Frameworks for Clinical Learning and Teaching

Original Editor - Stacy Schiurring based on the course by Angela Patterson

Top Contributors - Stacy Schiurring, Jess Bell and Kim Jackson  

Teaching and Learning in Clinical Education Experiences

Clinical education in healthcare settings is a collaborative learning process that benefits both students and clinical instructors. It is most effective when approached as a partnership, though achieving this partnership can be challenging. To create meaningful learning experiences, many clinical instructors combine elements from various teaching models and frameworks, adapting them to meet the needs of the specific setting. When selecting a model or framework, clinical instructors must consider many factors, including context-specific factors and the framework's alignment with educational needs.

Context-specific factors: include the environment where learning occurs (such as a hospital, clinic, or community setting) and the learner’s background, including their academic institution and previous clinical experience. These elements influence how the teaching approach is tailored to the learner’s current abilities. Time constraints, available resources, and institutional requirements also play a role in determining the most suitable framework.

Alignment with educational needs: instructors ensure that the chosen model supports the specific learning goals and competencies needed for the discipline. This involves assessing the complexity of clinical scenarios, determining the necessary balance between theoretical knowledge and practical skills, and identifying how much reflective practice is needed for effective learning. The goal is to bridge the gap between classroom theory and real-world clinical application.

Ultimately, the choice of framework is a thoughtful process that aligns with both the clinical environment and the learner’s development, supporting the learner's progression through different stages of learning.

This article describes several leading models and frameworks that can help create an effective teaching and learning environment for rehabilitation students during their clinical education.

Best Practice Clinical Learning Environment Framework

The Best Practice Clinical Learning Environment (BPCLE) framework is designed to guide healthcare organisations and educational institutions in creating optimal environments for clinical learning. This framework aims to ensure that learners, such as medical students, nursing students, and other healthcare trainees, are equipped with the knowledge, skills, and attitudes needed to succeed in their respective fields. The BPCLE framework helps improve the quality of clinical education using a comprehensive and systematic approach to create clinical learning environments that are supportive, effective, and focused on both educational and professional development goals.

The BPCLE framework identifies six key characteristics that define high-performing learning environments. These characteristics are designed to ensure that the clinical learning setting effectively supports the development of healthcare professionals. These characteristics are as follows.

Creating a culture that values learning: a high-performing learning environment prioritises a culture that actively values and supports learning at all levels. This includes fostering a mindset where education is seen as integral to clinical practice, promoting lifelong learning, and encouraging reflection and continuous improvement. Learners are encouraged to actively engage in their education, knowing that their growth is valued by the entire organisation.

Best practice clinical practice: a focus on high-quality clinical practice is critical. The environment is one that supports evidence-based clinical care, ensuring that learners observe and participate in practices that reflect the latest research and standards of care. This helps students not only gain technical skills but also understand the importance of staying up-to-date with evolving best practices.

Positive learning environment: a positive and supportive learning environment promotes psychological safety, respect, and encouragement. In such an environment, learners feel valued and supported, and their well-being is prioritised. Positive interactions between learners, educators, and staff help build trust and motivation, reducing anxiety and encouraging engagement and critical thinking.

Effective health service education-provider relationship: a strong partnership between health services and educational institutions is essential for creating a seamless learning experience. This relationship ensures that there is clear communication about expectations, a mutual understanding of objectives, and a collaborative approach to creating opportunities for students to learn. Educational institutions must align with the needs of healthcare providers to deliver relevant, high-quality clinical training.

Effective communication processes: open, clear, and timely communication is critical for ensuring that everyone involved in clinical education is on the same page. This includes communication between educators, clinical staff, students, and administrative teams. Effective communication helps prevent misunderstandings, clarifies expectations, and promotes feedback that supports learners' growth.

Appropriate resources and facilities: the availability of appropriate resources—such as well-equipped facilities, access to learning materials, and the presence of skilled staff—is essential for creating a conducive learning environment. High-performing environments ensure that learners have the tools and support they need, whether through technology, educational materials, or adequate time with experienced clinicians, to develop their skills and knowledge effectively.

The six key characteristics of high-performing learning environments according to the BPCLE Framework focus on establishing clear expectations, fostering a supportive and safe culture, providing meaningful educational experiences, offering effective supervision, ensuring continuous feedback, and promoting teamwork and collaboration. These elements combine to create an environment that maximises learning and professional growth for healthcare learners.

