How and what do medical students learn in clerkships? Experience based learning (ExBL)

Abstract

Clerkship education has been called a 'black box' because so little is known about what, how, and under which conditions students learn. Our aim was to develop a blueprint for education in ambulatory and inpatient settings, and in single encounters, traditional rotations, or longitudinal experiences. We identified 548 causal links between conditions, processes, and outcomes of clerkship education in 168 empirical papers pub-lished over 7 years and synthesised a theory of how students learn. They do so when they are given affective, pedagogic, and organisational support. Affective support comes from doctors' and many other health workers' interactions with students. Pedagogic support comes from informal interactions and modelling as well as doctors' teaching, supervision, and precepting. Organisational support comes from every tier of a curriculum. Core learning processes of observing, rehearsing, and contributing to authentic clinical activities take place within triadic relationships between students, patients, and practitioners. The phrase 'supported participation in practice' best describes the educational process. Much of the learning that results is too tacit, complex, contextualised, and individual to be defined as a set of competencies. We conclude that clerkship education takes place within rela-tionships between students, patients, and doctors, supported by informal, individual, contextualised, and affective elements of the learned curriculum, alongside formal, standardised elements of the taught and assessed curriculum. This research provides a blueprint for designing and evaluating clerkship curricula as well as helping patients, students, and practitioners collaborate in educating tomorrow's doctors.Shareable link http://rdcu.be/Fxjh

Social learning in a longitudinal integrated clinical placement

“…Social relationships in clinical placements are critical to the development of professional identity, which is considered an important process in learning and teaching in clinical placements (Dornan et al 2007;Roberts et al 2012). Dornan et al (2014) have described learning in a clinical placement as taking place ''within relationships between students, patients and doctors, supported by informal, individual, contextualised and affective elements of the learned curriculum alongside formal, standardised elements of the taught and assessed curriculum.'' In exploring links between learners in different domains in education research, researchers have conceptualised relationships in a learning environment as a social network.…”

“…A defining feature is that students who ''participate in the comprehensive care of patients over time, have longitudinal learning relationships with those patients, and clinicians.'' (Dornan et al 2014) Much of the current literature has been concerned with the logistics of running such programmes and with providing descriptive evaluations (Thistlethwaite et al 2013;Ellaway et al 2013;Brooks et al 2014). There has been some explanatory research to understand which aspects of the longitudinal integrated placement are most impactful on student learning.…”

Peer tutoring in clinical communication teaching: the experience of 1st year students and their peer tutors

“…While this is a positive finding for both groups of Tutors, it reinforces a benefit of peer tutoring in that it can create a warm and inclusive environment which fosters affective support (Dornan et al, 2014); such a learning environment can, in turn, promote supportive interactions between students and Tutors. Indeed the concept of 'social congruence' which is found in peer tutoring (Lockspeiser et al, 2006), as students and tutors have similar social roles (Burgess, Dornan, Clarke, Menezes, & Mellis, 2016), can create a safe environment where mistakes can be corrected in a collaborative and cooperative manner.…”

Social Workers as Workplace-Based Instructors of Alcohol and Drug Screening, Brief Intervention, and Referral to Treatment (SBIRT) for Emergency Medicine Residents

“…In learning a patient communication skill, as it is for most skills in medical care, it is centrally important that trainees participate in practice to gain facility. 38 Although there may be concern that an inadequately prepared trainee could detract from quality patient care, the balance between patient safety and practice can be reached in a well-supported learning environment such as we had with the social workers. 2 Furthermore, by incorporating evaluation in the workplace in the form of an entrustable professional activity, learning is geared toward progressive independence.…”