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What is quality improvement
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inhealthcare andwhy is it important?
The King’s Fund and the Health Foundation1 note that:
‘Now, more than ever, local and national NHS leaders
need to focus on improving quality and delivering
better- value care. All NHS organisations should be
focused on continually improving quality of care for
people using their services. This includes improving
the safety, effectiveness and experience of care’.
Whilst their report was completed in 2017 and much has changed
in that time (including a global pandemic), there has been a continued commitment to improving quality of care.
2
In agreed definitions of advanced clinical practice, quality
3–5
improvement is a key feature.
This includes an expectation
that ACPs use their knowledge, skills and experience to engage
with complex decision making, using the autonomy afforded
by their role to enable ‘innovative solutions to enhance people’s experience and improve outcomes’. ACPs are expected to
‘lead new practice and service redesign solutions in response
to feedback, evaluation and need, working across boundaries’
to ‘continually develop practice in response to changing population health need, engaging in horizon scanning for future
developments’.
3
Quality improvement is multifaceted, and whilst quality
maymean different things to different people at different times,
there is a set of principles that underpin quality improvement
(Table 44.1). These are echoed in the standards expected of ACPs
as registered healthcare professionals through their regulatory
6,7
bodies.
Stakeholders andassessing feasibility
In order for a quality improvement project to be successful, consideration must be given to both the needs of and possible impact
(positive or negative) on those affected by the project. We should
not underestimate the powerful contribution that can be made by
patients, families, carers and colleagues in shaping the project to
ensure it achieves its goals. Determining who the key stakeholders
are should occur at an early stage, before specific aims, actions and
outcome measures are planned, to ensure they are fit for purpose.
Use of SCOT analysis to collect the perspectives of stakeholders on the Strengths, Challenges, Opportunities and Threats to
the project can be helpful in shaping initial planning and assessing the feasibility of a project. Stakeholder analysis can also be
used to identify persons who can be engaged to facilitate the project and those who may need persuasion to prevent blockages or
obstructions to the project’s progress.
Feedback should be actively sought from stakeholders, with
the default position being that they are involved in the design
and production of the project. Through engagement with
stakeholders, the resources that will be needed to successfully
deliver the project can be identified. Resource consideration is
not just ensuring that sufficient funding is in place, but also
working out what facilities, access arrangements, people and
information may be needed.
A communications plan or matrix should be developed to
capture who needs to know what, and when, about the project.
This will help to keep the project on track and ensure people
remain on board with the proposed changes. Responsibility
charting can be used alongside the communications plan and
updated as the project is developed to ensure everyone involved
8
is clear about their role and responsibilities in delivering the
quality improvement.
8
Problem identification andmodels
forimprovement
The six steps of the quality improvement process can be found
in Figure 44.1. This starts with identifying the scope of the
project. Define what will be included/excluded by answering
the questions ‘What? When? Where? Who?’. This will promote
clarity and ensure each member is working in the same
direction.
9
A root cause analysis of the problem is paramount as the
project should focus on the cause, rather than the effect of the
problem. Initial quantitative or qualitative analysis will help
8
to capture and evaluate relevant data.
Specific tools can support development of understanding by gaining insight into
the causes of the problem, before making interventions or
changes based on assumptions (Table 44.2). This prevents
mistaken conclusions and ensures problem solving is factual
and
evidence based.
10
Improbable causes should be removed through general
agreement and the verified causes should be ordered in terms
11
of priority.
If a project is large and complex, the team may
focus on issues which will have the biggest impact within the
resources available (time, funding, staff, expertise). Through
this process, the project objectives can be agreed and established; these will be the focal points for the ‘design and plan’
stage. It is important in this stage to identify all the tasks and
activities that need to be delivered. During this process, the
use of SMART goals and GANTT charts can help in identification of actions and timelines.
