Internal Medicine

Clinical Work as Experiential Education

Experiential Education, Clinical Clerkship and the PortfolioOur emphasis on the importance of the students” time spent working with patients in various settings is based on a belief in the value of experiential learning.

Importance of the Oral Portfolio Interview

The principal aim of the oral portfolio interview is to determine whether all aspects of experiential learning have been met by the student during the student’s interaction with their patients. This cannot be adequately assessed by looking at a collection of written case reports, nor by merely allowing the student to read their reports out loud at the interview.

Students need to be questioned insightfully and drawn into a debate about their patients, in terms of meaning, significance and insight.

Modified Definition of Experiential Education

In the table below we have taken the standard definition of experiential education (which is reproduced in its original form at the foot of this page) and modified it to fit the process of experiential learning which underlies a successful clinical clerkship.

The column on the left contains this modified definition. On the right is our commentary on how this manifests in the student’s clinical clerkship. There is a very close correlation between the two columns.

 Experiential education is a holistic philosophy  where…  
 Students are exposed to a number of  discreet clinical experiences, namely a number  of encounters with patients seen, clerked and  followed.                     Students are required to seek out, clerk and follow up a
 number of patients and record these in a written portfolio.
 These experiences are subjected to reflection,  critical analysis, and synthesis.  Both during and after the clerking, students must reflect on,
 read around their cases, analyse and interpret their findings,
 and synthesise new, better, deeper and more realistic
 mental models
(schemas) to explain their patients.
 The student is required to take the initiative,to  make decisions, and to be accountable for the  eventual outcome of the clinical experience,  in terms of knowledge gained.  Both the initiative and the motivation to learn are the student’s
 responsibility. They need to identify suitable patients for their
 portfolios, determine the further reading, discussion or research
 necessary to understand their patients and take these  further steps. They must commit themselves to a clinical  formulation, a differential diagnosis or problem list and to  investigation and treatment strategies.
 The student’s engagement with their patients is  characterised by actively posing questions,  investigating, being curious, solving problems  and assuming responsibility.  Students engage in high-level thinking about their patients
 They are required to be creative, to construct  meaning out of the clinical experience, and  to integrate previously acquired  knowledge into a better mental model to explain  the patient’s situation.  Active learning must take place. The student must construct a
 broader, deeper, more useful meaning (a mental construct or
 schema which reflects that type of a patient as a “class” and
 not just an individual) out of the experience, in other words, they  must generalise from the individual experience to the broader  universe of similar patients.
 Students are engaged intellectually, emotionally,  socially, politically, spiritually, and physically in  an uncertain environment where they may  experience success, failure, adventure, and  risk taking.  They learn in a real-life, authentic clinical environment where
 successful outcomes (measured either in terms of “getting the
 case right” or in terms of “saving the patient’s life”) are not  guaranteed. They engage fully with the patient, not just in terms
 of deriving a physical diagnosis, but are stimulated to think
 about  the broader psychosocial issues arising from the patient  and their  illness.
 The learning involves interaction between  students, student and clinician, and student and the  health care environment.  Students interact with each other, their registrars, consultants and  tutors, other health care professionals and the ward environment,  laboratories, laboratory results, X-ray facilities, X-rays etc. All of  these are incorporated into the mental models they develop.
 It challenges the student to explore issues  of values, relationship, diversity, inclusion,  and community.  All these arise in parallel with the biomedical learning which takes  place. These aspects should be explored as part of the  assessment,
 The results of the learning form the basis of future  experience and learning.  At the end of the process the, student has not just gained  in experience, but has developed greater expertise, and is hence  able to deal with subsequent cases more appropriately and  confidently.

Below is the full definition of experiential education, which was adapted in the table above to reflect the experience of the clinical clerkship:

“Experiential education is a holistic philosophy, where carefully chosen experiences supported by reflection, critical analysis, and synthesis, are structured to require the learner to take initiative, make decisions, and be accountable for the results, through actively posing questions, investigating, experimenting, being curious, solving problems, assuming responsibility, being creative, constructing meaning, and integrating previously developed knowledge. Learners are engaged intellectually, emotionally, socially, politically, spiritually, and physically in an uncertain environment where the learner may experience success, failure, adventure, and risk taking. The learning usually involves interaction between learners, learner and educator, and learner and environment. It challenges the learner to explore issues of values, relationship, diversity, inclusion, and community. The educator’s primary roles include selecting suitable experiences, posing problems, setting boundaries, supporting learners, insuring physical and emotional safety, facilitating the learning process, guiding reflection, and providing the necessary information. The results of the learning form the basis of future experience and learning.” Association for Experiential Education (1994) (

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© R J Hift