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Heal h science s uden eache s' pe cep ions o eache compe ence : A quali a i e
s udy
© 2019 Else ie L d.
Accep ed e sion (Final d a )
Kui ila, Heli-Ma ia; Mikkonen, K is ina; Sjög en, Tuulikki; Koi ula, Mee i;
Koskimäki, Minna; Männis ö, Me ja; Lukka ila, Pi jo; Kää iäinen, Ma ia
Kui ila, H.-M., Mikkonen, K., Sjög en, T., Koi ula, M., Koskimäki, M., Männis ö, M., Lukka ila, P.,
& Kää iäinen, M. (2020). Heal h science s uden eache s' pe cep ions o eache compe ence :
A quali a i e s udy. Nu se Educa ion Today, 84, A icle 104210.
h ps://doi.o g/10.1016/j.ned .2019.104210
2020
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Heal h science s uden TEACHERS' pe cep ions o eache
compe ence: A quali a i e s udy
Heli-Ma ia Kui ila, K is ina Mikkonen, Tuulikki Sjög en, Mee i
Koi ula, Minna Koskimäki, Me ja Männis ö, Pi jo Lukka ila,
Ma ia Kää iäinen
PII: S0260-6917(19)30703-8
DOI: h ps://doi.o g/10.1016/j.ned .2019.104210
Re e ence: YNEDT 104210
To appea in: Nu se Educa ion Today
Recei ed da e: 8 May 2019
Re ised da e: 30 June 2019
Accep ed da e: 6 Sep embe 2019
Please ci e his a icle as: H.-M. Kui ila, K. Mikkonen, T. Sjög en, e al., Heal h science
s uden TEACHERS' pe cep ions o eache compe ence: A quali a i e s udy, Nu se
Educa ion Today(2019), h ps://doi.o g/10.1016/j.ned .2019.104210
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Ti le page and Au ho de ails
Ti le: HEALTH SCIENCE STUDENT TEACHERS’ PERCEPTIONS OF TEACHER
COMPETENCE: A QUALITATIVE STUDY
Fi s au ho (co esponding au ho ): Heli-Ma ia KUIVILA, Uni e si y Teache , Doc o al
Candida e, MHSc; Resea ch Uni o Nu sing Science and Heal h Managemen , Uni e si y o Oulu,
Oulu, Finland
Mailing Add ess:
Resea ch Uni o Nu sing Science and Heal h Managemen
Facul y o Medicine
P.O. Box 5000
FI- 90014 Uni e si y o Oulu
Tel.: +358 407404735
Email: [email p o ec ed]
Twi e : @HeliKui ila
Second au ho : K is ina MIKKONEN, Resea che , PhD; Resea ch Uni o Nu sing Science and
Heal h Managemen , Uni e si y o Oulu, Oulu, Finland
Email: [email p o ec ed]
Twi e : @K is inamikkon
ORCID: h ps://o cid.o g/0000-0002-4355-3428
Thi d au ho : Tuulikki SJÖGREN, Senio Lec u e , PhD; Facul y o Spo and Heal h Sciences,
Uni e si y o Jy äskylä, Jy äskylä, Finland
Email: uulikki.sjog en@jyu. i
Fou h au ho : Mee i KOIVULA, Associa e p o esso , PhD; Facul y o Social Sciences,
Uni e si y o Tampe e, Tampe e, Finland
Email: [email p o ec ed]
Fi h au ho : Minna KOSKIMÄKI, Lec u e , PhD Candida e MHSc, Facul y o Social Sciences,
Uni e si y o Tampe e, Tampe e, Finland
Email: [email p o ec ed]
Six h au ho : Me ja MÄNNISTÖ, Lec u e , Doc o al Candida e, MHSc; Resea ch Uni o Nu sing
Science and Heal h Managemen , Uni e si y o Oulu, Oulu, Finland; Heal h ca e and nu sing, Oulu
Uni e si y o Applied Sciences, Oulu, Finland
Email: [email p o ec ed]
Se en h au ho : Pi jo LUKKARILA, PhD, Adminis a i e Head Nu se, Oulu Uni e si y Hospi al
(OYS), Oulu, Finland
Email: [email p o ec ed]
Eigh au ho : Ma ia KÄÄRIÄINEN, P o esso , PhD; Resea ch Uni o Nu sing Science and
Heal h Managemen , Uni e si y o Oulu, Oulu, Finland; Medical Resea ch Cen e Oulu, Oulu
Uni e si y Hospi al and Uni e si y o Oulu, Oulu, Finland; The Finnish Cen e o E idence-Based
Heal h Ca e: A Joanna B iggs Ins i u e Cen e o Excellence, Helsinki
Email: [email p o ec ed]
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Funding Sou ce: No applicable
Con lic o In e es : No con lic o in e es .
