including Australia, Brazil, Ghana, Hong Kong, Pakistan, the United Kingdom, and the United States. Up to recently however, there was no mechanism in place to adequately support the ongoing teaching/learning needs of our distant partners. Ultimately, our vision is to create a virtual learning community without borders for educators in the professional disciplines involved in preceptorship ⁎ Corresponding author. Tel.: +1 780 492 0251; fax: +1 780 492 2551. E-mail addresses: fl[email protected] (F. Myrick), [email protected] (W. Caplan), [email protected] (J. Smitten), [email protected] (K. Rusk). 0260-6917/$ – see front matter © 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.nedt.2010.10.026
or field teaching. The purpose of this particular project was to leverage our established research and teaching experience in preceptorship in nursing with technologies that allowed us to create accessible and engaging learning environments. The goal was to improve the quality of the student practicum experience while enhancing professional teaching capacity. The online environment permitted us to develop content and materials that encouraged interaction and dialogue while creating a social learning space in which our local, national and international partners can interact. Using WebCT, Elluminate, and educational learning objects that foster learner interaction and engagement such as case studies, Quandary decision-making mazes and e-portfolios, our preceptors had the opportunity to connect with the learning materials and with each other. This project was designed to become the foundation of our learning program to foster excellence in preceptor/mentor teaching through the engagement of our partners within the broader health care community locally, nationally and internationally. While preceptors are not mandated or required to complete such a program, they are encouraged to participate prior to and during the time that they assume the preceptor role. In addition, preceptors are supplied at no cost to them with a textbook on preceptorship together with a computer headset and upon completion of the program they receive a “Certificate of Attendance” which can be used as part of their continuing competencies as registered nurses. By facilitating the professional development of our community partners and assisting them to increase their capacity to support and
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encourage the education of our students, we will have a significant impact on clinical teaching and on strengthening the connection between the academic and clinical practice worlds. Recognizing the preceptor/mentor demographic and their individual contexts, the online program was designed to be: a) informative b) user friendly; c) easily accessible; d) fun and engaging; and e) experientially relevant. Background/literature Over the past several decades, e-technology has expanded faculty approach to the teaching learning process in particular and to nursing education in general (Lee and Nguyen, 2007; Maor, 2008). Indeed, the adoption of this medium fosters creativity and innovation, and has served to revolutionize teacher to student interactions and student to student interactions alike. Through online education, a climate of flexibility and convenience in postsecondary education has emerged with greater opportunities for the structuring of virtual learning communities of practice (Aviv, 2000; Garrison et al., 2000; Maor, 2008; Reeves, 2005). More recently, the virtual approach to preceptor preparation has also begun to surface (Phillips, 2006). This project in turn was a most timely endeavour and one which has extended our knowledge and understanding of preceptor preparation through the medium of e-technology. Preceptorship is the teaching/learning approach of choice for the practicum experience in undergraduate nursing education. This active learning approach is used to socialize students into their role as professional practitioners; contribute to the development of student confidence and competence; foster critical thinking; and nurture the use of practical wisdom (Kaviani and Stillwell, 2000; Ohrling and Hallberg, 2000a,b; Myrick and Yonge, 2005; Myrick et al., 2010). In addition to nursing, university faculties in which this teaching method is readily used include education, engineering, medicine, nursing, occupational therapy, pharmacology, physiotherapy, psychology, rehabilitation medicine, and social work. Through this approach to clinical teaching students are assigned to specific expert practitioners (preceptors/mentors) in the practice setting. This arrangement is designed to ensure that students acquire experience on a one-to-one basis with a role model and resource person who is immediately available to them in the practice setting. Despite the recognized value of those involved in preceptorship, little progress has been made regarding the development of an infrastructure that adequately supports their ongoing professional development. Over the years this lack of structure has become abundantly clear as preceptors, students and faculty alike continue to request support for their specific roles and responsibilities (Myrick and Yonge, 2005). Currently, to meet this challenge the Faculty of Nursing involved in this study offers on-site introductory and advanced “preceptorship conferences” in the fall and winter semesters. Through these conferences, preceptors are afforded the opportunity to attend didactic and interactive sessions on various topics germane to the preceptorship experience and to assist them in their role as preceptor. A certificate of attendance is formally presented to each participant upon conference completion. An important outcome of this educational process has been participant connection and engagement in dialogue with colleagues who are living through similar experiences. The sharing of this knowledge has been thus found to be fundamental to their validation as preceptors and to their growth as professionals. Feedback from participants has been uniformly positive with findings from ongoing research indicating positive impacts on their ability to fulfill their roles and responsibilities more effectively as preceptors. While we in the Faculty of Nursing have been able to provide this educational opportunity to local preceptors, there has continued to be a growing demand for professional development of this nature to the increasing numbers of preceptors who work with us at a distance, and who are often in isolation. In addition, often local preceptors are
unable to attend the on-site preparatory and advanced conferences owing to time constraints related to work and family commitments. Methods Prior to commencing the study, the researchers sought and received permission from the Dean of the Faculty of Nursing with ethical approval also sought and granted from the appropriate Ethics Review Committee. Each participant was provided with both a written and a verbal explanation of the interview procedures and purpose of the study. Participants were requested to sign a written consent form prior to being interviewed and audiotaped, apprised of their right to refuse to answer any questions without fear of reprisal, and advised that they were free to withdraw from the study at any time. To ensure confidentiality, the names of the participants were removed from the tape recordings, written transcripts, and field notes, and replaced with randomly assigned code numbers. The tape recordings, transcriptions, and notes were retained in a locked cabinet. The tape recordings will be retained for later use subject to appropriate ethical review. Specific references or descriptions regarding participants were excluded from the annual report of the study and accordingly are excluded from this publications and/or presentations. For the purpose of confidentiality, pseudonyms rather than actual names of the participants are used throughout this paper. The purpose of this study was to determine how the provision of an ongoing structured online support program influences the teaching practices of preceptors in the preceptorship experience. The specific objectives of the study were threefold: a) to evaluate the effectiveness of e-learning technology as an approach to educational preparation on the teaching practices of the preceptor; b) to ascertain preceptor perceptions of this approach in supporting them in their teaching and learning needs; and c) to determine how such support contributes to the preceptor's approach to teaching and learning. Research questions The research questions for this study were as follows: 1) How does the provision of virtual learning spaces influence the teaching practices of preceptors in the clinical setting? 