Improving Effectiveness of Student Learning During Clinical Rotations at a Teaching Hospital in Rwanda

As in many developing countries, Rwanda suffers from a chronic shortage of skilled healthcare professionals, including clinical instructors. This shortage negatively affects the quality of the clinical experience and has a significant impact on student learning outcomes. Due to poor clinical supervision, it is often noted that students have minimal structure and a lack of consistent guidance during their clinical rotation learning process. This abstract addresses the collaborative work of Clinical Educators sponsored by the Human Resources for Health (HRH) Program and their partnerships with Rwanda colleagues at the Rwanda Military Hospital (RMH) to implement an effective and structured learning program that attends to the aforementioned educational deficiencies.

HRH, a collaborative initiative with the Rwandan Ministry of Health (MOH), will take place over a seven-year period and work with several leading US institutions to improve the quality of healthcare in Rwanda in academia, research, and practice and decrease the Rwandan healthcare system’s dependence on foreign aid. Within the last four years, HRH has recruited numerous nurses to provide educational support to Rwanda’s nursing personnel in the clinical sector. HRH Clinical Educators are assigned to various teaching hospitals throughout the country to conduct needs assessments, plan and implement quality improvement projects to improve clinical practice, and promote autonomy among Rwandan colleagues and long-term sustainability.

It has been noted in the literature that providing a structured learning program to nursing students contributes toward a more enjoyable experience and a decrease in anxiety (Gauder & Zauderer, 2013), thereby promoting healthy teaching-learning environments and an ability to maximize beneficial clinical exposure. The resource-sensitive characteristics of a structured learning program, including low-technology and low-cost implementation requirements (Watt et al., 2011), meet the needs of the resource-constrained setting present at RMH. The international collaborative partnerships between HRH Clinical Educators and Rwandan colleagues may aid in increasing the capacity of nursing and nursing students at RMH and fill the gaps in care as they are identified (George & Meadows-Oliver, 2013).

Structured student learning has been initiated at RMH by the Clinical Educator team to maximize student-learning outcomes. During nursing student clinical orientation at RMH, the expectations of the student learning process, as well as expected collaboration of the school-provided Clinical Instructors with RMH nurses and HRH Clinical Educators is outlined. RMH unit managers facilitate structured learning by helping the students identify a maximum of two patients per shift, using the school’s objectives to guide the appropriate allocation. Throughout the day, Clinical Educators along with Clinical Instructors, whenever they are available, conduct ongoing assessments of learning and provide feedback to the students in real-time. Post-conference is conducted one to two times weekly to provide students the opportunity to present patients, clarify clinical questions, share experiences, and practice critical thinking skills. 

Nursing students practicing in this environment are found to be more confident applying newly learned knowledge and skills gained during their clinical experience. Additionally, RMH evaluations completed by students at the end of their rotations highlight students’ increased overall satisfaction and recommendation to continue the structured learning program.

Based on the satisfaction of both students and Clinical Instructors, this structured learning program will continue to be implemented and evolve over time. At this time, more research and evidence-based practice is necessary to effectively address the needs of nursing and midwifery students throughout Rwanda and across the spectrum of resource-limited practice settings. This project highlights just one aspect of the collaboration to establish a more efficient and cost effective clinical education model that will continue to enhance clinical skills and knowledge for all nursing students in Rwanda. .