8
When implementing changes, it is advisable to pilot the
intervention on a small scale first before wider implementation. Using the Plan, Do, Study, Act (PDSA) cycle enables
testing interventions and learning in a structured framework
(see Chapter 43, Figure43.1).
8
Quality improvement methods
In deciding which methods to use, it is important to know what
needs to be tested, what should be achieved, and how outcomes will be measured.
resentation of the different steps of the journey and overall
picture (Table44.3). This enables teams to understand the project, engage effectively in their part of the process, and identify
through a process map can highlight how well the project is
developing and offers the opportunity to reflect on issues that
may arise and address them where needed.
Process mapping should connect with measuring the project’s
actual performance to evaluate the real impact of decisions and
15
actions taken.
The Statistical Process Control tool can support
data analysis of the outcomes previously defined in the ‘design
and plan’ stage.
8,9
and analysed throughout the project delivery and beyond to
ensure that the changes implemented are beneficial.
Regardless of the outcome, dissemination of the results of the
project should form part of the communications plan. Mistakes
should be highlighted to avoid them being repeated by others,
and examples of effective practice should be shared widely to act
as a beneficial learning experience.
12,13
Process mapping allows visual rep-
14
Indicator measurements should be recorded
15
117
Chapter 44Improving quality ofcare
ISTUDY
ISTUDY
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Advanced clinical
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practice education
Part 6
Chapters
45 Exploring the challenges with advanced clinical
practitioner education
46 Opportunities for advanced clinical
practice education and associated support
mechanisms
47 Education and learning theories 126
124
120
48 Simulated learning and decision-making
theories
49 Integrating simulation and virtual reality into
clinical practice education
50 The advanced practitioner as clinical educator
and supervisor 132
128
130
ISTUDY
119
120
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Part 6Advanced clinical practice education
46
45
Exploring thechallenges withadvanced
clinical practice education
Table45.1 Challenges concerning ACP education and actions identied at system (macro) and regional (advanced practice faculties/
employers/HEI) (meso) levels
Challenges Issues Activities by/for: government agencies/HEIs/employers/
Ensuring that professionals working
1.
at ACP level have the knowledge,
skills and behaviours relevant to their
professional setting and job role
2.
Promoting implementation and
application that allow for local
context but result in sufficient
consistency to transform the
workforce in line with national
government priorities
3. Encouraging collaboration between
educators and employers to enable
practitioners to develop their abilities,
particularly clinical capa bilities, a nd
for supervisory and assessment
purposes
4.
Focus on an outcome- driven
approach
1,2
tACPs
1a.
Developing curricula to meet
generic and specialist advanced
practice content and capabilities
aligned to four pillars of
professional practice
Defining and ensuring tACPs are
1b.
able to meet area- specific/
specialist capabilities in the ACP
programme alongside generic
knowledge and capabilities
2a. Informing the development and
implementation of national ACP
frameworks and areacapabilities to introduce greater
consistency of role definition and
capabilities between HEI
programmes
2b. Working with Association of
Advanced Practice Educators
(AAPE), national ACP centres/
boards and regional faculties for
advanced practice, undertaking
accreditation of ACP
programmes, developing routes
of equivalence, maintaining a
directory of ACP practitioners
4. Ensuring rigour across all four
pillars of professional practice with
associated standard of teaching,
learning and assessment
specific
1a. Developing curricula which meet HEI academic regulations,
national ACP frameworks, generic and area- specific/
specialist capabilities– with national accreditation or
recognition for programmes where available
1b.
Using national ACP frameworks and area- specific/specialist
capabilities to inform curricula, programme structure,
teaching, learning and assessment strategies to meet
academic and clinical capabilities
1c.
Collaboration between employers, HEIs and tACPs to
confirm role requirements and ensure range of placements/
experience available to meet role and area- specific/
specialist capabilities and accreditation (see below)
HEIs/employers identify relevant academic and workplace-
1d.
based supervision, support and assessment (see below)
2a. HEIs/employers/tACPs: improving awareness of national
ACP frameworks and developments, including impact of
these frameworks on HEI programmes– level of award,
learning outcomes, teaching, learning and assessment
requirements
2b.