2) Is such an approach effective in supporting preceptors in their role in the preceptorship experience? 3) How do preceptors perceive this program in supporting them in their role? 4) How does such support influence preceptors in facilitating student learning and promoting critical thinking? Research design Semi-structured interviews were conducted with a sample of the preceptor participants and analyzed using constant comparative analysis. The researchers carried out data collection with the participants during tape-recorded interviews which were then transcribed by a professional transcriber. A purposive sample of 25 preceptors was selected with a total of 18 preceptors successfully completing the five month project. Participants were chosen for the study based on the following criteria, they must have: a) been willing to participate in the study; b) been able to speak and understand English; c) been preceptors in the fourth year of the university undergraduate nursing program in which preceptorship was the primary approach to teaching in the clinical practice setting; d) participated in the structured online support program provided by the Faculty of Nursing; and e) signed a consent form agreeing to participate in the study. Of the 18 who completed the program, nine participants agreed to be interviewed. An interview guide was used which comprised open-ended questions. Sample questions included “Tell me about your role as preceptor.” “Why did you participate in this online support program?” “What was your perception of this online support program?” “How would you describe your approach to
F. Myrick et al. / Nurse Education Today 31 (2011) 263–267
the preceptorship experience as a result of your participation in this program?” and “Did the online support program influence your approach in any particular way?” These questions were a beginning guide only and were revised as data emerged throughout the study. Interviews, each lasting approximately 90 min, were conducted with the individual participants in a time and place deemed convenient for them. Authentication of information was ascertained during these times. Secondary data sources included field notes and a journal of personal reflections that was chronicled by the researchers throughout the study. To ensure accuracy, data were confirmed by the participants. Data analysis Constant comparative analysis, an inductive strategy was used to examine the data collected in this study on online preceptor/mentor support. First, the researchers systematically scrutinized the data through substantive coding (open and selective) and then through theoretical coding. As a result of this process of analysis and the concomitant data collection, the researchers were thus guided by the data (Glaser, 1978), a process which precipitated the generation of concepts and themes that culminated in a core variable described as “a world of possibilities.” Integral to the process of analysis was memo writing through which questions about the connection between concepts and/or their properties was delimited and merged with clusters of other concepts that contributed to the generation of the core variable (Glaser, 1978; Glaser and Strauss, 1985). Again to ensure that the researchers were guided by the data and that they themselves did not either intentionally or unintentionally force the data or the emerging core variable, this phase of the analysis was guided by such questions as: “What is occurring in the online support program that is serving to influence the teaching practices of the preceptors?” “Are there any unacknowledged aspects of the online support program that might be contributing to the preceptor's approach to the teaching/learning process?” and “Are there any factors that are tangential to the online support program that might be influencing their teaching practices?” Mechanisms to ensure for rigour There are four criteria against which rigour in qualitative research is measured (Guba and Lincoln, 1989). These include credibility, fittingness, auditability and confirmability. Throughout this study, specific mechanisms will be instituted to ensure that these criteria be achieved, thus enhancing the rigour of this investigation. To maintain rigour and to contribute to the fit, credibility and confirmability of findings, findings were confirmed with the participants (Lincoln and Guba, 1985). The researchers also developed an audit trail. Data/results/discussion As previously alluded to, the overriding theme that emerged from the data reflected what the researchers came to identify as “a world of possibilities” one in which preceptor participants were exposed to new knowledge in a flexible and supportive environment where they could readily explore their approach to preceptorship and share their experiences with one another through e-technology. Intrinsic to this “world of possibilities” were four ambient conditions: a) the ethos of the online program; b) the virtual space; c) professional enhancement; and d) its influence on teaching practice in preceptorship. The Ethos of the Online Program reflected the general atmosphere or the learning climate that was created. Online learning environments provide an interaction virtual space in which learners can actively engage in critical dialogue and discussion (Jonassen et al., 1998). For example, participants in this study indicated that they found the program to be supportive, connected, current and relevant. One preceptor (Audrey) stated, “You felt the enthusiasm through the whole
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thing. So it was really good. And you had a connection with other nurses from all over which was really cool, all different areas.” Another preceptor (Barbara) described, “I loved all of this because every single time you went on this [online program] I heard actual examples of everybody else commenting on things. I just found it very enriching.” One of the more experienced preceptors in the group, Marion, observed: “A lot of them, one in particular I remember that she was a novice at it and she was really learning a lot. It was just nice to hear their reflections, you know, on what they were learning or what they realized they didn't know…to be able to have those discussions, how do you handle this, you know, it's not to be understated.” Brenda, another preceptor stated, “I thought that those personalized stories were more enriching for me.” One preceptor, Audrey described it this way, “I probably would not have gotten through the program if I hadn't had that access person.” Brenda indicated, “I like that Connie [e-learning support] and Joan [facilitator] were excellent at being available. It made it abundantly clear through the whole program, you know, how available she was and she was.” Key to the success of online learning is the assumption that technology and social context are equally important for the