Kolb’s Experiential Learning Model

Kolb’s Experiential Learning Model is a theory that emphasises learning through experience, rather than passively receiving information. It is based on the idea that knowledge is created through the transformation of experience. According to Kolb, learning is a process involving four stages:

1. Concrete Experience: this is the initial stage where the learner actively experiences an event or activity. It could be something hands-on or a direct encounter.
2. Reflective Observation: after the experience, the learner reflects on what happened, analysing the experience and considering how it fits with prior knowledge or assumptions.
3. Abstract Conceptualisation: in this stage, the learner makes sense of the experience by developing theories or concepts that explain it. The learner uses critical thinking to understand the broader implications or principles.
4. Active Experimentation: the learner then applies these new ideas in real-world situations to test their validity and make predictions for future situations.

These four stages form a cycle, and learners typically move through them in a continuous loop. Kolb also identified four distinct learning styles, which correspond to different preferences in how individuals engage with the stages. The model emphasises that effective learning occurs when all stages of the cycle are experienced and integrated.

The Cognitive Apprenticeship Model in Educational Practice

The Cognitive Apprenticeship Model (CAM) is an educational framework that emphasises the importance of learning through guided, hands-on experiences in authentic contexts. It draws from traditional apprenticeship models, where learners gain skills by working closely with a more experienced mentor. However, in the cognitive apprenticeship approach, the focus is on developing cognitive skills, such as problem-solving, reasoning, and critical thinking, rather than just technical expertise.

In cognitive apprenticeship, the mentor (often the teacher or expert) supports the learner by modelling tasks, providing guidance, and fostering independent learning. The process typically involves several key components, including the following.

Modelling: the instructor demonstrates the skill or process being learned, thinking aloud to make the cognitive processes visible to the learner. This helps students understand how to approach the task.

Coaching: the learner attempts the task with the instructor’s guidance. The mentor offers feedback, provides hints, and helps troubleshoot as the learner works through challenges.

Scaffolding: the mentor provides temporary support to help the learner perform tasks they cannot yet do independently. As the learner’s skills improve, the support is gradually reduced, encouraging more autonomy.

Articulation: the learner is encouraged to talk through or discuss their thinking and reasoning during the task. This helps deepen understanding and allows the mentor to identify and address any misconceptions.

Reflection: the learner reflects on their performance, comparing their approach with that of the mentor or peers, which helps them identify areas for improvement and refine their strategies.

Exploration: finally, the learner is encouraged to apply the new skills in novel contexts or more complex situations, allowing them to experiment and further develop their cognitive abilities.

The Cognitive Apprenticeship Model promotes active, contextualised learning, with the learner gradually taking on more responsibility for their learning. It encourages deep understanding by making thinking processes visible, supporting learners in becoming independent thinkers and problem-solvers.

One-Minute Preceptor Model

The One-Minute Preceptor (OMP) Model is a clinical teaching framework designed to provide focused, efficient, and effective feedback in a short amount of time. It's widely used in medical education but can be applied in various disciplines to help instructors guide learners in a time-constrained environment. The model involves five key steps that help instructors engage learners and provide valuable teaching moments in brief interactions. These steps are as follows:

1. Get a Commitment: the instructor asks the learner to make a clinical decision or state their reasoning about a case or topic. This helps assess the learner's understanding and reasoning abilities.
2. Probe for Supporting Evidence: after the learner makes their commitment, the instructor asks questions to explore the learner’s rationale and the evidence or reasoning behind their decision. This helps ensure that the learner is thinking critically and using appropriate knowledge.
3. Teach a General Principle: based on the learner's response, the instructor introduces a broader principle or lesson that applies to the situation. This principle helps connect the learner’s specific experience to general knowledge or broader concepts.
4. Provide Feedback: the instructor gives feedback on the learner's performance, both positive and constructive, offering suggestions for improvement. The feedback is specific, actionable, and brief to fit within the time frame.
5. Summarise and Close: the instructor quickly summarises the key points of the interaction, reinforcing the important lessons or takeaways. The interaction ends with clear expectations for the learner’s next steps or areas to focus on.

The One-Minute Preceptor Model is designed to make the most of short teaching opportunities, fostering active learning and critical thinking while providing learners with immediate, meaningful feedback. It promotes a structured, efficient approach to teaching that is especially valuable in busy clinical or practical settings.

