Background: Clinical learning is the crux of medical education. Students perceive many barriers to effective clinical learning due to transition, poor supervision, and lack of orientation. There is an urgent need for recommendations to alleviate these barriers and improve the quality of medical education in a public sector institute of a developing country.
Aims: The study aims to identify the barriers in clinical learning perceived by the students during their clinical rotations in emergency. The study also aims to provide recommendations to alleviate these barriers.
Methods: A cross-sectional study conducted among 300 students from a public sector institute of Pakistan. The perception of clinical learning was assessed using a structured questionnaire in students attending medical and surgical emergency ward. Independent samples t-test and ANOVA were used to assess differences in perception scores across gender and academic years.
Results: The mean perception score was 52.0±11.74. There was a significant difference in perception scores across academic years (p=0.028) with the final year having lower perception scores than the junior students. The mean scores of items in domain 1 (Transition and stress) and domain 4 (Supervision and feedback) were lower indicating a negative perception in these domains.
Conclusions: Lack of clinical orientation, non-integration of the clinical curriculum in preclinical years, poor supervision, lack of resources, and a crippled feedback delivery system are barriers to clinical learning. Interventions such as integration of clinically orientated curriculum, teacher training, student-centered teaching methodology, and development of an effective feedback delivery system must be employed for quality clinical learning during rotations.
Roy B, Rashid M, Sathian B, Banerjee I. Clinical skills and it’s importance in undergraduate medical curriculum. J Biomed Sci. 2018; 4(1):1–2.
Nordquist J, Hall J, Caverzagie K, Snell L, Chan MK, Thoma B, et al. The clinical learning environment. Med Teach. 2019;41(4):366–72.
Zuniga D, Leiva I, Calderon M, Tomicic A, Padilla O, Riquelme A, et al. [Learning during the early clinical years takes more than good study habits: Perceptions of students and teachers]. Rev Med Chil. 2015 Nov; 143(11):1395–404.
Alhaqwi AI, Taha WS. Promoting excellence in teaching and learning in clinical education. J Taibah Univ Med Sci. 2015;10(1):97–101.
Dunham L, Dekhtyar M, Gruener G, Cichoskikelly E, Deitz J, Elliott D, et al. Medical Student Perceptions of the Learning Environment in Medical School Change as Students Transition to Clinical Training in Undergraduate Medical School. Teach Learn Med. 2017 Mar; 29:1–9.
McGrady A, Lynch D, Brennan J, Whearty K. Effects of a stress management program on third year medical students’ anxiety depression and somatization. MedEdPublish. 2017 Mar;6.
Sahu PK, Chattu VK, Rewatkar A, Sakhamuri S. Best practices to impart clinical skills during preclinical years of medical curriculum. J Educ Health Promot. 2019 Mar; 8:57.
Pokhrel R, Tandon A, Bhatnagar R. Integrated Versus Traditional Method in Basic Medical Science Education: A Comparative Study in an Indian Medical College. Med J Shree Birendra Hosp. 2016 Jul 5; 15:32.
Nasim M. Medical education needs to change in Pakistan Need of Curricular change: J Pak Med Assoc 2011 Aug;61(8)790-4. 2011;61(8):790-794.
Changiz T, Yamani N, Shaterjalali M. The challenge of planning learning opportunities for clinical medicine: a triangulation study in Iran. BMC Med Educ. 2019;19(1):292.
Cleland J, Patey R, Thomas I, Walker K, O’Connor P, Russ S. Supporting transitions in medical career pathways: the role of simulation-based education. Adv Simul (London, England). 2016 Jun; 1:14.
Abdalla ME, Shorbagi S. Challenges faced by medical students during their first clerkship training: A cross-sectional study from a medical school in the Middle East. J Taibah Univ Med Sci [Internet]. 2018;13(4):390–4. https://doi.org/10.1016/j.jtumed.2018.03.008.
Arabshahi KS, Haghani F, Bigdeli S, Omid A, Adibi P. Challenges of the ward round teaching based on the experiences of medical clinical teachers. J Res Med Sci. 2015 Mar;20(3):273–80.
Kumar B, Shah MAA, Kumari R, Kumar A, Kumar J, Tahir A. Depression, Anxiety, and Stress Among Final-year Medical Students. Cureus. 2019;11(3).
Beigzadeh A, Yamani N, Bahaadinbeigy K, Adibi P. Challenges and Problems of Clinical Medical Education in Iran: A Systematic Review of the Literature. Strides Dev Med Educ. 2020;16(1):1–15.
Sakai DH, Fong SFT, Shimamoto RT, Omori JSM, Tam LM. Medical school hotline: transition to clerkship week at the John A. Burns School of Medicine. Hawaii J Med Public Health. 2012;71(3):81–3.
McLean SF. Case-Based Learning and its Application in Medical and Health-Care Fields: A Review of Worldwide Literature. J Med Educ Curric Dev. 2016; 3: JMECD.S20377.
Bosch J, Maaz A, Hitzblech T, Holzhausen Y, Peters H. Medical students’ preparedness for professional activities in early clerkships. BMC Med Educ. 2017;17(1):1–11.
O’Brien B, Cooke M, Irby DM. Perceptions and attributions of third-year student struggles in clerkships: do students and clerkship directors agree? Acad Med. 2007 Oct;82(10):970–8.
Stark P, Fortune F. Teaching Clinical Skills in Developing Countries: Are Clinical Skills Centres the Answer? Educ Health (Abingdon). 2003 Dec 1; 16:298–306.
Bing-You R, Hayes V, Varaklis K, Trowbridge R, Kemp H, McKelvy D. Feedback for Learners in Medical Education: What Is Known? A Scoping Review. Acad Med. 2017 Sep;92(9):1346–54.
Alhaqwi AI. Importance and process of feedback in undergraduate medical education in Saudi Arabia. Saudi J Kidney Dis Transpl. 2012;23(5):1051–5.
This work is licensed under a Creative Commons Attribution 4.0 International License.