PP 0126 Within this asingment, I will analyse the significance of facilitating and assessment in practice arena as a context for

learning. I am an Assistant Medical Officer (AMO) for three years in Paediatric Department in one of the government hospitals in Northern Malaysia. Im graduated as a AMO in Medical Assistant College in 2010. My clinical area has 48 beds including acute and non-critical beds, in which four beds are allocated for isolation cases. On the top of that, my department also accepts a range of learner including student nurses, medical students, and AMO students to improve their professionalism. I will examine my area as learning environment and critically evaluate its effectiveness in contributing to learning. The physical enviroment makes a person to contribute in learning process which are available in a particular working areas. My ward located in ground floor which are easier to come over and structured with facilities, equipments and information sources to support leaners in practice area. As an example, i can use the internet services that are provided widely in my department. Internet surfing allows immediate information that is valid to help with learning and to use the information available without delaying our work. As stated by Green (2009), internet surfing is more effective compared to an open book learning as it provides fast access. Meanwhile , the computer's normally used by the doctors for patients discharge summary and its only available from 8.00 am until 5.00 pm becouse sister incharge will close the computer room after office hour. This kind of things makes us in trouble to learn becouse staffs only can use the computer's after finish their shift so they only have limited time to acess it in the ward.

The learning portfolio is a flexible, evidence-based process that combines reflection documentation and collaborative analysis of learning (Anker 2004) . Provide courses assessment, general education program, technical and professional skills, and practicum can approch to successful portfolio in learning opportunities (POLO) . My clinical settings provide short courses by senior AMO's , students clinical instructors and qualified doctors about the latest hot topics , procedures and patients care based on evidence. So all staff and students need to attend it atleast once in a month and have to fill up the assessment books about the short courses that we attended and it will analys by a person incharge. Its help to clarify the staff development and outcomes in clinical settings which are base on incidents reporting by other organization to my ward. Every single acheicements and negative impacts need to mention in yearly department report. There are various styles in which we as learners can develop the ability to enhance the learning process. Besides POLO, we also have a library that offers informational books that give us details and data about questions that are asked frequently at our working areas. Reading has been one of the best ways in finding significant information. According to Shull (2000), readings about information online or via the Internet could be incorrect at times, therefore reading books that are available in libraries would provide more accurate information. My ward library only can occupied 10 people and its consist of more then 1,000 medical books and protocols. In addition, there also have some litureture books, newspapers, articles and also jurnals which are related to medical terms.

Other than that, according to Collin (2002), transformative learning is a good way of expanding knowledge and is classified as good learning. When we have discussion during work, the information from a single person is transferred to the rest of the team members and this helps to improving our skills and help patients care during work. Normally the senior staffs and higher post offices like doctors and specialits will give us more information during ward rounds or while doing any procedures by their own working experiences. Communication processes dominate information exchanges by sharing the ideas and to improve team communication , as well as develop clinical work and positive impact on clinical outcomes (Enrico W Colera 2002) . I learn more effectively by attend training or courses at the hospitals. These courses are conducted by professionals from medical backgrounds that have high qualifications and experience in particular working areas. It is proven that short courses help us improve our skills and knowledge based on recent theories and applications. According to Fristsche (2007 ) training of health professionals through short courses help to improve evidence based practice. However, we only can attend the short training once year each person and let others to rotate according to the working experience becouse shortage of staffs make us difficult to take leave to attend the courses and some courses are costly which are cannot effort by the departments finance to pay . My ward also has student nurses who are posted for two weeks for learning purposes in clinical settings. They will obserb by their clinical instructors. I examine that although there has been discrepancy between what is taught in the classroom and how care is actually given in practice (Landers 2001), we can judge what is being taught to

the students during their practice in caring for patients. Besides performance, assingnments are given to improve thier knowledge. It is important that we assess students and provide feedback for them to contribute in learning process. It is stated by Truemper (2004) that instructors should provide assessment that is valid to the students for their feedback in their evaluation. Clinical instructors provide feedback regarding the students knowledge by filling up their logbooks and assignments.

Staff's need to be up-to-date with the curriculum and assessment changes because new techniques or information will give better outcomes and effective care to patients. In my department AMO's need to fill-up the credentialing and privileging book according to standard of procedures (SOP) checklist. This allows us to receive certificate within six months as a reward to continue doing the procedures. In order to achieve this, existing curricula needs to be assessed in terms of their limitations and strengths by the person incharge. Internal meeting within staffs regarding problems , suggesstion and open

questions in field to solve thier problems, upgrate the clinical settings and to complete needs in ward. After the meeting, any discussions, plans or suggestions will be attached on the information board. I join in meeting and learn about the current issues and information towards the meeting session. Information board also take place in learning process by attach the latest news and updates for who was never attending the internal department meetings. Its more to self reading style which are staffs initiative to learn by reading the information surrounding the clinical place to improve their kowledge.