HEIs/employers: engaging with developments in ACP
credentials, roles, governance
2c. HEIs: incorporating recognition of prior learning and
portfolio routes into programme approval and delivery
3a. Employers/ACPs/tACPs: map core capabilities and
specific/specialist capabilities to service opportunities
areato identify appropriate placements and where gaps may
exist requiring reciprocal arrangements to be developed
3b. Health boards/regional HEE/employers: establish process for
local reciprocal arrangements between organisations to enable
tACPs access to services/supervision to achieve workplacebased supervision and achievement of clinical capabilities
3c. HEIs/employers: agree criteria for workplace- based
ordinating education supervisors and associate
cosupervisors; recruit and provide training and support
3d. HEIs/employers: consider a formal support network across
regions for ACP practice co- ordinating education
supervisors and associate supervisors
3e. HEIs/employers/ACPs: discuss continuing supervision and
support needs of ACPs following successful completion of
programme and transition to ACP role
4a. HEIs/employers: collaborative curriculum development
meeting HEI regulations, national frameworks and
area- specific/specialist credentials, apprenticeship standard
4b. HEIs/employers/ACPs/tACPs: improve understanding about
ACP developments across the workforce and service users
4c. HEIs: incorporate four pillars of professional practice and
associated capabilities in teaching, learning and
assessment strategies
Advanced Clinical Practice at a Glance, First Edition. Edited by Barry Hill and Sadie Diamond Fox.
© 2023 John Wiley & Sons Ltd. Published 2023 by John Wiley & Sons Ltd.
ISTUDY
Table45.1 (Continued)
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Challenges Issues Activities by/for: government agencies/HEIs/employers/
Promote portfolio approaches and
5.
consistent, transparent processes
for accreditation or recognition of
prior learning
6.
Collaborating across an area or place
6.
if necessary to optimise costeffective training with flexibility to
develop generic capabilities and
area- specific/specialist competence
7.
ACP developments must be
multiprofessional and encompass
interprofessional learning and
support
8. Responding to apprenticeship
requirements and royal colleges/
faculties involvement in
credentialling programmes
9. Enable ACP education to flourish 9a.
Specialist module(s)/programmes
may need to be delivered across
each country, regionally to be
educationally and financially viable
Concerns re erosion of professional
8.
identity if royal colleges drive
credentialing of specialist skills in
ACP education and if ACP roles
regarded, or used, as doctor
substitutes in service
Planning and long- term
investment for HEIs to develop
capacity and capability, investing
in ACP programmes.
Timely notification about
9b.
commissions– funding and
applications. Fees funding for
learners
tACPs
5a. HEE (or equivalent)/HEIs/AAPE: guidance for establishing an
equivalence route for demonstrating advanced practice
capabilities and Master’s level thinking and practice– how
to understand, measure, test and evidence these
6a. HEIs/employers: co-
identifying range of programmes and modules required and
available
7a. Employers: reviewing service delivery and identifying
opportunities for developing multiprofessional ACP services/
roles
7b. Employers/HEIs: interprofessional learning and teaching
strategies; range of clinical supervisors
8a. Employers/HEIs/ACPs/tACPs: develop understanding of
apprenticeship requirements and structuring programmes to
accommodate the end point assessment
8b. HEIs: contribute nationally (for example, via AAPE) to
development of area-
9a. Funding identified by UK nations for ACP workforce
development
9b. HEIs/employers: working regionally to establish timely and
co-
ordinated processes for recruitment to ACP
programmes, clinical educator criteria, opportunities for
shared placements, sharing innovative practice
ordinate recruitment to tACP roles,
specific/specialty credentials
121
Chapter 45Exploring thechallenges withadvanced clinical practice education
his chapter explores the challenges with ACP education
for governmental bodies, higher education institutions
T
(HEIs), employers and trainee ACPs (tACPs) resulting from
historic and current systemundertaken to achieve the clarity, consistency and standardi
wide changes, and the work being
sation required for the role and to facilitate wider service
transformation.
