Consolidating clinical learning through post-rotation small group activities

Abstract

A significant proportion of the undergraduate medical curriculum is delivered in the workplace given its value in supporting students develop professional competencies. Clinical placements are often modelled on the cognitive apprenticeship where students learn about patient care under the close supervision of the expert clinician. Time-pressured clinicians, however, who have a patient-focussed approach to supervision often teach “on the run” rather than adopting a student-centred approach to learning whereby the full benefits of the cognitive apprenticeship can be realised. Students who do not have opportunities to participate fully in the healthcare team’s community of practice, albeit under close supervision, often report feeling underprepared for professional practice as a junior doctor (reference). As the core business of the healthcare setting is patient care, as opposed to clinical teaching, this situation is unlikely to change, and it is perhaps unwise to rely solely on the clinical placement to prepare medical students for full participation in the workplace. This chapter discusses an educational intervention known as the modified clinical debriefing tutorial (MCDT) that was designed to augment student learning during clinical placements. Final year medical students were exposed to six, 2-hour MCDTs where, in the presence of an experienced clinician, they were provided with additional space and time to examine and make sense of the day-to-day events of the clinical setting, as well as specific challenging incidents they encountered. Drawing on the principles of the cognitive apprenticeship model, tutors were trained to lead discussions such that students made their thinking visible through strategies such as reflection, articulation, modelling and scaffolding, with tutors using coaching and mentoring strategies. This intervention was evaluated, and results suggest that the MCDT affords students the opportunity to engage in and practise cognitive and metacognitive processes that are necessary to solve complex problems once they graduate. The MCDT is a valuable extension of the clinical placement that assists students adapt to the realities of the clinical workplace, both as students and once they graduate as junior doctors.