INTRODUCTION

1. CASE REPORT: PROFESSIONAL DEVELOPMENT OF A NOVICE PHYSICAL THERAPIST Susan Cunningham, PT; Mary Knab, PT, DPT Faulkner Hospital and MGH Institute of Health Professions, Boston, MA INTRODUCTION COMMUNICATION and TEAMWORK DISCUSSION REFLECTIVE PRACTICE In examining LB’s case it becomes apparent that her professional development was strikingly consistent with the current teaching and learning research in the health professions. Formal and informal mentoring can provide the support needed to develop as a clinician, but mentoring alone is not enough. Participation with the team, fostering immersion in the professional culture, nurtures professional identity development. With reflection emerging as the basis for critical thinking, self assessment, and lifelong learning, encouragement of reflective practice should also be part of the practice in which the novice is immersed. Facilitated by a schedule and culture on the inpatient service that provided for ready access to the team and her mentors/supervisors, LB thrived. • The novice clinician will have a wide variety of experiences with communication issues, including problems in this domain, and should gain skill as confidence increases. • Communication breakdowns can significantly impact patient care, with novice needing support and ability to reflect-in-, -on-, and -for-action. • Active participation in the interdisciplinary team is essential to professional identity development. • Drawing on personal experience, an in-depth exploration of one novice PT’s journey through her first year of practice, and current educational literature, the goal of this project was to identify critical elements in the development of reflective practitioners who are lifelong learners. • We attempt to answer the following questions: • What are the needs of the novice clinician as he or she transitions from student to health care professional? • Can we identify best practices to facilitate novice professional development and how do we optimize them? • What are some of the obstacles or barriers to development, and how might we minimize them? WHY FOCUS ON REFLECTION? • Facilitating reflection can be a means of fostering the development of clinical reasoning skills. • REFLECTION- • -in-action • -on-action • -for-action • Guiding reflection can help the novice clinician learn to ask and answer questions such as: • What occurred in that encounter that resulted • in the experience I just had with my patient? • What will I do differently next time? • How can my practice improve? • Competence and confidence • Realization of sound clinical decision making • can lead to increased confidence in one’s ability • to practice competently. To optimize learning and development, the novice must be actively engaged in the practice community. METHODS This case analysis is based on qualitative data consisting of LB’s personal recollection of, and reflections on, her first year of clinical practice, as reported to the author in two semi-structured interviews and numerous lunchtime conversations. Analyzed for major themes, these data validate the findings of a comprehensive literature review exploring novice to expert development, teaching and learning best practices, reflection and reflective practice, and the role of communities of practice. PROFESSIONAL RELEVANCE As this case illustrates, reflection, engagement with the team, and immersion in the professional culture are critical to the novice clinician’s learning and development. Conscious attention to formal and informal mentoring, inclusion in team process, and focused reflection and self-assessment can, thus, set the stage for a career of lifelong learning and development. By engaging our novice practitioners in this way, we can facilitate the assimilation of the values and beliefs of the profession. Reflection is necessary to learn from one’s own practice and to think critically. PROFESSIONAL SOCIALIZATION RESULTS: MAJOR THEMES • The importance of the professional culture can be seen in this novice clinician’s first year, where she experienced… • SUCCESS on the inpatient service, having had mentoring that included: • Encouragement and support • Ongoing evaluative feedback • Access to supervisors and peers, • Participation as full fledged member of the inpatient team • FAILURE on the outpatient service, having had: • Inadequate access to mentors and peers • Lack of necessary professional engagement and interaction within the outpatient culture Analysis of the case data, when integrated with the literature, reveals four themes which, while discussed separately here, contain overlap and are not mutually exclusive. They are: ELEMENTS NECESSARY FOR THE DEVELOPMENT OF REFLECTIVE PRACTICE: • Intellectually and emotionally supportive environment • Authentic context • Support for differences in learning styles • Mentoring • Peer discussions • Freedom to express opinions • Mann, et al, 2007. SELECTED REFERENCES • Reflection/reflective practice • Communication • Teamwork • Professional Socialization Atkinson, H. L., & Nixon-Cave, K. (2011). A tool for clinical reasoning and reflection using the international classification of functioning, disability and health (ICF) framework and patient management model. Physical Therapy Journal of the American Physical Therapy Association, 91(3), 416. Black, L. L., Jensen, G. M., Mostrom, E., Perkins, J., Ritzline, P. D., Hayward, L., et al. (2010). The first year of practice: An investigation of the professional learning and development of promising novice physical therapists. Physical Therapy Journal of the American Physical Therapy Association, 90(12), 1758. Mann, K., Gordon, J., & MacLeod, A. (2007). Reflection and reflective practice in health professions education: A systematic review. Advances in Health Science Educ Theory Pract 14(4) 595. Plack, M. M. (2006). The development of communication skills, interpersonal skills, and a professional identity within a community of practice. Journal of Physical Therapy Education, 20(1), 37.