Beginning teachers’ developing clinical judgement: knowledge, skills and attributes for clinical teaching

December, 2020

Source: Teaching Education, 31:4, 381-403

(Reviewed by the Portal Team)

This research aimed to contribute to the development of a more in-depth understanding of a clinical practice approach within Initial Teacher Education (ITE) and to gain better insight into how beginning teachers develop and apply their clinical judgement.
The results of this Australian-based study may assist academic staff within ITE programs, both in terms of the content selection and sequence within ITE programs and in better facilitating the development of clinical judgment in their pre-service and beginning teachers.

The research context

An employment-based pathway to teaching
The findings presented in this paper are drawn from a study of an employment-based ITE program – the Master of Teaching (Secondary) Internship program (MTSI), offered at a metropolitan university, in the state of Victoria, Australia.
All participants in this research (from here on referred to as ‘interns’) were beginning teachers in the MTSI.
The MTSI is a three-year, postgraduate, 200-credit-point program, comprising concurrent part-time study and part-time teaching (80% of a full-time teaching load).
Interns are prepared to teach across the secondary years of school with specialist knowledge in two discipline areas.

To generate robust data on interns’ understandings or clinical judgement and clinical teaching, a survey was administered to the inaugural MTSI cohort at two points in time during the first year of their course.
Interns were first surveyed at the end of their initial university-based intensive stage but before they started their first six months of independent classroom teaching.
Interns were surveyed a second time, using the same instrument and same survey items, at the end of their first six months of classroom practice, during their second university-based study period.
The questionnaires used open-text items that were carefully structured to elicit participants’ broad conceptualisations of clinical judgement and clinical teaching.
Of particular interest were the ways in which they described their mobilisation of the clinical teaching cycle to enable their clinical judgements.
The data presented in this paper draws from the survey responses completed by a sample of 23 interns – the complete MTSI cohort.
At the time of the second survey, two interns had withdrawn from the program and a small number of interns elected not to complete the survey.
The findings presented below draw from two items on the questionnaire; each item included a set of questions.
The first item, seeking an holistic understanding of the beginning teachers’ conceptualisation of their clinical practice, asked interns:
What is ‘clinical judgment’? How do you formulate it? Who might be involved?
The second item, focused more explicitly on processes and the stages within their clinical practice, asked interns: What does ‘Clinical Teaching’ mean to you?
What do you need TO KNOW, to be able TO DO and what attitudes do you need TO HAVE to be able to make clinical judgments?

Findings and discussion
The evidence from the two surveys of beginning teachers in this employment-based ITE program are useful in supporting understanding in three areas:
● The ways in which these beginning teachers are constructing knowledge for clinical judgement in the first sixth months of their classroom practice;
● The ways in which these beginning teachers are mobilising the prescribed framework for clinical teaching (the Clinical Teaching Cycle) to underpin their practice; and
● The efficacy of the framework for clinical teaching (the Clinical Teaching Cycle) in scaffolding the development of clinical judgement.

Knowledge construction for clinical judgement
Consistent with the principles of clinical judgement, interns’ responses indicated a strong understanding that their own clinical judgements needed to be based on observation and evidence of student learning gained through assessment.
The data from the interns indicate a limited awareness or consideration of the role of classroom, school or community context in informing their clinical judgements.
This suggests the interns’ capacity to articulate their in situ reasoning or in other words make their ‘thinking in action’ visible is still at an early stage of development.
Although responses from interns highlight the importance of seeking data and evidence to understand their students, in most cases this was realised as a narrow conceptualisation of learner need specifically to a point on a learning continuum or as a quantifiable level within a cohort.
Some interns described a range of sources of evidence required in order to effectively assess need; however, it was limited in scope.
Generally, interns appeared to be focused on the collection of initial diagnostic assessment data.
There did not appear to be any substantial evidence that the interns understood the importance of gathering data to determine the impact of their pedagogy and inform subsequent teaching practice.
This level of understanding amongst the interns may be reflective of the context of their own learning and teaching practice.
Extrapolating from these findings of how the interns are constructing their clinical judgement in this initial phase of their training, there are some possible implications for ITE programs.
For example, the findings suggest a need for teacher educators to clarify the purpose and process of using evidence to enable clinical judgements beyond the diagnostic processes.
The findings presented here also indicate a need to challenge beginning teachers to deepen their knowledge and understanding of the interplay of contextual factors and student learning, including key diagnostic information not captured through their assessment methods.
Scaffolding beginning teachers in their development towards an understanding of clinical judgement as functioning holistically throughout their clinical practice is a necessary step in the consolidation of their clinical practice.