distant learner (Spitzer, 1998). According to Vygotsky (1978) the sociocultural context in which learning takes place is critical, in particular how that context impacts on what is learned. In other words, it is not only important that content be relayed to and shared with the learner but it is equally important how that content is relayed or shared. According to Huang (2002), “Some distance educators don't recognize that technology and social context are equally important for distance learning. Moreover, the online learning environment constrains us by allowing communication through the computer technology, not a real person. It loses some humanity or it forms isolation” (p. 31). With these assumptions in mind then, the researchers were cognizant of the importance of social presence and endeavoured throughout the program to ensure an environment that reflected social presence and indeed teacher presence. This social presence was ensured through the provision of a full time facilitator who engaged the participants in both synchronous and asynchronous discussion and interactive sessions throughout the trajectory of the program. This facilitator ensured that the preceptors were readily accommodated to actively participate in dialogue that was not only current and relevant to their workplace environment, but was supportive and connected, an environment which in turn served to engage them to reflect on information in such a way that facilitated their knowledge acquisition about precepting (Jonassen et al., 1998; Quitadamo and Brown, 2001). In other words, this program provided a socially engaging communal workplace space for group as well as peer-based teaching and learning in which preceptor awareness and critical understanding could be developed and fostered (Collis et al., 1996; Hannafin et al., 1997). The Virtual Space itself was found by the preceptors to be challenging and engaging while at the same time it was also found to provide them with an opportunity to enhance their individual skill in the use of technology. One preceptor (Deborah) noted: “For me that [technology] was also a challenge because outside of email, you know, or looking up something on the internet, my computer knowledge is very low.” Another preceptor, Jennifer described: “It gave me that goal to learn how to do something different. Like a program like that. Now I go into different sites way more often than I would before because I thought, well it doesn't hurt to check it out.” Yet another (Frances) stated: “I think what I liked about this [program] is that it was all on one website. Like the references were great so you really didn't have
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to do anything additional. I felt it captured everyone, so I really enjoyed that.” In referring to the aesthetics of the program as it actually appeared on the website, Eleanor, another preceptor, said, “I really quite liked the set up. I thought that it looked visually appealing and it was easy to navigate.” Because voice over power point presentations were an integral part of the program, their impact on preceptor learning was also found to be important. One preceptor, Jennifer, described them this way: “It was nice to have the face to face, to even know who that was, you know, who kind of orchestrated this. I quite like that. I thought that was great. I like the power point. I liked having a face to the voice.” According to Winfield et al. (1998), the actual design of the program itself plays a significant role in the success of online learning. While technology contributes to the enabling of learning opportunities, it is the careful planning and integration of instructional strategies that foster participant interaction, learning and growth. According to Blake (2010), computer-based learning objects have the potential to enrich the learning process. Thus, the quality of instructional design is critical to the success of the online experience. Moreover, the design of the online program itself requires a sound knowledge of education, an understanding of learning theory, and an affinity with modern technologies (Blake, 2010; Maxwell et al., 2005). In the planning of this online preceptorship support program, an instructional designer with a background in educational theory was consulted so that the appropriate learning tools could be adopted to facilitate an effective learning experience of the preceptors. A member of the project team also possessed a Masters degree in education with a focus in online learning. Enhancement of Professional Development was also found to be integral to this program. Preceptors were provided with eleven modules designed specifically to address the various pedagogical issues they would potentially encounter in their preceptor role. Modules designed to address these issues included but were not limited such issues as: how to engage effectively in the evaluation process; the timing and relevancy of giving feedback; the importance of understanding the different teaching and learning styles when working with students; cultural competence and safety; and precepting the unsafe student, etc. The topics of these modules emanated from preceptor feedback and faculty interaction throughout the on-site preceptorship conferences as well as previous research related to preceptorship. One preceptor, Frances, stated, “I loved the readings, I loved the assignments. I loved the book…it's not telling you what to do it is just giving you guidance to do what you need to do.” Caroline, another preceptor stated, “I found the module on the intergenerational even more interesting because it is so much a part of our workplace now.” Barbara, another preceptor, observed, “I think it certainly opened my mind to things that I hadn't really thought about. Like maybe some assumed thinking that was already sort of ingrained but to actually have it articulated and to read it made a difference. It made me more conscious of it.” Deborah stated, “We are starting to do more. We are starting to learn more. But it was a huge learning curve for us.” Caroline expressed it in the following way: “It was a huge challenge for me because I had never done anything like that. But once I got into it, I had a lot of fun going and checking the mail and seeing what people write.” Through their participation in this online support program, the preceptors not only enhanced their knowledge concerning precep-
torship, but they also acquired technological skills and ability which they had not previously possessed. The acquisition of such skills in turn augmented their preceptor role particularly as they proceeded to engage with millennial learners (born between 1980 and 2000) who are purported to constitute the majority of students in today's university and college classrooms and who are themselves technologically savvy (Johnson and Romanello, 2005). These learners expect and appreciate the use of technology in learning environments, prefer experiential learning, enjoy opportunities for collaboration, and expect immediate and respectful feedback (Earle and Myrick, 2009; Mangold, 2007). Such knowledge is important for preceptors if they are to promote a quality preceptorship for the student and indeed for themselves. Influence on Teaching Practice in preceptorship. Key to this program also was its influence on the preceptor participants' approach to the way they engaged in preceptorship. The program generated reflection by raising awareness of the various aspects of preceptorship and by contributing to individual confidence building. Deborah stated, “And it was funny because I took the program and the following day met my student and I just felt a lot more in tune with what it was she was looking for and she actually said so, she said like ‘wow that wasn't what I expected.’” Yet another preceptor, Audrey