Health science student teachers' perceptions of teacher competence : A qualitative study

This is a self-archived version of an original article. This version may differ from the original in pagination and typographic details. Author(s): Title: Year: Version: Copyright: Rights: Rights url: Please cite the original version: CC BY-NC-ND 4.0 https://creativecommons.org/licenses/by-nc-nd/4.0/ Health science student teachers' perceptions of teacher competence : A qualitative study © 2019 Elsevier Ltd. Accepted version (Final draft) Kuivila, Heli-Maria; Mikkonen, Kristina; Sjögren, Tuulikki; Koivula, Meeri; Koskimäki, Minna; Männistö, Merja; Lukkarila, Pirjo; Kääriäinen, Maria Kuivila, H.-M., Mikkonen, K., Sjögren, T., Koivula, M., Koskimäki, M., Männistö, M., Lukkarila, P., & Kääriäinen, M. (2020). Health science student teachers' perceptions of teacher competence : A qualitative study. Nurse Education Today, 84, Article 104210. https://doi.org/10.1016/j.nedt.2019.104210 2020 Journal Pre-proof Health science student TEACHERS' perceptions of teacher competence: A qualitative study Heli-Maria Kuivila, Kristina Mikkonen, Tuulikki Sjögren, Meeri Koivula, Minna Koskimäki, Merja Männistö, Pirjo Lukkarila, Maria Kääriäinen PII: S0260-6917(19)30703-8 DOI: https://doi.org/10.1016/j.nedt.2019.104210 Reference: YNEDT 104210 To appear in: Nurse Education Today Received date: 8 May 2019 Revised date: 30 June 2019 Accepted date: 6 September 2019 Please cite this article as: H.-M. Kuivila, K. Mikkonen, T. Sjögren, et al., Health science student TEACHERS' perceptions of teacher competence: A qualitative study, Nurse Education Today(2019), https://doi.org/10.1016/j.nedt.2019.104210 This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2019 Published by Elsevier. Journal Pre-proof Title page and Author details Title: HEALTH SCIENCE STUDENT TEACHERS’ PERCEPTIONS OF TEACHER COMPETENCE: A QUALITATIVE STUDY First author (corresponding author): Heli-Maria KUIVILA, University Teacher, Doctoral Candidate, MHSc; Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland Mailing Address: Research Unit of Nursing Science and Health Management Faculty of Medicine P.O. Box 5000 FI90014 University of Oulu Tel.: +358 407404735 Email: [email protected] Twitter: @HeliKuivila Second author: Kristina MIKKONEN, Researcher, PhD; Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland Email: [email protected] Twitter: @Kristinamikkon ORCID: https://orcid.org/0000-0002-4355-3428 Third author: Tuulikki SJÖGREN, Senior Lecturer, PhD; Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland Email: [email protected] Fourth author: Meeri KOIVULA, Associate professor, PhD; Faculty of Social Sciences, University of Tampere, Tampere, Finland Email: [email protected] Fifth author: Minna KOSKIMÄKI, Lecturer, PhD Candidate MHSc, Faculty of Social Sciences, University of Tampere, Tampere, Finland Email: [email protected] Sixth author: Merja MÄNNISTÖ, Lecturer, Doctoral Candidate, MHSc; Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland; Health care and nursing, Oulu University of Applied Sciences, Oulu, Finland Email: [email protected] Seventh author: Pirjo LUKKARILA, PhD, Administrative Head Nurse, Oulu University Hospital (OYS), Oulu, Finland Email: [email protected] Eight author: Maria KÄÄRIÄINEN, Professor, PhD; Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute Centre of Excellence, Helsinki Email: [email protected] Journal Pre-proof Journal Pre-proof Funding Source: Not applicable Conflict of Interest: No conflict of interest. Ethical Approval: The University of Jyväskylä provided a statement (12.12.2017) that the planned research was ethically acceptable. Acknowledgement: We would like to acknowledge the contact persons for their significant help during the data collection phase. We would like to thank the student teachers for taking the time to participate in the interviews. Journal Pre-proof Journal Pre-proof HEALTH SCIENCE S TUDENT TEACHERS’ PERCEPTIONS OF TEACHER COMPETENCE: A QUALITATIVE STUDY Abstract Background. Health science teacher competence is multifaceted and continuously changing according to national and international healthcare standards. Organizational restructuring and emphasis on cost effectiveness is changing the scope of health science teachers’ practical work and their role in healthcare (worldwide). Aim. This study aimed to describe student teachers’ perceptions of the competencies needed to work as an educator in the healthcare field. Objective of study was to gain new knowledge which can be used in the development of teacher education programs in nursing science and to define a broader definition of the health science educators. Methods. A qualitative study was conducted. Data were collected from 23 Finnish students completing a master’s degree in teaching in the healthcare context using focus group interviews. The data were analyzed by inductive content analysis. Results. The student teachers identified eight main categories of teacher competence: leadership and management competence; evidence-based practice competence; subject competence; ethical competence; pedagogical competence; collaboration competence; internationalization competence; and continuous professional development competence. Conclusion. This study identified essential teacher competencies that can be evaluated among students to develop health science teacher curricula. The findings can be used in follow-up studies or comparative research to investigate competence differences between novice and experienced teachers. Key words: Competence, Education, Health sciences, student teacher, Teacher, Teacher degree program Journal Pre-proof Journal Pre-proof Introduction The concept of competence can be considered to encompass an individual’s knowledge, skills, abilities, attitudes and experiences (Delamare