Clouder D.L.1, Mackintosh S.2, Jones M.2, Adefila A.1
1Coventry University, Centre for Excellence in Learning Enhancement, Coventry, United Kingdom, 2University of South Australia, School of Health Sciences, Adelaide, Australia
Background: Learning on clinical placement is dependent on being given enough scope to practice with some degree of autonomy, within the confines of being a student. Being trusted to take on increasing levels of responsibility is dependent on a wide range of factors intrinsic and extrinsic to the student. Some factors are not easy to influence. For instance, the clinical educator they are allocated can sometimes be the 'luck of the draw.' However, others, such as proving themselves trustworthy, are open to influence when students know about them. Although some students readily acknowledge the interaction between trust and trustworthiness, others fail to grasp its importance.
Purpose: The rationale for this study was to understand factors influencing the extent of responsibility that students are given on clinical placement and how students can engender trust. Increased student insight about why clinical educators give, or withhold, responsibility may influence their ability to optimise their learning and prevent dissatisfaction, decreased confidence, or even placement failure. We wanted to determine what students can do to influence perceptions of their trustworthiness, and become more proactive, within the student/clinical educator relationship.
Methods: This qualitative study used semi-structured interviews with 15 students and 12 clinical educators associated with two Universities, one in South Australia, and the other in the United Kingdom.
Results: Educators readily identified issues which students were not taught to consider. Following instructions, listening, asking and acting on feedback, and showing commitment to learning and to the placement, all help to enhance trust and develop transferrable skills important to lifelong learning. A major factor influencing Clinical Educators impressions and level of trust, is what they observe students doing. Typically, students do not like being observed but they need to be comfortable with this if they expect to be trusted with increasingly complex patients. Students appreciate feedback but its nature significantly affects their confidence and further learning. Explaining clinical reasoning and using underpinning knowledge to do so demonstrates that students understand their patients and what they are trying to achieve, so they need to be prepared. Competent and self-aware students assess risk and if in doubt seek advice they double-check before they act. This does not suggest incompetence; knowing that students have a safety valve creates trust that students will not do anything unsafe. Trust and trustworthiness are interdependent so establishing mutual trust is crucial.
Conclusion(s): Adopting strategies to establish trustworthiness on clinical placement is essential for students to optimise their learning, as being trusted with more responsibility leads to a wider range and depth of experience. Future studies should explore if being aware of, and using, strategies influences student success on placement.
Implications: Increased transparency of what clinical educators expect from students, in proving their trustworthiness, would boost students confidence in taking increasing levels of responsibility. Student uncertainty, vulnerability and passivity on clinical placement would decrease allowing students and clinical educators to get on with optimising learning.
Funding acknowledgements: The research is unfunded in the UK and Australia.
Topic: Education: clinical
Ethics approval: The study had approval from Coventry University Ethics Committee; University of South Australia´s Human Research Ethics Committee (Application ID: 0000033152).
All authors, affiliations and abstracts have been published as submitted.