stated: “I would have to say that being a boomer myself and having millennial students, I would really say that it's so important for them to receive feedback. So based on the knowledge I gained about that generation, I did implement a lot of those strategies, you know, in my own clinical tutoring.” Once again, the importance of understanding the different generations that co-exist in the workplace setting was identified by this preceptor. According to Oblinger (2003), one of the greatest challenges confronting today's educators is intergenerational diversity when planning pedagogical approaches. The boomer generation with which Audrey identifies is described as being born between 1945 and 1960. As students, they expected caring educational environments and were dependent on teachers to provide them with knowledge and they were able to function without the technologies currently available to millennials (Earle and Myrick, 2009; Mangold, 2007). Another finding in this study related specifically to how this program highlighted the importance of the preceptor's own attitude and the learning environment that is created in which the preceptorship experience takes place. Marion described, “It's given me some new tools as a preceptor to use and I think that it kind of even more brought into focus how the environment and how your attitude can really alter or influence that environment.” The module on teaching and learning styles also raised the preceptors' awareness of the importance of understanding how each student may learn differently, but more especially how that difference can directly influence the preceptorship experience. Jennifer stated, “I had always kind of distantly known that some people are visual learners and auditory learners and kinesthetic learners. But I don't think I realized how it impacts some people.” Subsequent to participating in this online support program, the preceptors came away with a new found knowledge not only about preceptorship but the complexity that inheres in teaching. As a result, their approach to teaching in the clinical setting was enriched through this new knowledge. They were thus exposed to dialogue about issues such as the intergenerational workplace setting, teaching and learning styles, the act of giving feedback, etc. and knowledge which they came
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to understand and recognize as being key to their role as informed, confident and competent preceptors. Implications and recommendations In light of the findings of this study several key points have come to light which have implications for the preceptorship experience. First, online preceptor support is a feasible, facilitative and an accessible medium by which to provide ongoing professional development for preceptors. Second, such a program needs to be developed from a sound knowledge of education, an understanding of learning theory, and an affinity with modern technologies. Third, through such a program preceptors can be afforded the ability to be able to engage with faculty in discussion about their role in clinical teaching and also communicate readily with one another through the virtual medium. Fourth, preceptors benefit appreciably from participation in such ongoing support. The preceptors who participated in this study indicated that their approach to clinical teaching had become more informed, enhanced and current. In light of these discoveries, the researchers would recommend further study into online preceptor support to focus specifically on the development of support for the international preceptorship experience and the expansion of such support to accommodate an interprofessional approach. Limitations of the study Despite the fact that mechanisms were set in place to ensure for the rigour of the study, several limitations may be inherent in this study. First of all, the length of time was limited to five months which could have influenced the depth and richness of the data. Secondly, the researchers' analytical creativity also may have posed a limitation. Finally, personal bias is always a potential overriding factor, and reliance on the interview as the primary data source potentially may have posed serious constraints and biases. Conclusion This online preceptorship support program opened up a world of possibilities for the preceptor participants. Through engagement in online learning they acquired not only new knowledge about preceptorship that contributed to their approach to precepting, but they also extended their thinking about the teaching and learning process, enhanced their professional development and acquired skill in the use of technology. The findings from this study can be thus used to extend our understanding of preceptor preparation through etechnology. Not only is the substantive nature of the learning material or knowledge provided important but equally important is the social context in which the learning occurs as is the overall instructional design of the program itself. The opportunity to engage in this preparatory process with preceptors also opened up to us as educators and researchers a world of possibilities, a world in which we could further enrich the substantive nature and infrastructure of online preceptor education and contribute to clarifying best practices for preceptor support, facilitation, and ongoing professional development with a view to enhancing the preceptorship experience. Acknowledgement This project was funded by a research grant from the Teaching, Learning Enhancement Fund (TLEF), University of Alberta, Edmonton, Alberta, Canada.
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Contents lists available at ScienceDirect
Nurse Education Today j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / n e d t
Preceptor/mentor education: A world of possibilities through e-learning technology Florence Myrick a,⁎, Wendy Caplan a, Jayne Smitten a, Kerry Rusk b a b
3rd Floor, Clinical Sciences Building, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada Faculty of Nursing, Ed N2-111, University of Alberta, Canada, Edmonton, Alberta T6G 2G5
a r t i c l e
i n f o
Article history: Accepted 18 October 2010 Keywords: Preceptor Mentor e-Learning technology Support Teaching and learning
s u m m a r y Preceptorship/mentorship is designed to socialize students into the nursing profession, promote their confidence/competence and foster their critical thinking ability. In today's global context, opportunities exist for local, rural, national and international student placements which provide exciting and mutually rewarding preceptorship experiences. Despite the recognized value of those involved in preceptorship/mentorship, however, little progress has been made regarding the development of an infrastructure that effectively supports their ongoing education. This project, piloted from October 2008 to February 2009, leveraged our established research and teaching experience in preceptorship with technologies that allowed us to create an accessible and engaging e-learning space designed to support preceptors in a seamless fashion, improve the quality of the student preceptorship and enhance professional teaching capacity. A purposive sample of 25 preceptors was selected with a total of 18 preceptors successfully completing the five month program. Upon completion, participants were surveyed and individually interviewed. Data analysis revealed the program to be informative, supportive and highly valued. Knowledge derived from this study can: a) further enrich the substantive nature and infrastructure of online preceptor education; and b) contribute to clarifying best practices for preceptor support, facilitation, and ongoing professional development with a view to enhancing the preceptorship experience. © 2010 Elsevier Ltd. All rights reserved.
