Learning from clinical work: the roles of learning cues and credibility judgements
Open accessAbstract
Medical Education 2012: 46 : 192–200 Context: How learners interpret their clinical experiences to create meaningful learning has not been well studied. We explored experiences considered by doctors to be influential in their learning in order to better understand this process. Methods: Using a grounded theory approach, we interviewed 22 academic doctors who had been in practice for ≤ 5 years. Participants were asked to reflect on experiences they considered to have been influential during their training. Constant comparative analysis for emerging themes was conducted iteratively with data collection. Results: A model of clinical learning emerged in which the clinical work itself is central. As they observe and participate in clinical work, learners can attend to a variety of sources of information that facilitate the interpretation of the experience and the construction of knowledge from it. These ‘learning cues’ include feedback, role models, clinical outcomes, patient or family responses, and comparisons with peers. The integration of a cue depends on the learner’s judgement of its credibility. Certain cues, such as clinical outcomes or feedback from patients, are seen as innately credible, whereas other cues, particularly feedback from supervisors, are subjected to critical judgement. Conclusions: Learners make complex judgements regarding the credibility of information about clinical performance. Credibility judgements influence the learning that arises from the clinical experience. Further understanding of how such judgements are made could guide educators in providing credible information to learners.
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Opportunities to practice consultation skills and receive constructive assessment remain limited in clinical settings.
“However, opportunities to practice these skills and receive constructive assessment remain limited in clinical settings.”
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Invested, credible supervisors and a supportive, open culture are integral to positive learning and coaching in medicine and education.
“Invested, credible supervisors 2,4-7 and a supportive, open culture [33][34][35][36] are integral to positive learning and coaching in medicine 8 and education.16,19”
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Features important to the provision of feedback include actively engaging providers and recipients in the feedback interaction and addressing factors that influence feedback credibility and use, such as relationships, context, and culture.
“Features seen to be especially important to the provision of feedback include actively engaging providers and recipients in the feedback interaction and addressing factors that influence feedback credibility and use, such as relationships, context, and culture.[2][3][4][5][6][7][8]”
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Relevance and credibility are important parameters for learners to decide how to act on feedback.
“Relevance and credibility are important parameters for learners to decide how to act on feedback [10].”
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Trainees must perceive feedback as credible in order for it to be influential.
“Do recognize that trainees must perceive feedback as credible in order for it to be influential.”
From Guidelines: The do’s, don’ts and don’t knows of feedback for clinical education. (2015) · cites this paper as [10]
Trainees may begin to devalue external feedback in general, relying instead on self-assessment, as a consequence of poor-quality feedback.
“As a consequence, trainees may begin to devalue external feedback in general, relying instead on self-assessment [10, 11].”
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The quality of feedback received in medical training is often reported as low and poorly informed due to factors including limited direct observation of performance.
“In reality, however, the quality of the feedback received in medical training is often reported as low, and poorly informed due to factors including limited direct observation of performance.”
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- Authors
- Watling, C., Driessen, E., van der Vleuten, C. P. M., & Lingard, L.
- Affiliations
- Western University (CA)
- Maastricht University (NL)
- Corresponding author
- Watling, Christopher
- Venue
- Medical Education
- Publisher
- Wiley
- Published
- 2012-01-12
- Volume
- 46
- Issue
- 2
- Pages
- 192-200
- ISSN
- 0308-0110 (ISSN-L)
- 1365-2923
- OpenAlex
- W1944495410
- Cited by
- 261
- References
- 25
- Citations by year
- 2026: 16 · 2025: 8 · 2024: 22 · 2023: 23 · 2022: 15 · 2021: 16 · 2020: 17 · 2019: 23 · 2018: 29 · 2017: 17 · 2016: 23 · 2015: 11 · 2014: 20 · 2013: 15 · 2012: 6
- FWCI
- 16.05
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Medical Education (publishedVersion)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Research Publications (Maastricht University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Health Sciences › Medicine › Psychiatry and Mental health › Empathy and Medical Education
- Keywords
- clinical learning, clinical supervision, feedback, role models, clinical outcomes, peer comparison, patient feedback, knowledge construction, early-career physicians, clinical experience
- MeSH terms
- Attitude of Health Personnel, Clinical Competence, Cues, Education, Medical, Female, Humans, Judgment, Learning, Male, Sampling Studies, Knowledge, Feedback, Psychological
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