Physician supervision stood out as the major determining factor behind ‘excellent’ learning outcomes in a clinical environment.
Medical education centres around clinical experiences, which help students apply learned skills and adapt to the workflow. But for physicians-in-training, not all clinical experiences are equal. The outcome of training can be perceived as more or less useful based on specific factors, according to Cathinka Thyness, lead author on the study1 from the Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
Among the most crucial findings, students reported that supervisors' behaviour, the model of participation and proactive preparation all impact perception of learning benefits in a clinical setting. Researchers quantified these metrics with a self-administered questionnaire issued to 908 medical students in Norway.
Students were much more likely to report an "excellent learning outcome" when supervisors were present to engage in positive role modelling. A supervisor's presence was the most significant factor in determining whether the student would report a positive learning outcome. Among those surveyed, 26% of students who had a supervisor present "most of the time" during a clinical experience reported an excellent experience. Only 12% reported an excellent experience when a supervisor was not present.
Notably, independent experiences did not equal excellent outcome. Previous research did not find an association between independent clinical practice and students' positive perception of their learning experience. Results from this study supported those prior arguments.
The students’ self-reported perceptions of learning outcomes suggest that medical students benefit from having a supervisor on-hand for several reasons. In unfamiliar clinical situations, for example, patients were more likely to report a perceived positive learning outcome if they had the opportunity to observe their supervisor, rather than navigating the patient encounter alone.
Researchers also considered the sub-scale aspects of the Maastricht Clinical Teaching Questionnaire (MCTQ) and Clinical Learning Evaluation Questionnaire (CLEQ). Using those sub-scales, researchers were able to identify physician and student behaviours which contributed to positive educational outcomes.
Students reported a more positive experience when their supervisors directly addressed their learning goals. Identifying and addressing learning goals, especially through role modelling, helped students appreciate the educational experience. Students also had positive learning experiences when they felt a sense of psychological safety in the learning environment.
The study also addressed student behaviour. Reports indicated students felt more positive about their learning experiences when they approached clinical learning with more preparation and enjoyment. While aspects such as maintaining proactive attitudes toward clinical work reflect students’ behaviour, they do demonstrate ties to a psychologically safe supervisory learning environment. Physicians in clinical education can consider these successful models when cultivating a positive learning environment, especially when working with student populations who are still in the early stages of supervised patient care.