Introduction For facilitation of discussion, the authors use the term preceptorship and its derivatives (preceptors and preceptee) to describe the process of pairing a student in the clinical area with an experienced nurse on a one-to-one basis to engage in clinical practice. The authors acknowledge that in countries such as the United Kingdom, the term preceptorship is analogous to and used interchangeably with the term mentorship and its subsequent derivatives (mentor and mentee) and is used to describe the same process (Andrews and Wallis, 1999; Kaviani and Stillwell, 2000; Neary, 2000; Sword et al., 2002; Watson, 1999). Opportunities for rural, national and international student placement are exciting and mutually rewarding and rely heavily on faculty accessibility. The Faculty of Nursing in which this study was conducted currently partners with agencies throughout Canada and the world including Australia, Brazil, Ghana, Hong Kong, Pakistan, the United Kingdom, and the United States. Up to recently however, there was no mechanism in place to adequately support the ongoing teaching/learning needs of our distant partners. Ultimately, our vision is to create a virtual learning community without borders for educators in the professional disciplines involved in preceptorship ⁎ Corresponding author. Tel.: +1 780 492 0251; fax: +1 780 492 2551. E-mail addresses: fl[email protected] (F. Myrick), [email protected] (W. Caplan), [email protected] (J. Smitten), [email protected] (K. Rusk). 0260-6917/$ – see front matter © 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.nedt.2010.10.026
or field teaching. The purpose of this particular project was to leverage our established research and teaching experience in preceptorship in nursing with technologies that allowed us to create accessible and engaging learning environments. The goal was to improve the quality of the student practicum experience while enhancing professional teaching capacity. The online environment permitted us to develop content and materials that encouraged interaction and dialogue while creating a social learning space in which our local, national and international partners can interact. Using WebCT, Elluminate, and educational learning objects that foster learner interaction and engagement such as case studies, Quandary decision-making mazes and e-portfolios, our preceptors had the opportunity to connect with the learning materials and with each other. This project was designed to become the foundation of our learning program to foster excellence in preceptor/mentor teaching through the engagement of our partners within the broader health care community locally, nationally and internationally. While preceptors are not mandated or required to complete such a program, they are encouraged to participate prior to and during the time that they assume the preceptor role. In addition, preceptors are supplied at no cost to them with a textbook on preceptorship together with a computer headset and upon completion of the program they receive a “Certificate of Attendance” which can be used as part of their continuing competencies as registered nurses. By facilitating the professional development of our community partners and assisting them to increase their capacity to support and
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encourage the education of our students, we will have a significant impact on clinical teaching and on strengthening the connection between the academic and clinical practice worlds. Recognizing the preceptor/mentor demographic and their individual contexts, the online program was designed to be: a) informative b) user friendly; c) easily accessible; d) fun and engaging; and e) experientially relevant. Background/literature Over the past several decades, e-technology has expanded faculty approach to the teaching learning process in particular and to nursing education in general (Lee and Nguyen, 2007; Maor, 2008). Indeed, the adoption of this medium fosters creativity and innovation, and has served to revolutionize teacher to student interactions and student to student interactions alike. Through online education, a climate of flexibility and convenience in postsecondary education has emerged with greater opportunities for the structuring of virtual learning communities of practice (Aviv, 2000; Garrison et al., 2000; Maor, 2008; Reeves, 2005). More recently, the virtual approach to preceptor preparation has also begun to surface (Phillips, 2006). This project in turn was a most timely endeavour and one which has extended our knowledge and understanding of preceptor preparation through the medium of e-technology. Preceptorship is the teaching/learning approach of choice for the practicum experience in undergraduate nursing education. This active learning approach is used to socialize students into their role as professional practitioners; contribute to the development of student confidence and competence; foster critical thinking; and nurture the use of practical wisdom (Kaviani and Stillwell, 2000; Ohrling and Hallberg, 2000a,b; Myrick and Yonge, 2005; Myrick et al., 2010). In addition to nursing, university faculties in which this teaching method is readily used include education, engineering, medicine, nursing, occupational therapy, pharmacology, physiotherapy, psychology, rehabilitation medicine, and social work. Through this approach to clinical teaching students are assigned to specific expert practitioners (preceptors/mentors) in the practice setting. This arrangement is designed to ensure that students acquire experience on a one-to-one basis with a role model and resource person who is immediately available to them in the practice setting. Despite the recognized value of those involved in preceptorship, little progress has been made regarding the development of an infrastructure that adequately supports their ongoing professional development. Over the years this lack of structure has become abundantly clear as preceptors, students and faculty alike continue to request support for their specific roles and responsibilities (Myrick and Yonge, 2005). Currently, to meet this challenge the Faculty of Nursing involved in this study offers on-site introductory and advanced “preceptorship conferences” in the fall and winter semesters. Through these conferences, preceptors are afforded the opportunity to attend didactic and interactive sessions on various topics germane to the preceptorship experience and to assist them in their role as preceptor. A certificate of attendance is formally presented to each participant upon conference completion. An important outcome of this educational process has been participant connection and engagement in dialogue with colleagues who are living through similar experiences. The sharing of this knowledge has been thus found to be fundamental to their validation as preceptors and to their growth as professionals. Feedback from participants has been uniformly positive with findings from ongoing research indicating positive impacts on their ability to fulfill their roles and responsibilities more effectively as preceptors. While we in the Faculty of Nursing have been able to provide this educational opportunity to local preceptors, there has continued to be a growing demand for professional development of this nature to the increasing numbers of preceptors who work with us at a distance, and who are often in isolation. In addition, often local preceptors are
