Exploring the Crisis in Clinical Training: Looking to the Future

Abstract

How can the crisis in training be understood? How can it be resolved? A context for this paper is provided in terms of relevant professional and educational policy. A critical review of nationally available data is presented. It will be argued that commonly cited reasons for not offering student placements might have obfuscated underlying dynamics, which are related to the model of education adopted in the United Kingdom. It will be argued that a shift in emphasis in initial and continuing professional education is relevant.

Learner : preceptor ratios for practice-based learning across health disciplines: a systematic review

“…The learner-cited challenges of the 1 : 1 ratio are the lack of peer support 9,17,26,35 and the lack of peerassisted learning (PAL). 26,30,35,36 PAL is a broad term encompassing a variety of cooperative and collaborative educational strategies, including peer teaching, peer learning, peer assessment, peer mentoring and peer leadership, where a 'peer' is another learner at a different or similar academic level. [37][38][39][40] Preceptors most commonly cited increased workload with the 1 : 1 ratio compared with having no learner.…”

A Strategic Approach to Clinical Placement Learning

“…As the strategic plan developed, there was a reexamination of some of the fundamental assumptions which seemed to be inherent in the traditional model for SLT placements (Morris 1998). Alternative models were available in the different approaches taken by other professions (Bamett et al 1987) and related literature provided much discussion of these dlfferent approaches in relation to adult learning models (e.g.…”

“…Either the department could continue to allocate considerable resources to the time-consuming process of securing the numbers of placements required for the students or the department's courses could be changed to reduce the expectation that students would learn from direct experience in work placements. However, it became clear that there were deeper underlying causes to the problem than the reasons given by the clinicians and managers for not taking students (Morris and Parker 1998), and that these needed to be investigated. It was decided that short-term solutions, such as the allocation of resources, while necessary to secure the immediately required placements, would not be sufficient and that a long term strategy based on an understanding of the underlying process was required.…”

Moving beyond solutionism: Re‐imagining placements through an activity systems lens

“…5 The challenges of sourcing clinical placements are long standing and well recognised across medicine, nursing and the allied health professions. [6][7][8][9] This challenge is amplified in resource-stretched health services where the prevailing view is that students are a further draw on scarce resources leading to education being thought of as separate from, and additional to, the core business of delivering patient care. 10,11 We contend that this stressed interaction between HPE programmes and service providers leads to simplistic framing of the problem.…”