E hical App o al: The Uni e si y o Jy äskylä p o ided a s a emen (12.12.2017) ha he planned
esea ch was e hically accep able.
Acknowledgemen : We would like o acknowledge he con ac pe sons o hei signi ican help
du ing he da a collec ion phase. We would like o hank he s uden eache s o aking he ime o
pa icipa e in he in e iews.
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HEALTH SCIENCE S TUDENT TEACHERS’ PERCEPTIONS OF TEACHER COMPETENCE: A
QUALITATIVE STUDY
Abs ac
Backg ound. Heal h science eache compe ence is mul i ace ed and con inuously changing acco ding
o na ional and in e na ional heal hca e s anda ds. O ganiza ional es uc u ing and emphasis on cos
e ec i eness is changing he scope o heal h science eache s’ p ac ical wo k and hei ole in heal hca e
(wo ldwide).
Aim. This s udy aimed o desc ibe s uden eache s’ pe cep ions o he compe encies needed o wo k as
an educa o in he heal hca e ield. Objec i e o s udy was o gain new knowledge which can be used in
he de elopmen o eache educa ion p og ams in nu sing science and o de ine a b oade de ini ion o
he heal h science educa o s.
Me hods. A quali a i e s udy was conduc ed. Da a we e collec ed om 23 Finnish s uden s comple ing
a mas e ’s deg ee in eaching in he heal hca e con ex using ocus g oup in e iews. The da a we e
analyzed by induc i e con en analysis.
Resul s. The s uden eache s iden i ied eigh main ca ego ies o eache compe ence: leade ship and
managemen compe ence; e idence-based p ac ice compe ence; subjec compe ence; e hical
compe ence; pedagogical compe ence; collabo a ion compe ence; in e na ionaliza ion compe ence; and
con inuous p o essional de elopmen compe ence.
Conclusion. This s udy iden i ied essen ial eache compe encies ha can be e alua ed among s uden s
o de elop heal h science eache cu icula. The indings can be used in ollow-up s udies o compa a i e
esea ch o in es iga e compe ence di e ences be ween no ice and expe ienced eache s.
Key wo ds: Compe ence, Educa ion, Heal h sciences, s uden eache , Teache , Teache deg ee p og am
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In oduc ion
The concep o compe ence can be conside ed o encompass an indi idual’s knowledge, skills, abili ies,
a i udes and expe iences (Delama e Le Deis and Win e on, 2005). Compe ence can be de ined as he
success ul comple ion o indi idual asks and unc ions, o al e na i ely, as speci ic knowledge and
indi idual solu ions based on basic gene ic capabili ies. Compe ence means ha a pe son can combine
a a ie y o skills o unc ions depending on he si ua ion in which hey wo k. The abili y o pe o m
ce ain unc ions always equi es some combina ion o knowledge, skills, disposi ions and alues (Gonzi
2013). This unique se o a ibu es – which is bo h de elopmen al and con ex -dependen – enables a
pe son o accomplish he asks and goals ha exis a an expec ed le el o pe o mance (Eps ein and
Hunde , 2002).
P o essional compe ence co e s he habi ual and calcula ed use o communica ion, knowledge,
echnical skills, easoning, emo ions, and alues o bene i he indi idual as well as he communi y in
which hey wo k. Compe ence in he p o essional con ex also includes he abili y o manage ambiguous
p oblems, ole a e unce ain y, and make decisions wi h limi ed in o ma ion (Eps ein and Hunde ,
2002; Delama e Le Deis and Win e on, 2005). The p esence o di e en de ini ions o he concep o
compe ence has led o he challenge o ying o conclude wha compe ence eally is. A p esen , i seems
unlikely ha he e e e will be a uni e sally accep able de ini ion o compe ence (Ga side and
Nhemachena, 2013).