unable to attend the on-site preparatory and advanced conferences owing to time constraints related to work and family commitments. Methods Prior to commencing the study, the researchers sought and received permission from the Dean of the Faculty of Nursing with ethical approval also sought and granted from the appropriate Ethics Review Committee. Each participant was provided with both a written and a verbal explanation of the interview procedures and purpose of the study. Participants were requested to sign a written consent form prior to being interviewed and audiotaped, apprised of their right to refuse to answer any questions without fear of reprisal, and advised that they were free to withdraw from the study at any time. To ensure confidentiality, the names of the participants were removed from the tape recordings, written transcripts, and field notes, and replaced with randomly assigned code numbers. The tape recordings, transcriptions, and notes were retained in a locked cabinet. The tape recordings will be retained for later use subject to appropriate ethical review. Specific references or descriptions regarding participants were excluded from the annual report of the study and accordingly are excluded from this publications and/or presentations. For the purpose of confidentiality, pseudonyms rather than actual names of the participants are used throughout this paper. The purpose of this study was to determine how the provision of an ongoing structured online support program influences the teaching practices of preceptors in the preceptorship experience. The specific objectives of the study were threefold: a) to evaluate the effectiveness of e-learning technology as an approach to educational preparation on the teaching practices of the preceptor; b) to ascertain preceptor perceptions of this approach in supporting them in their teaching and learning needs; and c) to determine how such support contributes to the preceptor's approach to teaching and learning. Research questions The research questions for this study were as follows: 1) How does the provision of virtual learning spaces influence the teaching practices of preceptors in the clinical setting? 2) Is such an approach effective in supporting preceptors in their role in the preceptorship experience? 3) How do preceptors perceive this program in supporting them in their role? 4) How does such support influence preceptors in facilitating student learning and promoting critical thinking? Research design Semi-structured interviews were conducted with a sample of the preceptor participants and analyzed using constant comparative analysis. The researchers carried out data collection with the participants during tape-recorded interviews which were then transcribed by a professional transcriber. A purposive sample of 25 preceptors was selected with a total of 18 preceptors successfully completing the five month project. Participants were chosen for the study based on the following criteria, they must have: a) been willing to participate in the study; b) been able to speak and understand English; c) been preceptors in the fourth year of the university undergraduate nursing program in which preceptorship was the primary approach to teaching in the clinical practice setting; d) participated in the structured online support program provided by the Faculty of Nursing; and e) signed a consent form agreeing to participate in the study. Of the 18 who completed the program, nine participants agreed to be interviewed. An interview guide was used which comprised open-ended questions. Sample questions included “Tell me about your role as preceptor.” “Why did you participate in this online support program?” “What was your perception of this online support program?” “How would you describe your approach to
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the preceptorship experience as a result of your participation in this program?” and “Did the online support program influence your approach in any particular way?” These questions were a beginning guide only and were revised as data emerged throughout the study. Interviews, each lasting approximately 90 min, were conducted with the individual participants in a time and place deemed convenient for them. Authentication of information was ascertained during these times. Secondary data sources included field notes and a journal of personal reflections that was chronicled by the researchers throughout the study. To ensure accuracy, data were confirmed by the participants. Data analysis Constant comparative analysis, an inductive strategy was used to examine the data collected in this study on online preceptor/mentor support. First, the researchers systematically scrutinized the data through substantive coding (open and selective) and then through theoretical coding. As a result of this process of analysis and the concomitant data collection, the researchers were thus guided by the data (Glaser, 1978), a process which precipitated the generation of concepts and themes that culminated in a core variable described as “a world of possibilities.” Integral to the process of analysis was memo writing through which questions about the connection between concepts and/or their properties was delimited and merged with clusters of other concepts that contributed to the generation of the core variable (Glaser, 1978; Glaser and Strauss, 1985). Again to ensure that the researchers were guided by the data and that they themselves did not either intentionally or unintentionally force the data or the emerging core variable, this phase of the analysis was guided by such questions as: “What is occurring in the online support program that is serving to influence the teaching practices of the preceptors?” “Are there any unacknowledged aspects of the online support program that might be contributing to the preceptor's approach to the teaching/learning process?” and “Are there any factors that are tangential to the online support program that might be influencing their teaching practices?” Mechanisms to ensure for rigour There are four criteria against which rigour in qualitative research is measured (Guba and Lincoln, 1989). These include credibility, fittingness, auditability and confirmability. Throughout this study, specific mechanisms will be instituted to ensure that these criteria be achieved, thus enhancing the rigour of this investigation. To maintain rigour and to contribute to the fit, credibility and confirmability of findings, findings were confirmed with the participants (Lincoln and Guba, 1985). The researchers also developed an audit trail. Data/results/discussion As previously alluded to, the overriding theme that emerged from the data reflected what the researchers came to identify as “a world of possibilities” one in which preceptor participants were exposed to new knowledge in a flexible and supportive environment where they could readily explore their approach to preceptorship and share their experiences with one another through e-technology. Intrinsic to this “world of possibilities” were four ambient conditions: a) the ethos of the online program; b) the virtual space; c) professional enhancement; and d) its influence on teaching practice in preceptorship. The Ethos of the Online Program reflected the general atmosphere or the learning climate that was created. Online learning environments provide an interaction virtual space in which learners can actively engage in critical dialogue and discussion (Jonassen et al., 1998). For example, participants in this study indicated that they found the program to be supportive, connected, current and relevant. One preceptor (Audrey) stated, “You felt the enthusiasm through the whole
