Best practice framework for clinical learning
ADAVB last month commented on the latest draft of the Department of Health’s Best Practice Framework for Clinical Learning. The framework is intended to be useful and relevant to the majority of health professional disciplines and health service settings in Victoria.

The Branch welcomed the framework’s provision of ‘guidance’ to health services and education providers in jointly exploring effective and appropriate mechanisms to achieve high quality clinical training experiences for learners.

The ADAVB supported the key elements that underpin a quality clinical learning environment:
 An organisational culture that values learning
 Best practice clinical practice
 A positive learning environment
 A supportive health service-training provider relationship
 Effective communication processes
 Appropriate resources and facilities.

Endorsing the principles supporting the framework, ADAVB commented:
1: Patient (or client) care is an integral component of quality clinical education.
• Dental students must have access to a full range of patients in preparation for graduation when they will be presented with all sorts of cases.
2: Learning in clinical environments is an essential component of training all health professionals.
• The need for sound pre-clinical experiences is essential for clinical students to be able to provide safe and effective services for patients. This is of particular importance in dentistry where invasive and non-reversible surgical procedures are provided by students. The framework should acknowledge this.  Not to do so runs the risk of placing students and patients in situations which produce poor clinical outcomes.
• Use of simulation laboratories is an essential and efficient means of introducing clinical work to undergraduates, but once the students’ basic skills have been developed, nothing prepares them for treating people better than treating patients in normal clinical settings.
3: Registration, accreditation or competency standards set down by professional bodies (where these exist) are the appropriate mechanism for ensuring that clinical education arrangements meet minimum standards for educational or training outcomes.
• The new Dental Board of Australia will determine professional standards to be met by all dental care providers. There should not be any other body seeking to establish a second set of standards.  Were this to happen it would lead to conflict, confusion, unnecessary cost and potential risk to patients.
• ADAVB endorses the use of standards set by professional bodies.
4: Many different models of clinical education and training exist and successfully produce health professionals of required competency and standard.
• There is nothing to be gained from a ‘cookie-cutter’ approach to clinical training, where everyone is expected to complete identical exercises.
• Diversity of educational approaches is healthy and necessary because of the differences in rural and metropolitan training facilities.
• Adequate exposure to various clinical cases is vital to ensure appropriate training and a concomitant standard of patient care.

ADAVB also emphasised:
• A preference for the framework to include the term “mentor” in addition to “educator” because the best supervisors have both skills, but not all do.  The success of dental outplacement programs relies on having a good mixture of both.
• Students are not a workforce and nor are they a solution to a shortage or mal-distribution of oral health care providers. 
• Consideration must be given to the value of information collected and how it would be used.
• The notion that an educator/health service provider's position description should include a career structure related to being an educator is worthy but is not practical. The draft framework states that 'There is a documented strategy for career progression for staff involved in educational activities’. This is related to external factors rather than internal ones. This is because State awards and remuneration levels are not set by the health services. The government supports funding for educators in health services but there is no link to remuneration levels. The principle of continuity in providing educational experience is worthy and can be achieved by health service educators receiving training from the training provider partner to develop their educational skills.
• Support should be for permanent educators, either full or part-time rather than visiting staff.
• Disincentives for dentists to become educators:
o Lack of career structure and remuneration
o Competing productivity targets which detract from the educator focusing on teaching
• Lack of continuity of teaching as many educators were not trained by the training provider for their initial qualification.
• For output funded programs like dental, there is little funding to enable the development of educators to provide high quality educational clinical placements.  This creates a conflict between productivity targets and teaching time.  Resolution is usually because of the organisational culture of the individual health service - not government funding.