The Wo ld Heal h O ganiza ion has cha ac e ized he co e compe encies o nu sing educa o s di ided
in o eigh domains including: (1) abili y o unde s and educa ional heo ies, and p inciples and models
o cu iculum design ela ed o heal h educa ion and adul lea ning; (2) abili y o design, implemen ,
moni o and manage cu icula based on bes a ailable e idence; (3) abili y o main ain cu en
knowledge and skills in heo y and p ac ice; (4) abili y o de elop c i ical inqui y, conduc esea ch and
u ilize indings o iden i y p oblems and sol e hem; (5) abili y o e ec i e communica ion and
eamwo k, and in e disciplina y collabo a ion enhancing pa ne ship among heal h educa ion and
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clinical p ac ice p o essionals; (6) abili y o demons a e p o essionalism including legal, e hical and
p o essional alues in de eloping nu sing educa ion policies, p ocedu es and decision making; (7)
abili y o moni o and e alua e educa ional p og ammes, cu icula and s uden lea ning wi h di e ing
me hods; (8) abili y o manage, lead and c ea e educa ional p og ammes and shape he u u e o
educa ion ins i u ions (WHO, 2016).
In he Ame ican League o Nu sing (2012) he educa o ’s compe ence has been desc ibed om a mo e
s uden - o pe son-cen e ed pe spec i e. I includes he educa o ’s abili y o acili a e s uden lea ning
and he achie emen o desi ed cogni i e, a ec i e, and psychomo o ou comes. I in ol es lea ne
de elopmen and socializa ion; he abili y o use assessmen and e alua ion s a egies in di e en
se ings and domains o lea ning; abili y o pa icipa e in cu iculum design and e alua ion, and o
unc ion as a change agen and leade c ea ing a p e e ed u u e o nu sing educa ion and nu sing
p ac ice; abili y o pu sue con inuous quali y imp o emen s in he ole o a nu se educa o , engage in
schola ship, and he abili y o ac wi hin he educa ional en i onmen (The Ame ican Na ional League
o Nu sing, 2012; Ch is ensen and Simmons, 2019). Teache s need o possess e sa ile knowledge in
he subjec ha hey each as well as know how o each, mo i a e s uden s, and manage hei wo k in
na ional and in e na ional educa ional en i onmen s (Salminen e al., 2013; Töy ä i e al. 2016).
A ecen sys ema ic e iew showed ha heal h science eache s’ compe ence is complex as i cons an ly
changes acco ding o he heal hca e o ganiza ional and poli ical s uc u e (Mikkonen e al., 2018).
Fu he mo e, o ganiza ional es uc u ing and emphasis on cos e ec i eness has ans o med he
scope o heal h science eache s’ p ac ical wo k and hei ole in heal hca e (Guy e .al., 2010; OECD,
2017). Teache s a e also equi ed o use and c ea e e idence-based knowledge, wo k wi h digi al ools
and ake esponsibili y o con inuous lea ning (McAllis ai and Flynn, 2016; Mikkonen e al., 2018).
The cu icula unde lying deg ee p og ams o heal h science eache s a e designed o build
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compe encies which a e essen ial o guiding u u e heal hca e p o essionals. Educa ional p og ams
and minimum quali ica ions o equi ed compe encies o heal h science eache s a y be ween
coun ies. Acqui ing p o essional quali ica ion in e na ionally, heal h science educa o usually equi es
a Mas e 's and / o a doc o a e deg ee and a leas wo yea s o wo king expe ience in he heal hca e
sec o (Eu opean Commission, 2009, Salminen e .al, 2014, Uni e si y o Applied Science Ac 1129/2014,
Paul, 2015; Op escu e .al., 2017; Na ional League o Nu sing, 2019).
