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Title: How clerkship students learn from real patients in practice settings
Authors: Steven, Kathryn
Wenger, Etienne
Boshuizen, Els
Scherpbier, Albert
Dornan, Tim
Keywords: learning in the workplace
peripheral participation
student responsibility
rites de passage
medical students
Issue Date: 2014
Publisher: AAMC / Wolters Kluwer
Citation: Steven, K., Wenger, E., Boshuizen, H., Scherpbier, A., & Dornan, T. (2014). How clerkship students learn from real patients in practice settings. Academic Medicine, 89(3), 469-476
Abstract: Purpose To explore how undergraduate medical students learn from real patients in practice settings, the factors that affect their learning, and how clerkship learning might be enhanced. Method In 2009, 22 medical students in the three clerkship years of an undergraduate medical program in the United Kingdom made 119 near-contemporaneous audio diary entries reflecting how they learned from real patients. Nineteen attended focus groups; 18 were individually interviewed. The authors used a qualitative theory-building methodology with a conceptual orientation toward Communities of Practice theory. A learning theorist guided selective coding of a constant-comparative analysis. Results Participants learned informally by participating in the communicative practices of workplaces. Two overlapping practices, patient care and education, were identified. Patient care created learning opportunities, which were enriched when practitioners intentionally supported participants’ learning. Education, however, was not always coupled with patient care. So, talk positioned the boundaries of two practices in three configurations: education without patient care, education within patient care, and patient care without education. The nature and quality of participants’ learning depended on how practitioners entered dialogue with them and linked the dialogue to authentic patient care. Conclusions Findings strongly suggest that medical students learn from real patients by participating in patient care within an educational practice. Their learning is affected by clinicians’ willingness to engage in supportive dialogue. Promoting an informal, inclusive discourse of workplace learning might enhance clerkship education. This approach should take its place alongside—and perhaps ahead of—the currently dominant discourse of “clinical teaching.”
Appears in Collections:1. T2 Publications, books and conference papers

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