What Aspects of Supervised Patient Encounters Affect Students’ Perception of Having an Excellent Learning Outcome? A Survey Among European Medical Students

Abstract

Background

To investigate whether supervisor behavior, students’ participation and approach, and psychological safety were associated with self-reported excellent learning outcome from supervised encounters with patients among European medical students.

Methods

A cross-sectional, online survey among European medical students asking about their latest clinical supervision experience. Associations were examined with logistic regression.

Results

Students (N=908) from >25 countries reported on experiences from supervised patient encounters in most types of hospital departments and general practice. One out of six (17%) students perceived the learning outcome as excellent. In the multivariable logistic regression, this was independently associated with supervisor role modelling (odds ratio (OR) 2.1, 95% confidence interval (CI) 1.5–3.0) and addressing learning goals (OR 1.4, 95% CI 1.1–1.7), students’ approach to learning (OR 1.7, 95% CI 1.0–3.0) and psychological safety (OR 1.5, 95% CI 1.1–2.0). Supervisors being present during the patient encounter, coaching students or asking questions to have students express their thinking, and student participation in examination and/or history taking was not associated with perceived excellent learning outcome.

Conclusion

We encourage supervisors to recognize that students are beginners in most supervised clinical settings and often appreciate having learning goals addressed, behavior and thinking role modelled, and psychological safety established before they participate more fully.

Keywords:

• undergraduate medical education
• clinical supervision
• psychological safety
• Europe
• Experience-based Learning
• supervisor

Abbreviations

95% CI, 95% confidence interval; CLEQ, Clinical Learning Evaluation Questionnaire; ExBL, Experience-based Learning theory; IFMSA, International Federation of Medical Students Associations; MCTQ, Maastricht Clinical Teaching Questionnaire; OR, odds ratio; VIFs, variance inflation factors.

Data Sharing Statement

The data used to perform the analysis are included in additional file 1 and will be published on nsd.no upon completion of the thesis of which this paper is part.

Ethics Approval and Consent to Participate

As the research was conducted in Norway and recruiting was conducted online through an international organization, ethical approval was only sought in Norway. The study was discussed with the Norwegian Centre for Research Data and considered to be exempt from ethical review (reference number 235211) due to the anonymity of participants. An information letter based on the template for Norwegian ethical requirements and European data protection requirements was displayed on the first page of the survey. On the final page, respondents were told that by clicking “send” they agreed to their responses being used in research.

Acknowledgments

We wish to thank the International Federation for Medical Student Association (IFMSA) for their endorsement, all the student representatives that helped in distributing the survey, and Tim Dornan for reading and discussing an early draft of the introduction, methods, and results of the paper.

Authors Information

CT is a medical doctor and a PhD student in medical education. AS is a professor in behavioral sciences in medicine and health service research. VA is a medical student with a bachelor's degree in molecular biology. HG is a professor in general practice and behavioral medicine and leads the Center for Pedagogy, Learning and Teaching at the Faculty of Medicine and Health Sciences at the Norwegian University of Science and Technology.

Author Contributions

CT took the lead in all phases of the project including conception, design, execution, data collection, analysis, and interpretation, drafting the manuscript and revising it based on critical input from the other authors. AS and HG made significant contributions to the conception and design of the study, analysis and interpretation of data and several rounds of critical revision of the manuscript. VA made significant contributions in the design of the study, data collection, analysis and interpretation of data and a critical revision of the manuscript. All authors agreed on the journal to which the article was submitted, approved of the final manuscript, and agreed to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This work was supported by The Norwegian University of Science and Technology.