Le Deist and Winterton, 2005). Competence can be defined as the successful completion of individual tasks and functions, or alternatively, as specific knowledge and individual solutions based on basic generic capabilities. Competence means that a person can combine a variety of skills or functions depending on the situation in which they work. The ability to perform certain functions always requires some combination of knowledge, skills, dispositions and values (Gonzi 2013). This unique set of attributes – which is both developmental and context-dependent – enables a person to accomplish the tasks and goals that exist at an expected level of performance (Epstein and Hundert, 2002). Professional competence covers the habitual and calculated use of communication, knowledge, technical skills, reasoning, emotions, and values to benefit the individual as well as the community in which they work. Competence in the professional context also includes the ability to manage ambiguous problems, tolerate uncertainty, and make decisions with limited information (Epstein and Hundert, 2002; Delamare Le Deist and Winterton, 2005). The presence of different definitions for the concept of competence has led to the challenge of trying to conclude what competence really is. At present, it seems unlikely that there ever will be a universally acceptable definition for competence (Garside and Nhemachena, 2013). The World Health Organization has characterized the core competencies of nursing educators divided into eight domains including: (1) ability to understand educational theories, and principles and models of curriculum design related to health education and adult learning; (2) ability to design, implement, monitor and manage curricula based on best available evidence; (3) ability to maintain current knowledge and skills in theory and practice; (4) ability to develop critical inquiry, conduct research and utilize findings to identify problems and solve them; (5) ability for effective communication and teamwork, and interdisciplinary collaboration enhancing partnership among health education and Journal Pre-proof Journal Pre-proof clinical practice professionals; (6) ability to demonstrate professionalism including legal, ethical and professional values in developing nursing education policies, procedures and decision making; (7) ability to monitor and evaluate educational programmes, curricula and student learning with differing methods; (8) ability to manage, lead and create educational programmes and shape the future of education institutions (WHO, 2016). In the American League for Nursing (2012) the educator’s competence has been described from a more studentor person-centered perspective. It includes the educator’s ability to facilitate student learning and the achievement of desired cognitive, affective, and psychomotor outcomes. It involves learner development and socialization; the ability to use assessment and evaluation strategies in different settings and domains of learning; ability to participate in curriculum design and evaluation, and to function as a change agent and leader creating a preferred future for nursing education and nursing practice; ability to pursue continuous quality improvements in the role of a nurse educator, engage in scholarship, and the ability to act within the educational environment (The American National League for Nursing, 2012; Christensen and Simmons, 2019). Teachers need to possess versatile knowledge in the subject that they teach as well as know how to teach, motivate students, and manage their work in national and international educational environments (Salminen et al., 2013; Töytäri et al. 2016). A recent systematic review showed that health science teachers’ competence is complex as it constantly changes according to the healthcare organizational and political structure (Mikkonen et al., 2018). Furthermore, organizational restructuring and emphasis on cost effectiveness has transformed the scope of health science teachers’ practical work and thei r role in healthcare (Guy et.al., 2010; OECD, 2017). Teachers are also required to use and create evidence-based knowledge, work with digital tools and take responsibility for continuous learning (McAllistair and Flynn, 2016; Mikkonen et al., 2018). The curricula underlying degree programs for health science teachers are designed to build Journal Pre-proof Journal Pre-proof competencies which are essential for guiding future healthcare professionals. Educational programs and minimum qualifications or required competencies for health science teachers vary between countries. Acquiring professional qualification internationally, health science educator usually requires a Master's and / or a doctorate degree and at least two years of working experience in the healthcare sector (European Commission, 2009, Salminen et.al, 2014, University of Applied Science Act 1129/2014, Paul, 2015; Oprescu et.al., 2017; National League for Nursing, 2019). In a previous study, health science teachers ranked their competence in building relationships with students the highest and their teaching skills the lowest. This research found the weakest skil ls among health science teachers to be teaching decision-making and encouraging students to seek new knowledge (Salminen et al., 2009). Other research found that when delivering simulations, a teacher students’ knowledge, behavior, s kills, and ability to support students are important competencies (Topping et al., 2015). Research focusing on digital competence have found that student teachers are motivated to us e ICT and want to further develop their own skills (Sa lminen et al., 2016; Autio et al., 2018). Other studi es have focused on the challenges that student teachers face while developing their teaching skills (Black, 2015). Support from other teachers