Elsevier

Nurse Education Today

Volume 31, Issue 8, November 2011, Pages e22-e28
Nurse Education Today

Practice education learning environments: The mismatch between perceived and preferred expectations of undergraduate health science students

https://doi.org/10.1016/j.nedt.2010.11.013Get rights and content

Summary

Background

Practical hands-on learning opportunities are viewed as a vital component of the education of health science students, but there is a critical shortage of fieldwork placement experiences. It is therefore important that these clinical learning environments are well suited to students’ perceptions and expectations.

Purpose

To investigate how undergraduate students enrolled in health-related education programs view their clinical learning environments and specifically to compare students’ perception of their ‘actual’ clinical learning environment to that of their ‘preferred/ideal’ clinical learning environment.

Method

The Clinical Learning Environment Inventory (CLEI) was used to collect data from 548 undergraduate students (55% response rate) enrolled in all year levels of paramedics, midwifery, radiography and medical imaging, occupational therapy, pharmacy, nutrition and dietetics, physiotherapy and social work at Monash University via convenience sampling. Students were asked to rate their perception of the clinical learning environment at the completion of their placements using the CLEI.

Results

Satisfaction of the students enrolled in the health-related disciplines was closely linked with the five constructs measured by the CLEI: Personalization, Student Involvement, Task Orientation, Innovation, and Individualization. Significant differences were found between the student's perception of their ‘actual’ clinical learning environment and their ‘ideal’ clinical learning environment.

Conclusion

The study highlights the importance of a supportive clinical learning environment that places emphasis on effective two-way communication. A thorough understanding of students’ perceptions of their clinical learning environments is essential.

Introduction

Inadequate clinical fieldwork places will contribute to shortages of qualified health care professionals to fill positions in the health care system at the state and national level (Casares et al., 2003, Hall, 2006, Health Professions Council of Australia, 2004, Massaro Consulting Pty. Ltd. and Department of Human Services, Service and Workforce Planning Branch, 2009, Speech Pathology Australia, 2009). Despite the advocated importance of clinical placements in the development of competent healthcare practitioners and the purported generalization of skills learning in academic settings to clinical contexts, there has been minimal empirical research investigating how students view the two divergent learning environments (Jarski et al., 1990, Kilminster and Jolly, 2000, Molloy and Clarke, 2005, Mulholland et al., 2006). University students enrolled in health science programs attend academic classes at university and also complete clinical fieldwork or practical education placements. Both settings have different and varied learning opportunities for students. Education in traditional classroom environments is somewhat different to the real life context of practice education contexts. Clinical fieldwork is viewed as a vital part of the education of health science students and is a professional requirement for course accreditation by most professional bodies (Health Professions Council of Australia, 2004, McMeeken, 2008). In practice-based professions such as the health disciplines, practical ‘hands-on’ experience is a large part of the curriculum.

Currently, there is a global shortage of practice education placements for health science students including students enrolled in occupational therapy, physiotherapy, nursing, midwifery, pharmacy, social work, dietetics and nutrition, and paramedic studies (Gasciogne and Parker, 2001, Marshall, 2005, Overton et al., 2009, Speech Pathology Australia, 2009, Wray and McCall, 2008). External factors such as staff shortages, training costs, patient availability (e.g., shorter hospital stays; sicker patients), budget cuts, and increasing competition for placements due to the expansion in the number of education programs, and increased class sizes has contributed to a marked shortage of practice education opportunities internationally (Bonello, 2001, Casares et al., 2003, Hall, 2006, Hutchings et al., 2005, McAllister, 2005, Rodger et al., 2008, Smith et al., 2010). The purpose of this study was to investigate how undergraduate students enrolled in health-related programs viewed different clinical and practice education learning environments.

Section snippets

Literature review

Students in practice education contexts can learn by formal arrangements (such as direct instruction, conferences, ward rounds, and journal clubs) as well as informally (such as observation of others in action). The term ‘learning by doing’ is often cited to illustrate this concept. It has been developed by a number of writers, labelling the concept as ‘experiential learning’ (Kolb, 1984), ‘situated learning’ (Lave and Wenger, 1991), ‘informal learning’ (Garrick, 1998), and ‘workplace learning’

Design

A cross-sectional survey design using a standardized self-report scale was conducted.

Participants

Participants included all students enrolled in the following undergraduate programs offered at Monash University, Melbourne, Victoria, Australia in 2008–2009 who also completed a fieldwork placement: Bachelor of Occupational Therapy, Bachelor of Physiotherapy, Bachelor of Emergency Health, Bachelor of Midwifery, Bachelor of Nutrition and Dietetics, Bachelor of Pharmacy, Bachelor of Social Work and the Bachelor

Participant demographics

A total of 548/1000 (response rate of 55%) participants took part in the study. Of the 548 participants, 76/120 (response rate of 63%) were from Occupational Therapy, 33/75 (response rate of 44%) from Physiotherapy, 60/120 (response rate of 50%) from Paramedics, 39/65 (response rate of 60%) from Midwifery, 31/45 (response rate of 69%) from Nutrition and Dietetics, 116/300 (response rate of 39%) from Pharmacy, 78/150 (response rate of 52%) from Social Work, and 115/125 (response rate of 92%)

Discussion

Clinical education is a fundamental aspect of the health science curriculum. Its benefits are abundant and it ultimately prepares the neophyte student learner for their role as an entry-level health care provider. It is therefore critical for academic and clinical fieldwork educators to understand the expectations of students and how these differ from the opportunities they are currently receiving. It is important to recognize what their perceptions are and what they believe the clinical

Conclusion

This study explored the perceptions of health science students of their clinical learning environments. It was noted that students ‘actual’ and ‘preferred’ perceptions on the six CLEI subscales were all significantly different. It was also found that four of the five CLEI ‘actual’ subscales were significant predictors of the CLEI ‘actual’ satisfaction subscale accounting for 45% of the total variance. The study results emphasize the significance of a practice education context that focuses on

Acknowledgements

The undergraduate health science students who took the time to complete the questionnaire are thanked for their input.

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