Mobilisation of the clinical teaching cycle
The interns’ responses indicate a strong acknowledgement of the centrality of a student-centred approach to teaching and need for evidence and data to inform their judgements and teaching decisions.
Interns whose responses suggest they are at the earliest stages of development described a focus on evidence for diagnosis only.
Those interns demonstrating the most developed understanding described a more holistic role for their clinical judgement, combining evidence, experience, research and theory to determine how best to intervene with a student.
Interns’ responses indicate a preoccupation with the first stage and to a lesser extent the second stage of the Clinical Teaching Cycle (i.e. identification of learning needs through data and evidence, and use of research and theory to identify pedagogical options).
There is evidence from the data that most interns are not yet articulating a capacity to either evaluate or reflect on the impact of their interventionist practice.
In relation to the second stage of the Clinical Teaching Cycle – the identification of interventions that will target the point of need – interns’ responses indicate awareness of the importance of identifying a range of approaches to target identified need or needs as well as recognition that pedagogical interventions need to be supported by the latest research evidence and the theoretical literature that underpinned their university-based ITE program.
Although the interns’ responses indicated awareness of the requisite knowledge domains and the appropriate processes underpinning pedagogical choice, articulation of these two elements appeared to be abstracted from each other.
At this initial stage of development, the findings indicate that most of the interns were not yet proficient in their operationalisation of evidence-based interventionist practice.

Efficacy of the clinical teaching cycle in scaffolding the development of clinical judgement
The interns’ responses indicate that at this early stage in their ITE, they are able to provide a more robust and complete articulation of their clinical practice through the deployment of the Clinical Teaching Cycle than through the use of the clinical judgement construct.
The interns appear to be generally focused on mobilising the early stages of Clinical Teaching Cycle (diagnosis, research-informed pedagogical options, design of intervention) and are conceiving their clinical judgement at play primarily in the diagnostic stage.
In terms of their development moving forward, the evidence would suggest that interns’ are not yet at the stage of assimilating the sequential, cyclical nature of clinical teaching and the role of clinical judgement at each point of their interventionist practice.
Comparatively, limited mention was made in intern responses of evidence of impact of their own practice.
Where evaluation and reflection have been explicitly articulated in open-text responses, there were very limited instances of interns using evidence and data to reflect on or evaluate the effectiveness of their teaching on student learning.
This has implications for the revision and continuous improvement of this and other ITE programs - one implication being that the MTSI program needs to support interns to move beyond second base:
that is, beyond the adoption of a purely diagnostic role for evidence-informed clinical judgements, to a proficiency in utilising evidence in the evaluation of their practice.

The evidence from this research warrants both cautious optimism and further examination of the utility of the clinical model.
The authors are optimistic because it appears that this cohort of interns have adopted a student-centred, clinical teaching ethos of teacher responsibility for correctly identifying an individual’s point of need and providing appropriate evidence-based intervention.
However, further examination is needed to further understand why their use of evidence to determine the impact of their teaching and modification of practice through reflection did not yet appear to be part of most interns’ practice.
Evidence from this case study suggests that while developing teaching expertise takes time, beginning teachers need to be supported to embrace the role of evidence to determine the needs of their students, and also in understanding the effectiveness and the impact of their teaching practice. 

Updated: Apr. 26, 2021