Rethinking Education Environment: The Clinical Education Environment Framework

Educational environment is an important determinant of medical students’ behaviour. It impacts their academic performance, motivation, and psychological well-being. Quantitative evidence have shown that there is a decrease in the positive perception of clinical medical students towards the educational environment. The primary focus on this study was to explore the clinical education environment through the lived experience of clinical medical students during medical training. Using hermeneutic phenomenology we aimed to interpret participants’ experience of personal clinical learning journey through free text input. Thematic analysis was performed to analyse the written texts. Various measures were taken to enhance the trustworthiness of the findings. A total of 154 (74.8%) fourth year students and 144 (74.6%) final year students participated in the study. We identified six overarching themes of education environment in clinical setting that are personal development, teaching and learning, assessment for learning, facility, support and nurturing curriculum. The overlapping relationship of the themes is illustrated in the Clinical Education Environment Framework. While many themes were consistent with existing framework, our findings also proposed assessment as an important component to influence perception on education environment. The themes in this study finding conform to the definition of education environment which covers physical, social, and psychological aspects of students learning. Medical schools should take active measures to incorporate a nurturing education environment especially in clinical year where students struggle with the hidden curriculum.