Journal of Current Research in Scientific Medicine

LETTER TO EDITOR
Year
: 2019  |  Volume : 5  |  Issue : 2  |  Page : 126--127

What are the informal learning gains expected out of early clinical exposure: Synthesis of contemporary theories


V Dinesh Kumar, S S. S N. Rajasekhar 
 Department of Anatomy, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

Correspondence Address:
V Dinesh Kumar
Department of Anatomy, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry - 605 006
India




How to cite this article:
Kumar V D, N. Rajasekhar S S. What are the informal learning gains expected out of early clinical exposure: Synthesis of contemporary theories.J Curr Res Sci Med 2019;5:126-127


How to cite this URL:
Kumar V D, N. Rajasekhar S S. What are the informal learning gains expected out of early clinical exposure: Synthesis of contemporary theories. J Curr Res Sci Med [serial online] 2019 [cited 2020 Apr 3 ];5:126-127
Available from: http://www.jcrsmed.org/text.asp?2019/5/2/126/275785


Full Text



Dear Sir,

Early exposure to clinical environments, being one of the esoteric activities suggested by the Medical Council of India, is aimed at providing a point of reference where preclinical students get exposed to the clinical environment at the earliest stage of medical education and realize the “relevance” of the learned content. However, it is common to see many faculty questioning the usefulness of the pedagogy, and this can be attributed to the lack of meticulous planning of a structured experience during early clinical exposure (ECE). In other words, when students are made to navigate a “poorly designed and under supervised” experience in the hospital environment, they seldom reap any of the desired learning outcomes.[1] To enable the students to gain a better outcome from early clinical experiences, we should reflect on the learning theories constituting the rationale behind ECE.

Many times, the ECE sessions are conducted with a singular goal of increasing the relevance of basic sciences by exposure to real patients and thereby stimulating the interest of the students.[2] In contrast, an ideal ECE session should be considered as the primer for the process of professional socialization shaped by experiential learning.[3] The learning outcomes should not only be in terms of “practical learning” by which students observe the performing of clinical skills but also in terms of “emotional learning” enabling the development of positive state of mind and professional identity.[2]

For experiential learning to take place, students should be given an active role which is duly supervised and provided with continuous feedback, when students engage in situ ational learning in the form of preceptorship, the biophysical environment, as such, shape their process of learning.[4] In this context, we would like to point out that a student in the preclinical year should not be expected to observe the environment unless he/she is taught to do so. Providing them with insight regarding the social and economic problems in real-life settings might help them get the pulse of various intricacies of the health-care delivery system. At the same time, based on social learning theory, giving the responsibility of interacting with some problematic patients with unconvincing attitude helps in developing the communication skills of the students.

For increasing the learning outcomes, it is essential to understand the dynamics of the learning environment from a sociocultural perspective.[5] If made to perceive actively, students may appreciate the learning environment in primary health center as a different learning environment from that of the surgical ward. Any educational environment can be analyzed based on three social dimensions: (a) goal-directed dimensions, which involves aligning with educational outcomes and learning content; (b) relationship dimensions, representing the perceived emotional relationships with various stakeholders; and (c) system observance, meaning the feeling of being a peripheral participant of a health-care team.[6]

In their recent study, Schei et al.[7] asked the first-year medical student to visit selected sick patients in their homes, and they studied the role of affective reactions in shaping patient-centered professional identity. In such early patient contacts, the knowledge gain becomes secondary, and the evoking of a rich array of emotional reactions becomes the primary objective. Similarly, Helmich et al.[8] classified the students' emotional reactions upon early patient contact into four subtypes: “idealism versus reality,” “critical distance versus adaptation, “involvement versus detachment,” and “feeling versus displaying.” These feelings may be unprofessional and nascent, but tend to constitute the much-needed impetus for further professional socialization processes.

We conclude by stating that ECE should be considered beyond the purview of cognitive dimensions, and this can be achieved by optimally utilizing the biophysical environment profiles of different available learning environments and by actively engaging in the proceedings of the clinical learning environment. Even though it is difficult to structure the experience, because of the uncertainty associated in the ward settings, various methods of reflection can be taught to the students, which form the basis of experiential learning. Enabling students to sense the contextual issues associated with a health-care environment, which are often overlooked, may enable them to develop a broader perspective and embark the “rite of passage” to the medical school.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Barrett J, Trumble SC, McColl G. Novice students navigating the clinical environment in an early medical clerkship. Med Educ 2017;51:1014-24.
2Dornan T, Littlewood S, Margolis SA, Scherpbier A, Spencer J, Ypinazar V. How can experience in clinical and community settings contribute to early medical education? A BEME systematic review. Med Teach 2006;28:3-18.
3Ottenheijm RP, Zwietering PJ, Scherpbie AJ, Metsemakers JF. Early student-patient contacts in general practice: An approach based on educational principles. Med Teach 2008;30:802-8.
4Torre D, Durning SJ. Social cognitive theory: Thinking and learning in social settings. In: Cleland J, Durning SJ, editors. Researching Medical Education. London: Wiley-Blackwell; 2015. p. 105-16.
5van der Zwet J, Zwietering PJ, Teunissen PW, van der Vleuten CP, Scherpbier AJ. Workplace learning from a socio-cultural perspective: Creating developmental space during the general practice clerkship. Adv Health Sci Educ Theory Pract 2011;16:359-73.
6Schönrock-Adema J, Bouwkamp-Timmer T, van Hell EA, Cohen-Schotanus J. Key elements in assessing the educational environment: Where is the theory? Adv Health Sci Educ Theory Pract 2012;17:727-42.
7Schei E, Knoop HS, Gismervik MN, Mylopoulos M, Boudreau JD. Stretching the comfort zone: Using early clinical contact to influence professional identity formation in medical students. J Med Educ Curric Dev 2019;6:2382120519843875.
8Helmich E, Bolhuis S, Laan R, Dornan T, Koopmans R. Medical students' emotional development in early clinical experience: A model. Adv Health Sci Educ Theory Pract 2014;19:347-59.