Directed learning can consider the learners practise setting and explore achievements of learning outcomes. Doctors, AMO's and nurses normally improve their knowledge from reading journals and also ward rounds with specialists. Journal reading is an intended learning which develops effective communication skills where else presentation by doctor's explain about issues and research's. Ward round is an unplanned activity in which the specialist explains about the disease and management of the patient while teaching the doctors and nurses. It deals with stressful situations because the learners have too much unexpected information in a particular time.

Formal learning is the normal teacher to learner education, learners can be AMO's or any medical professionals with reciprocal feedback from learners to teachers ( Drachsler 2009) . Formal learning can take place in academic centres and hospital settings. College of AMO's provides clinical instructor's for supervised practical trainings in the wards for those who come for postings. In the formal capacity as a AMO i participate in a workshops which are provide lecturing and demonstrations station by about our clinical settings. AMO's needs to be completed continuing professional

development points (CPD Points) which is have to achieve a minimal score for an upgrade in position by attending the courses. Informal learning is the process of learning which happens without an externallyimposed curriculum (Livingstone, 2001). Informal education can be viewed as an exchange of information among AMO's in the hospital attempting to improve outcomes for example sharing ideas and knowledge when interact or discuss with doctors

regarding the patients management. This how we transfer information in my clinical area by teamwork with doctors to achieve efficient and effective processes of care rather than perform individually. Discussions in healthcare professionals cooperatively exchange reliable current information regarding the patient management, so that doctors can have internal discussion with small group of AMO's about patients diagnosis, treatment, medications, and procedures. This serves to keep each member of the team educated and informed. There are different learning style depands on a individual person according to honey and mumford 2002 for example activist, reflector, theorist and pragmatist leaner. In my ward, I identified that students normally follwed reflector leraning styles becouse they stand back and look at the situation from different perspectives and they like to collect data and think about it carefully before perform in real situation. They enjoy observing others and will listen to their senior staffs before offering their own.

Learnin theory like cognitivism is based through interaction and self cognition development to acquire knowledge, and concern what the learners know and how to process information (Piaget 1998). Cognitivism is applied by instruction to students to make knowledge more meaningful. First, we should know the level of knowledge, because it will decide what instructional material should be designed, and make knowledge meaningful. Second, we should use the concept of information processing theory to arrange the easiest method and help student memorize, we also need to organize new information and relate it to existing memory, it also makes it easy to

memorize information. Third, we should let student's do active research and give proper help when students have questions, this idea fits discovery learning theory and zone of approximate development. Knowles Adult Learning Theory (1998) expands on the concept of the needs of the learner and focuses on self-directed learning involving the teaching of adults to be in control of their learning . Knowles Adult Learning Theory is based on andragogical model, or the art and science of helping adults learn, on six elements. In order for learning to occur students have to know their responsibility, the role of experience, a readiness or applicability of the information to ones life situation, motivation to learn, problem-centred learning with real-life problems. The concept of andragogy requires adults to have their own responsibility for their own learning, for example usually I look for my own practitioner guidelines that is provided in the library, Medical Assistant Board Act 1977 and never depend on others to feed the information. Adults should have readiness to learn and to have a life centred orientation learning that can be involved in problem solving. Most AMO's are facing problems in their clinical area because lack of knowledge and poor communication skills. According to andragogy concept they need to learn theories that helps to solve problems that occur during daily work. This helps to improve their skills. A role model is defined as someone who sets a good example and whose attitudes and values are followed by learners (Perry 2009). Usually when students come for practical the students will have a perception of what they expect an AMO's to do and how a AMO should behave when they start their programme. This influences who they choose as a role model and influence their professional development. Students usually

select senior staffs as a role models due to experience and professional skills to gain knowledge in clinical work. However there is a negative aspect to role modelling practice as this creates conflicts while assessing a student. There are some senior staffs who lack of knowledge, lazy to work and also not a pro-active staffs in my clinical settings. Often students want to fit in and create a good impression for higher marks, so they will not challenge their mentor and senior staffs if they see behaviour that conflicts with their sense of professionalism; instead they choose to ignore it for their assessment purposes. A positional hierarchy in practice influences the effect of role modelling (Felstead 2013). In conclusion, they are many different styles of learning environment as stated above but I think that group discussion with qualified mentors who are up-to-date with current evidence based practise is more effective for learning. This is because we can get better feedback from other group members during discussions and get more information from each other.

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