From mother duck to mother lode: clinical education for deep learning.

this lovely mixed metaphor had its origins in a recent presentation by Vicky Niederhauser (2009), who described the need to shift from the longstanding “mother duck” model of clinical education and humorously portrayed the great risks to the “baby-duckling” nursing students as their mother-duck faculty member attempts to lead them through a clinical day. and the “mother lode?” that refers to the gold mine of potential learning that surely exists in clinical settings; however, there are many barriers to striking that mother lode—not least of which is a model of clinical education that is ill-suited to contemporary practice. the call for reform in clinical education is reaching a fever pitch. lack of available clinical placements has been repeatedly cited as a factor in limited educational capacity (american association of Colleges of Nursing, 2007). reporting on a national study of clinical education, ironside and McNelis (2009) described the challenges that clinical faculty face in helping students gain the most out of their clinical experience while protecting the safety of an increasingly vulnerable patient population. a report from the National league for Nursing Clinical Education think tank (2008) lays out several elements of a reform model High-fidelity simulation has been introduced as one possible solution to both the shortage of faculty and the lack of clinical sites. We are beginning to get some evidence about the effectiveness of simulation in clinical learning, as presented by Harder in this issue of the Journal of Nursing Education. the introduction of high-fidelity simulation has raised a new set of questions by regulatory bodies—specifically, can simulation replace some of the time in “real” clinical practice, and if so, how much? this question begs a more fundamental question—if we are to be regulated by the number of clock hours in clinical, how many of those clock hours result in new learning? the study by ironside and McNelis (2009), as well as students’ anecdotal accounts, suggests there is far too much down time, far too much time focused on doing repetitive tasks that do not result in new learning, and far too little time focused on learning higher-order thinking skills. the sole reliance on a clinical education model that requires students to provide total patient care as their only or primary clinical activity is what stands between us and the mother lode of deep learning. true transformation of clinical education will require a fundamentally different way of approaching clinical education: