Medical Assistant profession is only known in Malaysia. It is part of the medical profession creates by the Ministry of Health, Malaysia in the sixties to overcome the shortage of medical officer in the country. We need to go through three years training program conducted by our Ministry of Health in order to be a qualified as a Medical Assistant. My speciality is in Emergency and Trauma care management, with sixteen years working experiences in the Emergency Department (ETD) and currently attached to the ETD in one of the hospital located in central region.
In this assignment I will discuss and explore how practice arena can assist in learning as well to identify the learning opportunity available for learners and how I integrate my professional role to develop health care profession competency. My focus will be on the factors of physical and social climate and how does it affect learning in my practice arena. Based on the theories of humanism and Androgogy compare with the concept suggested in the literature, I will come with my recommendation on how I am going to promote my practice arena into a more conducive learning environment.
There are few factors or element that can affect or influence learning environment. The most important elements are physical environment, social climate and learning opportunities (Ministry of Health Malaysia, 2006) that I am focusing now. Discussing about the physical element, resources are among thing that we should considered within the placement. Ileris (2011) claimed the variety of opportunity and situation offer to learners is the most significant factors influencing the quality of practice arena as 1 learning environment.
He further quotes that difference type of workplace offer different learning environment with different learning opportunity. The emergency and trauma department or my practice arena cover one whole block and the facilities and services available encompassing a wide range of emergent trauma and non trauma condition, from the critically ill or severely injured to those with minor ailment. The scope include pre hospital care services, resuscitation and stabilisation, diagnosis and definitive care management, one stop crisis centre and medical coverage. The facilities available are dividing into zone ranging from a critical to a non critical zone where patient management are triage according to the severity of illness.
There are three main zones, one observation bay equipped with 5 beds, a procedure room for minor surgical procedures and a sterilisation unit for collecting and receiving sterile item from the central sterilisation department. Each zone or treatment areas are equipped with standard equipment for it functionalities inclusive of an emergency trolley, cardiac monitor and defibrillators, portable ventilators and airway management, radiography machine, ultra sound machine, electrocardiogram, refrigerator and blood analyser machine. It provide a wide range of learning opportunity to learners and students to develops their skills ,knowledge and understanding of the role and function with the organisation( Evan et. al, 2006).
However all these equipment needs speciality and skills to be operates and 2 learners need period of time to get familiar with the equipment. The department need to send learners for user training and courses before they can handle the machine. My practice arena is amongst the busiest place in the hospital compound. Even worse when facing the incidence of mass casualties where every staffs busy with their own task. However it doesn’t mean that they have no time with the learner.
They are actually a good role model for learner where they can work and learn at the same time. They are willing to shares their working experience, skills, knowledge and ideas with student or learners even though they are very with their tasks. In fact chaotic working environment is rich for learning because of large volume of patient of varying acuity and learner will take responsibility of their own learning, identifying gap in knowledge, seeing feedback and working toward closing these gap. (Goldman et. al, 2009) Every zone is fully air conditioning and furnished with patient’s beds, trolleys and wheelchairs. We also have an access to internet and intranet where Learners will have the opportunity to access the heath information system, interaction between the instructors and as well among learners as it is the key point for good practice and learning expectation for each area (Severs and Pearson, 1999), (Ileris, 2011).
But there are limitations as some of the equipment and facilities only can be use by professional and expert and the use of internet has been block by the management from being access in an improper way and only involved with certain website, this may lead to frustration and conflict to extensive use in workplace learning (Ileris, 2011). We also 3 have teaching room or a seminar room with selection of books, journal and handout available which is accessible to learners. Apart from the facilities above my placement arena also have 2 unit of type A, 3 unit of type B and 5 unit of type C ambulances. They are all equipped with standard equipment and also link by the radio communication services.
In order to be part of the ambulance services team, learner need to undergo basic training on the basic equipment available inside the ambulance and how to use radio communication system. They are attached with qualified personnel as a mentor who is in charge of the ambulance services. For the convenience of every staffs, student and even public, my placement arena offer excellent facilities such as rest room with television set, tea room and pantry, accessible wash room and toilet, emergency fire exit with fire extinguisher and waiting area provided with chairs and queue number system.
Quinn (2007) states that this basic needs make learner feel secure and comfortable and enable them to concentrate in their learning. Nevertheless my placement area doesn’t have any skill laboratory where student can practice their skills and knowledge. However the higher management has planned to set it up in few years time for the benefit of all parties. 4 My practice arena offer a placement for student nurses, newly graduates medical assistant and medical students doing their internships and housemanship program from the nearby colleges and higher institution. In fact the facilities has been gazetted as one of the teaching hospital by the government and the Ministry of Health Malaysia as a whole.