Background/context
Globally, the integration of advanced practice roles into healthcare organisations and systems has evolved iteratively over time as
roles have been introduced in an ad hoc manner and the formal
policies and practices necessary to support optimal role implementation, legislation, regulation, competencies and education
have lagged behind the informal introduction of the roles. These
significant variations in ACP education, skills and experiences
have led to a bespoke approach to role deployment, impeded
wide innovation and created challenges to recruitment
systemand ongoing professional development of role holders.
Calls for clarity, consistency and standardisation of the ACP
role and education pathway led to the creation of national frameworks which aim to support UK healthcare providers to deliver
sustainable ACP services. These frameworks make evident the
changes required at system (macro), regional (meso) and individual employer/higher education institution (HEI)/tACP
(micro) levels when introducing, developing and supporting
ACP and embedding ACP roles in the workplace.
The introduction of these system- wide changes to ACP across
the four UK nations has also required changes to ACP education
and support to establish consistent education standards and credentialling systems, including work to define area-
specific or
specialty capabilities within the four pillars of professional practice, and secure sustainable funding to develop this workforce.
This is a rapidly developing field, requiring co-
ordination
nationally, regionally and locally, and there also exists variation
in academic and clinical support and supervision arrangements
for tACPs associated with geography, pathway, practice context
and roles.
System standard setting for, and
co- ordination of, ACP education
In response to the rapidly evolving ACP policy developments, in
2018, the Council of Deans of Health together with Health
Education England (HEE) and other stakeholders discussed the
future of ACP education to optimise the outcomes required by
health policy, employers and the workforce. The challenges and
actions identified at system (macro) and regional (advanced practice faculties/employers/HEI) (meso) levels are summarised in
Table46.1 alongside those obtained from a region- wide survey of
employers/HEIs/tACP (micro) levels.
Broadly, challenges for ACP education relate to the following.
•
Curriculum development and programme delivery: using
national frameworks defining generic and area- specific/specialist capabilities in education programmes; HEI and external
accreditation and quality assurance processes of programmes;
co- ordination of ACP programme development, recruitment
and delivery; recognition of prior learning.
1
ISTUDY
•
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122
Part 6Advanced clinical practice education
Education routes to ACP roles and sustainable funding:
co- ordinating and aligning recruitment to tACP roles and
education programmes; apprenticeship standard and levy
(in England); portfolio equivalence route; development and
inclusion of areaties and accreditation.
•
Teaching, learning and assessment: interprofessional learning/
teaching; Master’s level achievement of capabilities for four
pillars of professional practice; academic and workport, supervision and assessment.
•
Workplace- based supervision and assessment: securing access
to range of experience to achieve generic/core and areaspecific/specialist capabilities; supervisor/assessor criteria,
role descriptors and preparation; assuring quality of supervi-
sion and assessment.
Whilst focused on HEIs in England, challenges similar to those
identified in Table 45.1 may emerge for UK and international
education providers. As is evident in Table46.1, significant collaboration is required at all levels between employers, HEIs,
ACPs and tACPs to ameliorate these challenges.
specific/specialist ACP curriculum, capabili-
Development anddelivery ofACP
education– workplace- based
andacademic support andsupervision
The challenges identified in Table45.1 illustrate the workplacebased (clinical) supervision and support, alongside ongoing professional supervision, that tACPs require to ensure achievement
of the generic and area- specific/specialist capabilities across the
place sup-
pillars of practice, alongside meeting the academic require-
four
ments of the ACP programme.
