Optimizing school-supported clinical learning: an investigation in the context of nursing education

Optimizing school- supported clinical learning: an investigation in the context of nursing education The integration of school and practice learning in health professions education (HPE) is important for students’ development of conceptual knowledge and their transfer of learning across settings. Moreover, aligning expectations across different learning contexts can help design training trajectories that are both effective and accountable to society. A body of research about interventions and practices that successfully connect school and practice learning exists, such as portfolios, shared assessment standards and practice assignments. At the same time, it is known that resources and guidelines originating from the school context can be perceived as bureaucratic and lacking in practical relevance, thus merely leading to added workload. To date, our understanding of opportunities and threats in the use of school structures, standards and support to enhance and regulate clinical learning as well as underlying mechanisms is limited. This thesis aimed to investigate these opportunities and threats and their underlying mechanisms in the context of nursing education, and to integrate these into a model that can be used for future studies on “school-supported clinical learning”. In one scoping literature review as well four empirical studies we investigated how clinical learning is understood in the literature and among stakeholders, how students navigate clinical learning within and across settings, and how and why challenges in the use of tools, structures and support at the bridge between school and practice are experienced. We found that competency frameworks and formats can challenge students push their limits and seek various learning opportunities in spite of a task-oriented ward culture. Assignments, reflection tools, development plans and peer review meetings in school can support students to create a deeper understanding of patient care, to develop a critical attitude based on their experiences across settings and to structure their self-regulated learning. Threats include rigid criteria and guidelines directed at individual performance, extensive written formats, assessment criteria guiding students’ selection of learning opportunities, and self-regulated learning becoming a task instead of a social act. We introduced a conceptual model including the individual as well as the shared influence of school and practice on students’ clinical learning processes and on different types of learning outcomes. The model can be used for further studies on school-supported clinical learning. We concluded that school-supported clinical learning can help students to learn beyond the tasks that patient care dictates, to compare and contrast different experiences and to gain a deeper understanding of the profession and of patient care. This requires a move away from assessment-driven, individualized learning with detailed criteria. Instead it requires a mutual agreement between school and practice on the desirable outcomes of clinical education. Collaborations should focus on facilitating staff and students to achieve these outcomes in a way that suits each clinical ward and supports individual students, and on providing tools and aids that can be used around patient care.