A Student's Reflection on Her First Clinical Practicum

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As a student at the Dalhousie University School of Health Sciences, I have recently completed my first year of the radiological technology program. Although I already had 4 years of university education, the clinical component of this program was a new experience for me. My initial clinical practicum, an 8-week clinical placement at the Queen Elizabeth II Health Sciences Centre in Halifax, proved to challenge my academic knowledge, develop my clinical skills, and enhance my understanding of the role of a radiological technologist in today's health care system. As I have come to realize, the first-year clinical experience is a crucial one for students; it is here that our knowledge and confidence significantly increases and that the tone for future experiences is set. In this column I hope to shed light on the importance of the technologist-student relationship, discuss some obstacles I have encountered, and pass on some helpful advice to other first-year students.

During clinical placements at large hospitals, it is common for every student to work with different technologists and for every technologist to work with different students. This relationship is the backbone of the clinical experience; thus its influence on student learning must be understood. Academic literature reveals that the quality of teaching in the clinical setting is a strong predictor of student performance [1]. Students who experience a higher quality of clinical teaching tend to exhibit a higher level of performance during their clinical education [2]. Conversely, poor clinical teaching can have significant negative influence on student learning [1]. Quality of supervision, along with number and variety of patients, is also a deciding factor in how students perceive their personal clinical effectiveness [2].

These research findings were confirmed for me during my clinical placement. I had the opportunity to work with many different technologists; some were more supportive of my learning than others. I found that those who were more aware of the program's clinical learning expectations and the knowledge level of a first-year student were able to facilitate my learning in a more effective manner. Accordingly my clinical skills and confidence were raised when working with technologists who were able to encourage my independent decision making and problem solving while maintaining the appropriate level of supervision for a first-year student. More importantly, those who created a friendly and supportive environment, provided constructive feedback, and shared their expertise made me feel comfortable in my surroundings and allowed me to self-evaluate and set goals. On the other hand, those who were in a rush, were unfriendly, reluctant to let me participate, or provided no feedback left me with a negative experience in which I lost confidence and learned very little.

A common obstacle for first-year radiological technology students is the reality that technologists' work habits and preferences vary significantly, both among each other and from what we are taught in school. Examples of this include technologists preferring upright or recumbent positions for certain procedures, favoring automatic exposure control or manual exposure factors, variations in the order in which projections for examinations are completed, and use of different positioning techniques. I have experienced this myself; it is difficult to digest all of the variation. It can be overwhelming and can create confusion when we, as first-year students, are already dealing with such a large base of knowledge that is new (at least, to us). To overcome this obstacle, it is helpful if technologists explain why certain techniques (rather than others) work for them, and to allow us to attempt these different techniques. This enables us to begin to understand our options and to develop techniques that work for us.

Another challenge I met during my first clinical practicum was in regard to centering points. Many technologists no longer remember the specifics or use the centering points in our textbook, whereas we have spent two terms attempting to memorize them. Although the theory still applies, these technologists have moved beyond exact measurements and centering points. Experience has taught them where and how to center on every size and shape of patient they encounter. I believe this discrepancy affected my ability to completely bridge the gap between theory and practice. I now understand that although centering points are not used as precisely as expected, we must learn them regardless, as they are fundamental to practice.

As a result of my first clinical placement, I have gained many skills and much knowledge. I also have some suggestions to pass on to other students:

My final piece of advice is to use the technologists you work with as the great resource they are. They have extensive knowledge, skills, and experience. Ask lots of questions, request demonstrations, listen to stories, get helpful tips, have interesting conversations, and make friends.

I look back on my time spent in the hospital and hope I made the most of it. I now look forward to my second year and to continuing to learn about and experience radiologic technology. I hope my thoughts and suggestions have been helpful to others.

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References 

1. Griffith CH, Wilson JF, Haist SA. Ramsbottom-Lucier M. Do students who work with better housestaff in their medicine clerkships learn more?. Acad Med. 1998;73:S57–S59
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2. Wimmers PF, Schmidt HG, Splinter TA. Influence of clerkship experiences on clinical competence. Med Educ. 2006;40:450–458
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