can promote student teachers’ self-efficacy by helping them understand the developmental stages of teachers, encouraging critical reflection, and providing motivational and descriptive feedback to improve practical skil ls (Blac k, 2015). It has been discovered that new teachers feel a need for supplementary education to update their competencies only a few years after graduation (Vile n and Salminen, 2016). There is a limited amount of published research in this area worldwide. The purpose of this study was to describe health science student teachers’ perceptions of teacher competence. The primary question underlying the presented research was: what kind of perceptions do student teachers have of the competencies needed to work as a teacher in healthcare? Journal Pre-proof Journal Pre-proof Method Data Collection A qualitative study was conducted. The data were collected from 23 student teachers at five universities in Finland in spring 2018. The inclusion criteria for participants were being enrolled in postgraduate teaching studies in health sciences and completion of practical teacher training within healthcare education. All of the eligible participants were recruited with the help of coordinators at the universities. The 23 student teachers who joined the study were healthcare professionals, more specifically, nurses, physiotherapists, bio-analysts and radiographers, with working experiences ranging from three to 30 years. In this group of student teachers, 14 were completing a Master’s degree in teaching in the field of nursing science while the remai ning nine participants were completing a Master’s degree in teaching in the field of physiotherapy. Participants ages varied from 23 to 58 years. The data were collected in focus groups using semi-structured interviews. Focus groups were chosen as they produce conversation and yield collectively formulated information on the phenomenon of interest (Orvik et al., 2013). The themes of the interviews - focus on teachers’ work, curriculum development, collegiality and working community, organizational areas, internationalism and multiculturalism, and society and teaching - were based on a systematic review on healthcare teacher competence (Mikkonen et al., 2018). The themes were pre-tested in one interview, and data from this interview were used in the final data analysis because the themes remained unchanged after pre-testing. All but three interviews – which were conducted via Skype online connection - were conducted in a private space at the universities. The duration of the interviews ranged from 25 to 60 minutes. Interviews were audio recorded and coded by number of participants. The amount of data collected in this study can be considered sufficient since data saturation was reached. Data Management and Analysis Recorded interviews were transcribed into a word document (149 pages, line spacing 1,5; font size 11), after which data were analyzed by inductive content analysis (Elo and Kyngäs, 2008). The analysis applied the philosophical framework of critical realism, and by focusing on what was being said about competence by student teachers we hoped to gain an understanding of the current situation and how Journal Pre-proof Journal Pre-proof Nothing is static anymore, everything is in transition all the time (Interview nr IV)". Discussions of building competence at work evoked descriptions of on-the-job learning, the continuous updating of one’s competence, and a teacher’s utilization of competenc e to improve the entire work community. Participation in continuous education was associated with self-education and that a teacher should independently seek information to support their competence. Discussion The participating student teachers identified eight competence areas that were related to health science teacher competence. Leadership and consumer-oriented healthcare are essential competencies for teachers. Furthermore, health science teachers have a vital leadership role as clinical experts, role models, mentors, and supporters of quality projects, and are also responsible for developing more holistic models of care for patients (Sayers et al., 2015). This also involves innovation and flexibility in utilizing situational leadership approaches that nurture student confidence and commitment for health practice. Ideally, health science teachers lead by exceptional example (Walls, 2019). The domains of leadership and administration competence can be characterized by system management and leadership skills, which health science teachers can leverage to create, maintain and improve nursing programs – as well as shape the future of nursing education institutions (WHO, 2016; Pihlainen at al., 2016). Student teachers described managerial competence as the knowledge of administrative tasks and recognition of educational legislation - which is partly consistent with what was reported by Pihlainen et al. (2016) – as well as participating in the work community and focusing on work well-being-related areas as noted by Nilsson, Blomqvist and Andersson (2017) and van den Berg et.al., (2017). Student teachers did not associate a teacher's leadership competence – which manifests itself through acting as a role model - with managerial and administrative competence. They also did not see a leader in nursing education as a person who can create a vision for the future of nursing education and maintain a forward-looking, sustainable environment that contributes to the future. This deviates from what has been presented in previous studies of health science educators (Patterson and Krouse, 2015; Pihlainen et al., 2016). This may be due to the fact that the study participants were students who had not yet Journal Pre-proof Journal Pre-proof worked as teachers and may not have a deep understanding of the competencies