In a p e ious s udy, heal h science eache s anked hei compe ence in building ela ionships wi h
s uden s he highes and hei eaching skills he lowes . This esea ch ound he weakes skil ls among
heal h science eache s o be eaching decision-making and encou aging s uden s o seek new
knowledge (Salminen e al., 2009). O he esea ch ound ha when deli e ing simula ions, a eache
s uden s’ knowledge, beha io , s kills, and abili y o suppo s uden s a e impo an compe encies
(Topping e al., 2015). Resea ch ocusing on digi al compe ence ha e ound ha s uden eache s a e
mo i a ed o us e ICT and wan o u he de elop hei own skills (Sa lminen e al., 2016; Au io e al.,
2018).
O he s udi es ha e ocused on he challenges ha s uden eache s ace while de eloping hei eaching
skills (Black, 2015). Suppo om o he eache s can p omo e s uden eache s’ sel -e icacy by helping
hem unde s and he de elopmen al s ages o eache s, encou aging c i ical e lec ion, and p o iding
mo i a ional and desc ip i e eedback o imp o e p ac ical skil ls (Blac k, 2015). I has been disco e ed
ha new eache s eel a need o supplemen a y educa ion o upda e hei compe encies only a ew
yea s a e g adua ion (Vile n and Salminen, 2016). The e is a limi ed amoun o published esea ch in
his a ea wo ldwide. The pu pose o his s udy was o desc ibe heal h science s uden eache s’
pe cep ions o eache compe ence. The p ima y ques ion unde lying he p esen ed esea ch was: wha
kind o pe cep ions do s uden eache s ha e o he compe encies needed o wo k as a eache in
heal hca e?
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Me hod
Da a Collec ion
A quali a i e s udy was conduc ed. The da a we e collec ed om 23 s uden eache s a i e uni e si ies
in Finland in sp ing 2018. The inclusion c i e ia o pa icipan s we e being en olled in pos g adua e
eaching s udies in heal h sciences and comple ion o p ac ical eache aining wi hin heal hca e
educa ion. All o he eligible pa icipan s we e ec ui ed wi h he help o coo dina o s a he uni e si ies.
The 23 s uden eache s who joined he s udy we e heal hca e p o essionals, mo e speci ically, nu ses,
physio he apis s, bio-analys s and adiog aphe s, wi h wo king expe iences anging om h ee o 30
yea s. In his g oup o s uden eache s, 14 we e comple ing a Mas e ’s deg ee in eaching in he ield o
nu sing science while he emai ning nine pa icipan s we e comple ing a Mas e ’s deg ee in eaching in
he ield o physio he apy. Pa icipan s ages a ied om 23 o 58 yea s.
The da a we e collec ed in ocus g oups using semi-s uc u ed in e iews. Focus g oups we e chosen as
hey p oduce con e sa ion and yield collec i ely o mula ed in o ma ion on he phenomenon o in e es
(O ik e al., 2013). The hemes o he in e iews - ocus on eache s’ wo k, cu iculum de elopmen ,
collegiali y and wo king communi y, o ganiza ional a eas, in e na ionalism and mul icul u alism, and
socie y and eaching - we e based on a sys ema ic e iew on heal hca e eache compe ence (Mikkonen
e al., 2018). The hemes we e p e- es ed in one in e iew, and da a om his in e iew we e used in
he inal da a analysis because he hemes emained unchanged a e p e- es ing. All bu h ee
in e iews – which we e conduc ed ia Skype online connec ion - we e conduc ed in a p i a e space a
he uni e si ies. The du a ion o he in e iews anged om 25 o 60 minu es. In e iews we e audio
eco ded and coded by numbe o pa icipan s. The amoun o da a collec ed in his s udy can be
conside ed su icien since da a sa u a ion was eached.
Da a Managemen and Analysis
Reco ded in e iews we e ansc ibed in o a wo d documen (149 pages, line spacing 1,5; on size 11),
a e which da a we e analyzed by induc i e con en analysis (Elo and Kyngäs, 2008). The analysis
applied he philosophical amewo k o c i ical ealism, and by ocusing on wha was being said abou
compe ence by s uden eache s we hoped o gain an unde s anding o he cu en si ua ion and how
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No hing is s a ic anymo e, e e y hing is in ansi ion all he ime (In e iew n IV)". Discussions o
building compe ence a wo k e oked desc ip ions o on- he-job lea ning, he con inuous upda ing o
one’s compe ence, and a eache ’s u iliza ion o compe enc e o imp o e he en i e wo k communi y.