Learners and student will need to be introduced to the new environment to get them off to a good start by establishing a sense of belonging, creating a welcoming learning environment, supplying information that will answer their question and removing any uncertainties once they reporting themselves for the placement. Gopee (2008) stated this as an essential and effective when new experience are linked to prior knowledge where it begin with familiarisation with the clinical setting, clinical specialism, get to know with mentor and staffs and feeling that they are part of the team inorder to meet the learning needs and achievement of their practice objective.
The availability of the multidisciplinary staffs ranging from the higher level management and clinician to a well trained paramedics (Goppe, 2008) form the basis of inter- professional learning and will be an advantage for the student to learned and adopted as their role model and mentors. West et. al (2007) highlight that the practice is not only the environment where services is delivered to client but also a learning area where future and qualified practioner continually utilise the opportunity provide to them as an experience to facilitate their professional development.
5 It is an effort of every personnel to create the practice arena into an interesting and conducive place to learn. Fox (2009) describe learning environment as a place or setting where learning occur. This include physical setting, interpersonal and instructional characteristic that influence learner’s performance. The nature of learning environment is important in establishing an expansive learning area (Evan et. al, 2006) but sometime it is difficult to achieve as to some leader it is not a priority and therefore there must be a balance against priority in order to improve learning.
Hand(2006) suggest that placement should be of higher quality accompanied by improved teaching support to help student gain better practical skills. But a high standard ward with rigid task allocation, with hierarchical system exist are unlikely to meet student learning needs (Fretwell, 1980) Relationship between manager and subordinates and vice versa is another important aspect of social climate in learning environment.
Hand (2006) stated that mutual respect, integrated and valued student, manager’s commitment, interactive communication, motivated employers, supportiveness and openness are among the element that contributing to a conducive learning environment. Chan (2001) highlight that inter personnel relationship between staffs are crucial in order to develop a positive learning environment. Hand (2006) described the relationship between teacher and learner must be genuine, non- threatening, lasting relationship and encourage learner to give feedback in order to promote learning and Nolan (1998) found out that learning desire will reduce without supportive from learning arena. 6 My unit manager is very supportive and committed person, caring attitude and openness especially toward professional development, friendly, approachable and knowledgeable.
He motivates the staffs by sending them for courses, workshops and seminar to upgrade their skills and knowledge, counselling and indirectly benefit student placement in the areas. I believe he is a role model in my placement areas. The success and fall of the placement as a conducive learning arena depend on the management, leadership style and the relationship which exist between the people, the manager and the goals in the organisation (Weir et. al, 2010). Inorder to develop a positive learning environment, there must be a positive management style and interpersonal relationship among manager, staffs and learner. Fretwell (1988), Pembrey (1988) described ward manager as a key figure in the organisation in establishing and maintaining a ward atmosphere conducive learning environment and patient care environment as well.
Practice area learning are mostly student centred learning where learner and student needs to participates and involve themselves in the activities design in the practice area. Self awareness is therefore very important and Cook (1999), mention that many nurses educationist are focused on self awareness to get the learning opportunity in the practice area. In this way student are able to make judgement of their own and identify their strength and weakness in consistent to andragogy approach as self assessment which help them to develop awareness of their own standard of practice (Chambers, 1998). This can be in the form of formal and informal learning activities. In my placement area, student or learners will have the opportunity to involve themselves in 7 discussion, case presentation, in house courses and continuous medical education which is plan weekly for every qualified personnel.
For pre registration student this is a good chance to get new ideas, knowledge and skills and for post registration it is professional refreshment. Spouse (2001) clarified that knowledge quickly become outdated as rapid pace of technology and to be more effective this continuous professional development should be carried out under the guidance of experience and knowledgeable colleagues with the evidence of attendances. The collaboration of one department with other organisation and between unit and section in the department should be considered as one of the factors that influencing the provision of good experience within the placement. This is because exchange and sharing of ideas between these two different organisations happened to achieve the same goal.
We have been discussed many factors influencing learning in my practice setting such as physical environment, social climate and learning opportunities available in my practice setting and this will definitely give a better output toward learning environment in the placement arena. Although I have identified many of the learning opportunities but there are some limitation on the implementation especially on the resources. I have made some recommendation to be bringing forward to improve the placement arena in future. I believe that this can be fulfils if the higher level management, training institution, mentors as well learners themselves is really committed to make changes toward the excellence learning environment. To make the process going smoothly everybody should take parts and plays their role accordingly.