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thing. So it was really good. And you had a connection with other nurses from all over which was really cool, all different areas.” Another preceptor (Barbara) described, “I loved all of this because every single time you went on this [online program] I heard actual examples of everybody else commenting on things. I just found it very enriching.” One of the more experienced preceptors in the group, Marion, observed: “A lot of them, one in particular I remember that she was a novice at it and she was really learning a lot. It was just nice to hear their reflections, you know, on what they were learning or what they realized they didn't know…to be able to have those discussions, how do you handle this, you know, it's not to be understated.” Brenda, another preceptor stated, “I thought that those personalized stories were more enriching for me.” One preceptor, Audrey described it this way, “I probably would not have gotten through the program if I hadn't had that access person.” Brenda indicated, “I like that Connie [e-learning support] and Joan [facilitator] were excellent at being available. It made it abundantly clear through the whole program, you know, how available she was and she was.” Key to the success of online learning is the assumption that technology and social context are equally important for the distant learner (Spitzer, 1998). According to Vygotsky (1978) the sociocultural context in which learning takes place is critical, in particular how that context impacts on what is learned. In other words, it is not only important that content be relayed to and shared with the learner but it is equally important how that content is relayed or shared. According to Huang (2002), “Some distance educators don't recognize that technology and social context are equally important for distance learning. Moreover, the online learning environment constrains us by allowing communication through the computer technology, not a real person. It loses some humanity or it forms isolation” (p. 31). With these assumptions in mind then, the researchers were cognizant of the importance of social presence and endeavoured throughout the program to ensure an environment that reflected social presence and indeed teacher presence. This social presence was ensured through the provision of a full time facilitator who engaged the participants in both synchronous and asynchronous discussion and interactive sessions throughout the trajectory of the program. This facilitator ensured that the preceptors were readily accommodated to actively participate in dialogue that was not only current and relevant to their workplace environment, but was supportive and connected, an environment which in turn served to engage them to reflect on information in such a way that facilitated their knowledge acquisition about precepting (Jonassen et al., 1998; Quitadamo and Brown, 2001). In other words, this program provided a socially engaging communal workplace space for group as well as peer-based teaching and learning in which preceptor awareness and critical understanding could be developed and fostered (Collis et al., 1996; Hannafin et al., 1997). The Virtual Space itself was found by the preceptors to be challenging and engaging while at the same time it was also found to provide them with an opportunity to enhance their individual skill in the use of technology. One preceptor (Deborah) noted: “For me that [technology] was also a challenge because outside of email, you know, or looking up something on the internet, my computer knowledge is very low.” Another preceptor, Jennifer described: “It gave me that goal to learn how to do something different. Like a program like that. Now I go into different sites way more often than I would before because I thought, well it doesn't hurt to check it out.” Yet another (Frances) stated: “I think what I liked about this [program] is that it was all on one website. Like the references were great so you really didn't have
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to do anything additional. I felt it captured everyone, so I really enjoyed that.” In referring to the aesthetics of the program as it actually appeared on the website, Eleanor, another preceptor, said, “I really quite liked the set up. I thought that it looked visually appealing and it was easy to navigate.” Because voice over power point presentations were an integral part of the program, their impact on preceptor learning was also found to be important. One preceptor, Jennifer, described them this way: “It was nice to have the face to face, to even know who that was, you know, who kind of orchestrated this. I quite like that. I thought that was great. I like the power point. I liked having a face to the voice.” According to Winfield et al. (1998), the actual design of the program itself plays a significant role in the success of online learning. While technology contributes to the enabling of learning opportunities, it is the careful planning and integration of instructional strategies that foster participant interaction, learning and growth. According to Blake (2010), computer-based learning objects have the potential to enrich the learning process. Thus, the quality of instructional design is critical to the success of the online experience. Moreover, the design of the online program itself requires a sound knowledge of education, an understanding of learning theory, and an affinity with modern technologies (Blake, 2010; Maxwell et al., 2005). In the planning of this online preceptorship support program, an instructional designer with a background in educational theory was consulted so that the appropriate learning tools could be adopted to facilitate an effective learning experience of the preceptors. A member of the project team also possessed a Masters degree in education with a focus in online learning. Enhancement of Professional Development was also found to be integral to this program. Preceptors were provided with eleven modules designed specifically to address the various pedagogical issues they would potentially encounter in their preceptor role. Modules designed to address these issues included but were not limited such issues as: how to engage effectively in the evaluation process; the timing and relevancy of giving feedback; the importance of understanding the different teaching and learning styles when working with students; cultural competence and safety; and precepting the unsafe student, etc. The topics of these modules emanated from preceptor feedback and faculty interaction throughout the on-site preceptorship conferences as well as previous research related to preceptorship. One preceptor, Frances, stated, “I loved the readings, I loved the assignments. I loved the book…it's not telling you what to do it is just giving you guidance to do what you need to do.” Caroline, another preceptor stated, “I found the module on the intergenerational even more interesting because it is so much a part of our workplace now.” Barbara, another preceptor, observed, “I think it certainly opened my mind to things that I hadn't really thought about. Like maybe some assumed thinking that was already sort of ingrained but to actually have it articulated and to read it made a difference. It made me more conscious of it.” Deborah stated, “We are starting to do more. We are starting to learn more. But it was a huge learning curve for us.” Caroline expressed it in the following way: “It was a huge challenge for me because I had never done anything like that. But once I got into it, I had a lot of fun going and checking the mail and seeing what people write.” Through their participation in this online support program, the preceptors not only enhanced their knowledge concerning precep-