In the workplace, tACPs are supported through clinical
supervision from experienced practitioners. Clinical supervision provides an opportunity for practitioners to reflect on
their clinical practice, discuss individual case studies and identify changes to practice required to maintain professional and
public safety. It provides an opportunity to identify training
and continuing development needs. For tACPs, clinical supervision also relates to developing and demonstrating achievement of the core generic capabilities of advanced practice, and
national/local, area- specific/specialist capabilities. In this rapidly developing field of multiprofessional practice across a
growing range of settings, one challenge for education has been
to reduce the variation in support and supervision arrangements for tACPs associated with geography, pathway, practice
context and roles. To promote consistency across employers
and HEIs, the publication of Workplace Supervision for
Advanced Clinical Practice
provide consistency in this area.
Education and development in ACP combines workplacebased learning and training with academic learning at Master’s
level. Demonstrating Master’s level may be challenging for those
new to this level of study. Alongside the academic supervision
and support provided by module and course teams for individual
assessments, HEIs also offer a range of services to support students to develop their academic skills, maintain their well- being
and develop their career. These services are available to all students and tACPs are encouraged to identify and access these
throughout their ACP course.
3
and other national versions aims to
ISTUDY
ISTUDY
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124
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Part 6Advanced clinical practice education
47
46
Opportunities foradvanced clinical
practice education andassociated support
mechanisms
Table46.1
UK nations’ denitions, core knowledge andcapabilities foradvanced clinical practice
Country ACP framework/credential and link
Scotland Transforming nursing, midwifery and health professions roles: advance nursing practice www.gov.scot/publications/
transforming-
nursing- midwifery- health- professions- roles- advance- nursing- practice/
Advanced nursing practice
www.nes.scot.nhs.uk/our-
work/advanced- nursing- practice- anp/
England Multiprofessional framework for advanced practice in England
www.hee.nhs.uk/sites/default/files/documents/multi- professionalframeworkforadvancedclinicalpracticeinengland.pdf
Wales Modernising Allied Health Professions’ Careers in Wales: A post registration framework
https://gov.wales/sites/default/files/publications/2020- 02/modernising- allied- health- professions- careers- in- wales.pdf
Framework for Advanced Nursing, Midwifery and Allied Health Professional Practice in Wales
www.wales.nhs.uk/sitesplus/documents/829/NLIAH%20Advanced%20Practice%20Framework.pdf
Northern Ireland
Advanced AHP Practice Framework
www.health-
ni.gov.uk/publications/advanced- ahp- practice- framework
Advanced Nursing Practice Framework
www.health- ni.gov.uk/publications/advanced- nursing- practice- framework
Figure46.1 Issues for consideration and sources of information for aspirant and trainee ACPs and ACPs
Pre-registration
level Nursing
& AHP students
Registration
level
Issues for consideration and sources of information for aspirant and trainee ACPs and ACPs
Enhanced level
Advanced
level
Consultant
level
Advanced level practice:
Developing ACP roles
Issues for consideration:
Employers: Service
•
development: ACP
service & role
specification
• Employers: Governance
for trainee ACP and ACP
roles
• Employers/applicant:
Education/training &
development required
for trainee ACP to
achieve national & local
knowledge and
capabilities required
• Employers/applicant:
Meeting role
specification and
university entry criteria
• Employer/applicant:
Clinical & professional
supervision
requirements, clinical
supervisor criteria and
range of clinical
opportunities
• Employer/trainee ACP
Formal recognition as
ACP (national registers)
• On-going education,
development,
professional supervision
and support
Education and training
requirements:
Demonstrates Masters level
knowledge & capabilities focused on:
4 pillars of practice:
Clinical, Education, Research,
Leadership & Management
Curriculum aligned to PSRB, Royal
Colleges, national Frameworks &
specialist credentials, apprenticeship
standards, service & role
specifications, university regulations
Achievement of knowledge and
capabilities: Academic assessment
and clinical supervision and
assessment in practice by identified
and prepared academics and practice-
based supervisor(s)
Education providers:
Higher education institutions in
collaboration with employers and
practice supervisors
Health Education England Centre for
Advancing Practice
Funding sources:
National government/public
organisations (Eg Health Education
England NHS Education Scotland)
aligned to workforce transformation
priorities
Apprenticeship levy (England)
Employer: service/organisation
Sources of information &
support:
• National/country
guidance and, where available,
centres and regional faculties for
advancing practice for role
expectations, national curriculum
& capabilities and sources of
funding
• Royal Colleges, national
specialist & professional
organisations for information
about ACP curriculum in areaspecific/specialist areas of practice
and specialist accreditation
• Higher Education
Institutions for university
accredited courses, including
apprenticeships, and
opportunities for recognition of
prior learning. Also for
information about clinical
supervisor and assessor
requirements/criteria
During study:
• Course leaders/academic
teams, academic and wellbeing
support services
• Clinical/practice-based
supervisor and assessor
• Accessing Professional
supervision
• Employer/line manager
Advanced Clinical Practice at a Glance, First Edition. Edited by Barry Hill and Sadie Diamond Fox.
