The Ecology of Care: A Review of the Literature in Clinical Learning Environments

Abstract

Several challenges have emerged in clinical education over the past two decades. Health professional programs have increased in both number and size resulting in an upsurge of trainees. The unprecedented growth has increased the workload of clinicians and their office staff as they correspond with university administrators to coordinate learners' placements. Further complicating the matter are the varying teaching remuneration models. Surrounding the system is the interplay among government, post-secondary, and professional bodies and their social contracts, values, and mandates that inform and bind the profession's development. Globally, the ecology of family medicine is evolving and experiencing new challenges. Concerns have been raised about the shifting dynamics and erosion of relationships between healthcare professionals and patients. Compounding matters are patients' lack of health coverage; system pressures to find healthcare savings and efficiencies; demands for sub-specialization; and changes in the family structure and population demographics. This altered landscape and increasing divide stress the educational paradigms responsible for training learners. The purpose of this literature review is to better understand the context, challenges, and facilitators of clinical practice education as well as how we, as institutions, can improve the experience for learners, educators, and patients.