torship, but they also acquired technological skills and ability which they had not previously possessed. The acquisition of such skills in turn augmented their preceptor role particularly as they proceeded to engage with millennial learners (born between 1980 and 2000) who are purported to constitute the majority of students in today's university and college classrooms and who are themselves technologically savvy (Johnson and Romanello, 2005). These learners expect and appreciate the use of technology in learning environments, prefer experiential learning, enjoy opportunities for collaboration, and expect immediate and respectful feedback (Earle and Myrick, 2009; Mangold, 2007). Such knowledge is important for preceptors if they are to promote a quality preceptorship for the student and indeed for themselves. Influence on Teaching Practice in preceptorship. Key to this program also was its influence on the preceptor participants' approach to the way they engaged in preceptorship. The program generated reflection by raising awareness of the various aspects of preceptorship and by contributing to individual confidence building. Deborah stated, “And it was funny because I took the program and the following day met my student and I just felt a lot more in tune with what it was she was looking for and she actually said so, she said like ‘wow that wasn't what I expected.’” Yet another preceptor, Audrey stated: “I would have to say that being a boomer myself and having millennial students, I would really say that it's so important for them to receive feedback. So based on the knowledge I gained about that generation, I did implement a lot of those strategies, you know, in my own clinical tutoring.” Once again, the importance of understanding the different generations that co-exist in the workplace setting was identified by this preceptor. According to Oblinger (2003), one of the greatest challenges confronting today's educators is intergenerational diversity when planning pedagogical approaches. The boomer generation with which Audrey identifies is described as being born between 1945 and 1960. As students, they expected caring educational environments and were dependent on teachers to provide them with knowledge and they were able to function without the technologies currently available to millennials (Earle and Myrick, 2009; Mangold, 2007). Another finding in this study related specifically to how this program highlighted the importance of the preceptor's own attitude and the learning environment that is created in which the preceptorship experience takes place. Marion described, “It's given me some new tools as a preceptor to use and I think that it kind of even more brought into focus how the environment and how your attitude can really alter or influence that environment.” The module on teaching and learning styles also raised the preceptors' awareness of the importance of understanding how each student may learn differently, but more especially how that difference can directly influence the preceptorship experience. Jennifer stated, “I had always kind of distantly known that some people are visual learners and auditory learners and kinesthetic learners. But I don't think I realized how it impacts some people.” Subsequent to participating in this online support program, the preceptors came away with a new found knowledge not only about preceptorship but the complexity that inheres in teaching. As a result, their approach to teaching in the clinical setting was enriched through this new knowledge. They were thus exposed to dialogue about issues such as the intergenerational workplace setting, teaching and learning styles, the act of giving feedback, etc. and knowledge which they came
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to understand and recognize as being key to their role as informed, confident and competent preceptors. Implications and recommendations In light of the findings of this study several key points have come to light which have implications for the preceptorship experience. First, online preceptor support is a feasible, facilitative and an accessible medium by which to provide ongoing professional development for preceptors. Second, such a program needs to be developed from a sound knowledge of education, an understanding of learning theory, and an affinity with modern technologies. Third, through such a program preceptors can be afforded the ability to be able to engage with faculty in discussion about their role in clinical teaching and also communicate readily with one another through the virtual medium. Fourth, preceptors benefit appreciably from participation in such ongoing support. The preceptors who participated in this study indicated that their approach to clinical teaching had become more informed, enhanced and current. In light of these discoveries, the researchers would recommend further study into online preceptor support to focus specifically on the development of support for the international preceptorship experience and the expansion of such support to accommodate an interprofessional approach. Limitations of the study Despite the fact that mechanisms were set in place to ensure for the rigour of the study, several limitations may be inherent in this study. First of all, the length of time was limited to five months which could have influenced the depth and richness of the data. Secondly, the researchers' analytical creativity also may have posed a limitation. Finally, personal bias is always a potential overriding factor, and reliance on the interview as the primary data source potentially may have posed serious constraints and biases. Conclusion This online preceptorship support program opened up a world of possibilities for the preceptor participants. Through engagement in online learning they acquired not only new knowledge about preceptorship that contributed to their approach to precepting, but they also extended their thinking about the teaching and learning process, enhanced their professional development and acquired skill in the use of technology. The findings from this study can be thus used to extend our understanding of preceptor preparation through etechnology. Not only is the substantive nature of the learning material or knowledge provided important but equally important is the social context in which the learning occurs as is the overall instructional design of the program itself. The opportunity to engage in this preparatory process with preceptors also opened up to us as educators and researchers a world of possibilities, a world in which we could further enrich the substantive nature and infrastructure of online preceptor education and contribute to clarifying best practices for preceptor support, facilitation, and ongoing professional development with a view to enhancing the preceptorship experience. Acknowledgement This project was funded by a research grant from the Teaching, Learning Enhancement Fund (TLEF), University of Alberta, Edmonton, Alberta, Canada.
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