© 2023 John Wiley & Sons Ltd. Published 2023 by John Wiley & Sons Ltd.
ISTUDY
his chapter offers an overview of the current landscape
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related to opportunities for advanced clinical practice (ACP)
T
education, incorporating a synthesis of policy and practice.
It highlights the education opportunities and support mechanisms required for consideration by employers when developing
ACP services and roles, and for those registered nurses and allied
health professionals aspiring to, or applying for, trainee and
ACProles.
Background
The education requirements necessary to meet the underpinning
knowledge, skills and capabilities for advanced clinical practice
vary considerably both in the UK and internationally, with
requirements ranging from a firstaward. Governance, professional regulation and the associated
legislative framework in any given country or setting influence
these requirements. It is not within the scope of this chapter to
explore these aspects in detail.
In the UK, it is important to note there is no specific regulation
for the ACP role beyond the requirements held by the professional’s
statutory registration, normally either the Nursing and Midwifery
Council (NMC) or Health and Care Professions Council (HCPC)
or general pharmaceutical council (GPC), and the governance
arrangements in place within the practitioner’s organisation.
Instead, policy frameworks and guidance, including royal college
credentialing and accreditation schemes (for example, Royal
College of Nursing (RCN), Royal College of Emergency Medicine
(RCEM), Faculty for Intensive Care Medicine (FICM)), have
brought about greater consensus in defining the knowledge, capabilities and formal education necessary for the ACP role, with a
Master’scredentials focused on areahave been developed as supplementary to the core knowledge and
capabilities required by all ACPs (Table46.1).
level qualification the agreed requirement. In addition,
level degree to doctorate- level
specific/specialist areas of practice
Pathways toACP education
The pathways to ACP education may vary depending where and in
which country the practitioner is situated. In the UK, career and
educational pathways have evolved largely in response to health
and care policy, including service and workforce transformation
plans, introduced by the devolved governments. A common theme
is that practitioners working as and/or towards an ACP qualification and role must be prepared to support the shifting demands of
an ageing population and workforce shortages, and work effectively to establish new models of interdisciplinary systems of care.
A common curriculum has emerged, building from preregistration and postregistration graduate and postgraduate education, and also national definitions, knowledge and capability
frameworks for ACP (see Table 46.1) whereby practitioners
develop their core knowledge and skills focused on the four pillars
of professional practice (clinical, leadership and management,
research/evidence- based practice, education) as well as ensuring
flexibility to recognise prior learning through embedding
workplacespecialist knowledge where there is population-
based learning approaches and portfolios for mapping
specific need.