Pa icipa ion in con inuous educa ion was associa ed wi h sel -educa ion and ha a eache should
independen ly seek in o ma ion o suppo hei compe ence.
Discussion
The pa icipa ing s uden eache s iden i ied eigh compe ence a eas ha we e ela ed o heal h science
eache compe ence. Leade ship and consume -o ien ed heal hca e a e essen ial compe encies o
eache s. Fu he mo e, heal h science eache s ha e a i al leade ship ole as clinical expe s, ole
models, men o s, and suppo e s o quali y p ojec s, and a e also esponsible o de eloping mo e
holis ic models o ca e o pa ien s (Saye s e al., 2015). This also in ol es inno a ion and lexibili y in
u ilizing si ua ional leade ship app oaches ha nu u e s uden con idence and commi men o heal h
p ac ice. Ideally, heal h science eache s lead by excep ional example (Walls, 2019). The domains o
leade ship and adminis a ion compe ence can be cha ac e ized by sys em managemen and leade ship
skills, which heal h science eache s can le e age o c ea e, main ain and imp o e nu sing p og ams –
as well as shape he u u e o nu sing educa ion ins i u ions (WHO, 2016; Pihlainen a al., 2016).
S uden eache s desc ibed manage ial compe ence as he knowledge o adminis a i e asks and
ecogni ion o educa ional legisla ion - which is pa ly consis en wi h wha was epo ed by Pihlainen
e al. (2016) – as well as pa icipa ing in he wo k communi y and ocusing on wo k well-being- ela ed
a eas as no ed by Nilsson, Blomq is and Ande sson (2017) and an den Be g e .al., (2017). S uden
eache s did no associa e a eache 's leade ship compe ence – which mani es s i sel h ough ac ing as
a ole model - wi h manage ial and adminis a i e compe ence. They also did no see a leade in nu sing
educa ion as a pe son who can c ea e a ision o he u u e o nu sing educa ion and main ain a
o wa d-looking, sus ainable en i onmen ha con ibu es o he u u e. This de ia es om wha has
been p esen ed in p e ious s udies o heal h science educa o s (Pa e son and K ouse, 2015; Pihlainen
e al., 2016). This may be due o he ac ha he s udy pa icipan s we e s uden s who had no ye
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wo ked as eache s and may no ha e a deep unde s anding o he compe encies equi ed in he
eache ’s p o ession.
Heal h science eache s need o ha e e sa ile knowledge o he subjec (s) hey each (Töy ä i e al.
2016), heo e ical and p ac ical c edibili y, holis ic e hical awa eness, mo al judgmen skills and a
willingness o do good (Kulju e al., 2016). When asked abou he e idence-based p ac ice compe ence
ca ego y, s uden eache s el ha u u e heal h science eache s would be equi ed o gene a e and
manage e idence-based knowledge. As Mikkonen e al. (2018) ha e sugges ed, equi ing eache s o
hold highe educa ion deg ees and o ha e pa icipa ed in esea ch may be bene icial s a egies o
building e idence-based p ac ice compe ence. Holis ic ca e and heal h se ices can only be success ully
p o ided when heo y and p ac ice a e combined.
Conce ning he subjec compe ence ca ego y, s uden eache s emphasized he impo ance o
connec ing heo y and p ac ice. They u he speci ied ha a eache ’s clinical expe ience and subjec
compe ence allow hem o link heo e ical lea ning wi h p ac ical knowledge when eaching s uden s,
and emain connec ed o con empo a y clinical p ac ice, which is consis en wi h ea lie indings
(Fowle , Bake and Ge agh y, 2017). E hical compe ence comp ised e hical ounda ions and mo al
s anda ds o beha io in educa ion. O he esea che s ha e p e iously sugges ed ha awa eness o bo h
e hical dimensions and eaching obliga ions is essen ial as i imp o es p o essional skills and p ac ices
and can a ec s uden s' mo al easoning and a i udes (Wa nick and Sil e man, 2011). By saying ha ,
all eaching s a need o ecognize he mul i ace ed issues ha in luence s uden s' unde s anding o
e hical issues, and o in eg a e cul u al sa e y p inciples in o hei e hical eaching (Song, 2018 ).
