Accessing Clinical Wisdom: Mapping Clinical Students' Experiences of Integrated Learning

Abstract

The principal aims of this study were to investigate integrated learning and access to clinical wisdom by health professional students, and to identify whether differences in specific experiences and discernment of critical elements of these experiences contributed to this. An additional aim was to document participants’ evaluations of the ease of use, convenience and suitability as a learning tool of modified concept mapping which was developed specifically to capture integrated learning in clinical experiences. Based on views of clinical learning and wisdom informed by systems theory, embodied phenomenology and integrative dualism, this study used systems theory, visual, ethnographic and phenomenographically-informed methodologies to develop a modified concept map data collection tool and to analyse the data collected. Eleven participants from Occupational Therapy and Medicine took part in the study over an eight month period. Data analysis suggested varying integration of emotions/feelings, actions/artefacts, thinking/knowing, beliefs, attitudes and values in clinical learning. This variability related directly to the participants’ accounts of their clinical experiences and is expressed in two diagrams. The first, “The Who, What and Where of Clinical Learning” represents the critical contextual factors of clinical learning, the most important of which was “Interpersonal interactions”. The second diagram, “(Re)forming Identity”, represents the “How” of clinical learning as six critical elements of experience, the most prevalent being “Changing or revealing beliefs, attitudes, values” and “Building or negotiating relationships”. These diagrams suggest that students’ beliefs and values are revealed to them and sometimes changed through relationships with patients, clients and educators. Awareness of integration and relationship-based revelation or change to beliefs and values appear to be central to the (re)formation of student identity and to shape students’ becoming as persons, graduates and members of identifiable professions. Integration of three or more critical elements sometimes appeared to indicate access to clinical wisdom which is theorised as an external resource comprising all the information relevant to each unique, situated interpersonal interaction. The soul is proposed to function as the mediator of this access. The study suggests that health professional students appear to have the capacity for integration of learning across domains and contexts, and for some this is proposed to allow access to clinical wisdom mediated by a functional soul. The implications for increasing access to clinical wisdom in clinical education are that a systematic, embodied and integrative approach to learning in complex interpersonal contexts needs to be taken across the curriculum. To enhance integration a whole-person-centred focus on increasing awareness and engagement with becoming for students, educators, patients and clients is proposed. Specific teaching attention to integrating the psychomotor and affective domains with cognition, attitudes, values and beliefs is suggested to increase access to clinical wisdom for a greater number of students.