Medical student learner neglect in the clinical learning environment: Applying Glaser’s theoretical model

Abstract

Introduction Learner neglect is a relatively new concept in education, and no suitable framework for its exploration has been devised. The aim of this study was to determine whether an existing framework, Glaser's framework of child neglect, could be applied to learner neglect in clinical learning environments. This was a retrospective analysis of data obtained as part of a related study. Method Six focus groups were conducted with medical students in their early clinical years to explore their views of what experiences in medical education were challenging and why they presented a challenge. The transcript data were analysed using inductive content analysis, within an interpretivist approach in the development of categories. The identified categories were cross referenced with Glaser's framework categories replacing the carer with the teacher and the child with the learner. Results Glaser's classifications of teacher (parent) behaviours were all identified in the negative aspects of medical learner clinical education including emotional unavailability/unresponsiveness, acting in a hostile manner, inappropriate inconsistent developmental interaction, failure to recognise individuality and failure to promote social adaption. Physical unavailability was identified as an additional category and is included in our proposed framework of learner neglect. Discussion Adapting Glaser's framework was useful in considering learner neglect. Medical schools have a role in ensuring learning experiences are positive across contexts and to make explicit to teachers any behaviours that may appear as learner neglect. Applying this framework has the potential to make more explicit any subtle undermining teacher behaviours. Once explicit, there is a greater likelihood that behaviours may be reappraised both by the teacher and learner and modified to promote a more effective clinical learning experience.

Learner neglect in the surgical training setting

“…Learner neglect in the surgical training setting I read Rudland et al's paper 1 on Learner Neglect with interest and listened to the accompanying podcast. The question was posed as to whether this theory was applicable beyond medical school into postgraduate medical training.…”

Failure to fail: Fear of retribution or a response to neglecting the learner?

“…3 This may relate to learner neglect, a relatively new concept that can be defined as a lack of care, attention and/or input given to the educational process of a learner. 4 Learner neglect may include the educator being emotionally and physically unavailable, failing to recognise learner individuality and failure to promote social adaptation. 4 With clinicians working to capacity there may be less room for quality education.…”

Truly, there is no such thing as a bad teacher

“…To wit, two articles in this issue of Medical Education highlight the influence of negative role models, one focused on learner neglect and one focused on reporting mistreatment 2,3 . Such individuals exhibit negative attitudes towards students, being emotionally unavailable, interacting in hostile manners 2 and practising exclusivity 1 .…”

“…To wit, two articles in this issue of Medical Education highlight the influence of negative role models, one focused on learner neglect and one focused on reporting mistreatment 2,3 . Such individuals exhibit negative attitudes towards students, being emotionally unavailable, interacting in hostile manners 2 and practising exclusivity 1 . Repeated exposure to such negative examples can leave students feeling powerless, raising an internal conflict between the values of patient‐centred care they wish to uphold and the reality they experience, thus ensuring a long‐term impact 1 .…”

“…Tell me how you will manage your anger in your hectic clinics’. In doing so, even the subtler acts of learner neglect should be made explicit to stimulate reappraisal of teacher their behaviours 2 …”