Educational opportunities
Many universities in the UK and internationally offer ACP
programmes so the trainee ACP has considerable choice. These are
normally Master’s in Advanced Clinical Practice whose curriculum
design, learning outcomes and assessment strategies enable trainee
ACPs to demonstrate the knowledge and capabilities for the four
pillars of practice set out in the respective country framework,
alongside any areaaccreditation required to meet role requirements. Usually, programmes will be undertaken part time over a 2–4practitioners continuing to work under supervision in their trainee
ACP role. Trainee ACPs and their employers will need to identify
a workplacetrainee’s knowledge and capabilities in the clinical setting by
undertaking formative and summative assessment.
Curriculum design may vary depending on factors such as the
level of workplace collaboration, catered- for specialisms, service
user and wider stakeholder input, yet a range of both university
and work- based assessment strategies is the norm. Universities will
provide criteria, training and ongoing support for workplaceeducators and supervisors, with regular meetings to discuss the
trainee’s progress. National guidance detailing expectations for
workplace supervision for advanced clinical practice in England is
also available. This document defines the roles of, and criteria for,
the co- ordinating education supervisor and associate workplace
supervisors and promotes the importance of ongoing clinical and
professional supervision for trainee ACPs and ACPs.
In the UK, there are two common opportunities for funding
education programmes: either from government bodies (for
example, Health Education England NHS Education for Scotland
no longer funds Advanced Practice Education so remove please.)
via regional faculties or boards, or via the employer. A recent
development in the UK has been the introduction of the ACP
degree apprenticeship standard. This standard sets out the values, behaviours, knowledge and skills expected of the ACP and
details the education and workplace requirements, curricula and
end point assessment for the apprentice ACP to achieve their
Master’s award. The apprenticeship route is currently open for
eligible practitioners within NHS England.
In summary, prior to embarking on any ACP programme, the
employer and practitioner must consider an array of critical
elements which are key to ensuring the success of ACP education. These elements include organisational and/or service- level
need, service/role specification, governance, role requirements
including additional area- specific/specialist knowledge, capabilities and accreditation, funding, employer support, workplace- based
supervision arrangements and previous study experience, including
qualifications held. Ongoing professional and career development and supervision arrangements should also be considered as
the ACP role and services are established. Figure 46.1 offers a
summary of requirements for consideration and support.
specific/specialist knowledge, competencies and
year period with
based educator to supervise the development of the
125
Chapter 46Opportunities for ACP education and associated support mechanisms
based
ISTUDY
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Part 6Advanced clinical practice education
48
47
Figure47.1 Bloom’s taxonomy. Source: Korte D etal. (2015)/John Wiley & Sons
Education andlearning theories
Bloom’s Ta xonomy
High
Judge the validity of ideas
or quality of work based on
a set of criteria
Use information to solve
problems; transferring
theoretical concepts to
practical situations
Recognize and recall
High School UndergraduateGraduate
previously memorized
Low
Cognitive Level
Figure47.2 Sociocultural theory of human learning
Zone of Proximal
Development
information
Combine information to
produce a unique idea,
Creating
Evaluating
Analyzing
Applying
Understanding
Remembering
Figure47.3 Kolb’s learning cycle. Source: Botelho WT etal. (2015)/John
Wiley & Sons
solution, or product
Break objects or ideas into
component parts, determining
how parts relate to one
another and to the overall
structure
Demonstrate a
comprehension of
the facts
Concrete
Experience
Out of
reach
Zone of
Proximal
Development
Learns through
scaffolding
Current
Understanding
Can work
unassisted
ACCOMMODATOR DIVERGER
What would happen
Active
Experimentation
IF?
Why not?
if I did this?
HOW?
How?
What can I do?
Conceptualisation
WHY?
Why?
What is it?
Reflective
Observation
WHAT?
ASSIMILATORCONVERGER
What is there
to know?
What does
it mean
Abstract
Advanced Clinical Practice at a Glance, First Edition. Edited by Barry Hill and Sadie Diamond Fox.
© 2023 John Wiley & Sons Ltd. Published 2023 by John Wiley & Sons Ltd.
ISTUDY
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