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) (http://www.aee.org)
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