required in the teacher’s profession. Health science teachers need to have versatile knowledge of the subject(s) they teach (Töytäri et al. 2016), theoretical and practical credibility, holistic ethical awareness, moral judgment skills and a willingness to do good (Kulju et al., 2016). When asked about the evidence-based practice competence category, student teachers felt that future health science teachers would be required to generate and manage evidence-based knowledge. As Mikkonen et al. (2018) have suggested, requiring teachers to hold higher education degrees and to have participated in research may be beneficial strategies for building evidence-based practice competence. Holistic care and health services can only be successfully provided when theory and practice are combined. Concerning the subject competence category, student teachers emphasized the importance of connecting theory and practice. They further specified that a teacher’s clinical experience and subject competence allow them to link theoretical learning with practical knowledge when teaching students, and remain connected to contemporary clinical practice, which is consistent with earlier findings (Fowler, Baker and Geraghty, 2017). Ethical competence comprised ethical foundations and moral standards of behavior in education. Other researchers have previously suggested that awareness of both ethical dimensions and teaching obligations is essential as it improves professional skills and practices and can affect students' moral reasoning and attitudes (Warnick and Silverman, 2011). By saying that, all teaching staff need to recognize the multifaceted issues that influence students' understanding of ethical issues, and to integrate cultural safety principles into their ethical teaching (Song, 2018 ). When discussing pedagogical competence, the student teachers predicted that future education will be organized irrespective of place or time, and will be predominantly web-based. Technology has been listed as the largest change affecting health science education (LeRouge et al., 2014). In line with our findings, recent studies have shown that student-centred objectives need to be associated with the reform of conservative teaching methods, as well as the skilled use of information technologies (Öner, 2018 ).Today's learners require new tools for learning and are skilled and accustomed to using a wide Journal Pre-proof Journal Pre-proof variety of new and changing technologies (McQueen et al., 2017; National League for Nursing, 2019 ). Digital applications offer new, modern methods to support teaching and learning (Salminen et al., 2016; Bristol, 2019a), and health science teachers have an important role in teaching and guiding students to develop the technical skills and knowledge that will be necessary for future professions (McQueen et al., 2017; Bristol, 2019). The ability to teach, support, motivate and guide students, along with communication skills, were highlighted during discussions of educating and mentoring competence. The participating student teachers felt that a teacher should be able to identify each learner’s unique strengths and then motivate the learner by focusing on their strengths. These findings are in line with previous knowledge of student mentoring and guiding (Tuomikoski et al., 2018; Bristol, 2019b). It is also shown that students can benefit from a mentoring relationship, even from a distance, especially when the student and the mentor already know each other (Cheek, Walsh Dotson and Ogilvie, 2016 ) The World Health Organization (2016) has earlier stated that health science teachers must be effective communicators and promote team-building if they hope to improve interdisciplinary collaboration in healthcare and education (WHO, 2016). Student teachers expressed that the ability to operate in projects, both nationally and internationally, as well as language and cultural competence will be among the most important competencies for future teachers. Student teachers also stated that even though health science teachers are responsible for maintaining a sufficient level of competence, managers should nevertheless afford teachers the possibility to update their competence. Continuous education is vital as it ensures that professionals can adequately monitor their own professional development to provide safe and efficient services (Directive 2005/36/EC and EFN Strategic & Operational lobby plan 2014-2020, revised 2016; National league for Nursing, 2019). Other researchers have suggested that continuous education is crucial to maintaining the skills and competences that are needed to operate in a practical environment (Hendrickx and Winters, 2017) and that it significantly impacts the attendee’s knowledge, skills, attitudes and behaviors (Harden et al., 2017). Journal Pre-proof Journal Pre-proof Limitations All of the participants in the study were Finnish and, as such, they shared experiences of teacher competence that were relating to the Finnish education system. However, as education systems vary from country to country, the presented results may therefore not necessarily be generalizable to the international educational context. Conclusions A study of Finnish student teachers identified eight main categories of competence that were relevant to the work of health science teachers. Even though the participants were students, they already had a clearly developed understanding of the multidimensional competence needed in the work of a health science teacher. A comprehensive description of health science teacher competence is important, as the information provided in this article can be used to evaluate the competence of student teachers at different phases of their studies and then develop the curriculum accordingly. 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