Clinical Reasoning Cycle

The Clinical Reasoning Cycle (CRC) is a systematic process used by healthcare professionals to make decisions and solve problems in clinical settings. It is a model that helps guide practitioners through the steps required to assess, analyse, and plan interventions for patients. The cycle promotes critical thinking, reflection, and the integration of knowledge to improve patient care. The process involves several stages that typically follow a cyclical pattern, allowing practitioners to revisit and refine their decisions as new information emerges. These stages are summarised below.

Consider the Patient Situation: the cycle begins with gathering and considering relevant information about the patient, such as their medical history, symptoms, and context. This initial understanding sets the stage for the entire reasoning process.

Collect Cues and Information: in this step, the healthcare provider collects additional data from the patient, such as physical examination findings, test results, and observations. This step involves actively seeking out relevant facts to understand the patient’s condition more clearly.

Process Information: once data is collected, the clinician analyses the information to identify patterns, potential issues, and key concerns. This step requires integrating clinical knowledge and experience to make sense of the situation and understand the patient’s needs.

Identify Problems / Issues: after processing the information, the clinician identifies the problems or clinical issues that need to be addressed. This step involves prioritising the most critical issues and formulating a clear understanding of the patient’s main concerns.

Establish Goals: in this stage, the healthcare provider sets clear, patient-centred goals based on the identified problems. These goals provide direction for further action and guide decision-making.

Take Action: the clinician then implements interventions, which could involve prescribing treatment, making recommendations, or initiating other appropriate actions. These interventions are aligned with the goals and problems identified earlier in the cycle.

Evaluate Outcomes: after implementing interventions, the clinician evaluates the effectiveness of the actions taken. This involves assessing whether the patient’s condition has improved or whether new issues have emerged.

Reflect on the Process and New Information: finally, reflection takes place, where the clinician considers the reasoning process, evaluates the outcome, and reflects on what was learned from the experience. This reflection informs future clinical reasoning and decision-making.

The Clinical Reasoning Cycle encourages an ongoing process of critical thinking, assessment, and reflection. By following this model, healthcare professionals can ensure that their clinical decisions are informed, patient-centred, and grounded in evidence. The cyclical nature of the process also allows for continuous learning and improvement in practice.

Gibbs Reflective Cycle

The Gibbs Reflective Cycle is a structured framework for reflection, commonly used in education, healthcare, and other professional fields to help individuals critically analyse their experiences and improve their practice. This model provides a clear, step-by-step process to guide reflection and foster deeper learning. The cycle involves six stages, each designed to explore different aspects of an experience.

Here’s a summary of the six stages:

1. Description: in this stage, the learner describes the event or experience in detail. This includes what happened, who was involved, where and when it occurred, and what actions were taken. The goal is to provide an objective, clear account of the situation.
2. Feelings: next, the learner reflects on their emotional responses during the experience. This includes how they felt at the time, both immediately and afterwards. Reflecting on feelings helps to understand the emotional impact the situation had on them and how it may have influenced their actions.
3. Evaluation: in this step, the learner evaluates the positive and negative aspects of the situation and the outcomes. This step helps the learner understand what went well and what they could have done differently.
4. Analysis: in this stage, the learner analyses the experience in greater depth. This involves considering why things happened the way they did, looking at the underlying factors or theories that may have contributed to the situation, and connecting it to prior knowledge or learning.
5. Conclusion: after analysing the situation, the learner summarises what they have learned from the experience. They also reflect on how the experience could have been handled differently, what they might do next time, and what insights can be taken away.
6. Action Plan: the final step involves developing an action plan for future situations. Based on the learner's reflection, they identify specific changes they will make or strategies they will use to improve practice moving forward.

The Gibbs Reflective Cycle is cyclical, meaning it encourages continuous reflection and improvement over time. By following these stages, individuals can learn from their experiences, enhance their professional practice, and become more self-aware.

Resources for Educators

• The Best Practice Clinical Learning Environment framework (Victoria Department of Health)
• Kolb’s Experiential Learning Model clinical teaching handout (Cumming School of Medicine)
• The Cognitive Apprenticeship Theory of Learning guide (Medical College of Wisconsin)
• The One-Minute Preceptor teaching method (Physicians Assistant Education Association - PAEA)
• Clinical Reasoning Cycle instructor resource (University of Tasmania)
• Gibbs Reflective Cycle online reflection toolkit (University of Edinburgh)