When discussing pedagogical compe ence, he s uden eache s p edic ed ha u u e educa ion will be
o ganized i espec i e o place o ime, and will be p edominan ly web-based. Technology has been
lis ed as he la ges change a ec ing heal h science educa ion (LeRouge e al., 2014). In line wi h ou
indings, ecen s udies ha e shown ha s uden -cen ed objec i es need o be associa ed wi h he
e o m o conse a i e eaching me hods, as well as he skilled use o in o ma ion echnologies (Öne ,
2018 ).Today's lea ne s equi e new ools o lea ning and a e skilled and accus omed o using a wide
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a ie y o new and changing echnologies (McQueen e al., 2017; Na ional League o Nu sing, 2019 ).
Digi al applica ions o e new, mode n me hods o suppo eaching and lea ning (Salminen e al., 2016;
B is ol, 2019a), and heal h science eache s ha e an impo an ole in eaching and guiding s uden s o
de elop he echnical skills and knowledge ha will be necessa y o u u e p o essions (McQueen e al.,
2017; B is ol, 2019).
The abili y o each, suppo , mo i a e and guide s uden s, along wi h communica ion skills, we e
highligh ed du ing discussions o educa ing and men o ing compe ence. The pa icipa ing s uden
eache s el ha a eache should be able o iden i y each lea ne ’s unique s eng hs and hen mo i a e
he lea ne by ocusing on hei s eng hs. These indings a e in line wi h p e ious knowledge o s uden
men o ing and guiding (Tuomikoski e al., 2018; B is ol, 2019b). I is also shown ha s uden s can
bene i om a men o ing ela ionship, e en om a dis ance, especially when he s uden and he men o
al eady know each o he (Cheek, Walsh Do son and Ogil ie, 2016 )
The Wo ld Heal h O ganiza ion (2016) has ea lie s a ed ha heal h science eache s mus be e ec i e
communica o s and p omo e eam-building i hey hope o imp o e in e disciplina y collabo a ion in
heal hca e and educa ion (WHO, 2016). S uden eache s exp essed ha he abili y o ope a e in
p ojec s, bo h na ionally and in e na ionally, as well as language and cul u al compe ence will be among
he mos impo an compe encies o u u e eache s.
S uden eache s also s a ed ha e en hough heal h science eache s a e esponsible o main aining a
su icien le el o compe ence, manage s should ne e heless a o d eache s he possibili y o upda e
hei compe ence. Con inuous educa ion is i al as i ensu es ha p o essionals can adequa ely moni o
hei own p o essional de elopmen o p o ide sa e and e icien se ices (Di ec i e 2005/36/EC and
EFN S a egic & Ope a ional lobby plan 2014-2020, e ised 2016; Na ional league o Nu sing, 2019).
O he esea che s ha e sugges ed ha con inuous educa ion is c ucial o main aining he skills and
compe ences ha a e needed o ope a e in a p ac ical en i onmen (Hend ickx and Win e s, 2017) and
ha i signi ican ly impac s he a endee’s knowledge, skills, a i udes and beha io s (Ha den e al.,
2017).
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Limi a ions
All o he pa icipan s in he s udy we e Finnish and, as such, hey sha ed expe iences o eache
compe ence ha we e ela ing o he Finnish educa ion sys em. Howe e , as educa ion sys ems a y
om coun y o coun y, he p esen ed esul s may he e o e no necessa ily be gene alizable o he
in e na ional educa ional con ex .
Conclusions
A s udy o Finnish s uden eache s iden i ied eigh main ca ego ies o compe ence ha we e ele an
o he wo k o heal h science eache s. E en hough he pa icipan s we e s uden s, hey al eady had a
clea ly de eloped unde s anding o he mul idimensional compe ence needed in he wo k o a heal h
science eache . A comp ehensi e desc ip ion o heal h science eache compe ence is impo an , as he
in o ma ion p o ided in his a icle can be used o e alua e he compe ence o s uden eache s a
di e en phases o hei s udies and hen de elop he cu iculum acco dingly. Fu u e esea ch should
aim o s udy how a eache ’s compe ence a ec s hei well-being and coping wi h wo k, a i ude owa ds
s uden s, and s aying in he p o ession.
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