The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of Ausmed Education.
Defining Learning Environments
At face value, this looks like a straightforward question, but a deeper dive uncovers dichotomous paradigms. Even defining what a learning environment is or is not is complicated; in addition, comparing the past to the present objectively suggests that the protagonist of this prose has been immersed in the learning environment over time, both as a ‘giver’ and ‘recipient’ of a series of learning transactions, or a learning journey where there is no fixed destination. There may be learning aficionados amongst us who believe that stepping learners through knowledge, comprehension, application, analysis, synthesis and evaluation stages would constitute a ‘good’ learning environment and who would really be game enough to argue against the approach advocated through Bloom’s taxonomy many decades ago or revised, more recent versions.
Learner Expectations
Another reason why this is a tough question is that learners, specifically ‘students,’ may not even know what to expect from their learning environment and a mismatch may exist between their perceptions of what an actual versus a preferred clinical learning environment should be; in general, however, students prefer a more positive environment than what they may have experienced themselves (Yazdankhahfard et al, 2020).
Clinical Learning Challenges
The clinical learning environment, as a subset of the learning environment in general, is a complex and real-time interface that is subject to all the challenges and stressors that contemporary healthcare can bring. It is believed that there are four specific characteristics that affect, in particular, the learning experiences of students – the actual infrastructure, psychosocial factors, organisational culture and teaching/learning components (Flott & Linden, 2016). In comparing clinical learning environments on a continuum, it is important to remember that the context is continuously evolving; the process of learning is not independent from patient acuity, the ageing population, the costs of healthcare, especially technology, the burden of chronic disease including mental health, the cost of education, the competition for the ‘space’ for learning to occur, consumer expectations and workforce shortages.
Narrative Approach
So – in order to bring this to life, I am going to take a narrative approach to my professional journey through the profession of nursing, reflecting on my own 43 years as both a learning journey ‘passenger’ and ‘pilot’ to contrast the past with the present. I trained as a Nurse in the ‘gritty’ 1980s in the U.K, a largely subject-centred approach to teaching and learning, and a fragmented practice-theory gap. In short, practice was never an issue, but critical thinking was usurped by a task-allocation paradigm within a medical model of healthcare. The emphasis was on ‘doing so I became a valued ‘doer’ who followed instructions and never thought to challenge. I thrived in this learning environment and, because everyone was working in the same environment at the same time, had no comparator whatsoever. I thrived despite, on reflection, being in an environment where my gender was an issue for some, and the learning environment was based upon a reductionist approach where ‘connecting the dots’ was not encouraged.
Changing Environments
During my career journey, I have seen significant changes in the learning environments – the professionalisation of Nursing, in particular, has led to a far more rigorous preparation but has culminated in a set of different challenges. The emphasis has changed towards a more ‘if the learner has not learnt, the teacher has not taught’ analogy and a more constructivist approach to learning. A student recently, and proudly, told me that she did not need to remember anything I taught her because knowledge can be attained instantly through the internet – I did point out that knowledge is one thing but skills are different, and the application of knowledge through experiential learning and critical thinking cannot be instantly found on the internet.
Practice-Theory Gaps
Despite the evolving theoretical and clinical learning environment, the practice-theory gap I experienced has, for many, become the theory-practice gap. In Victoria alone, more than $30 million annually is invested to support the transition to professional practice and seek to bridge the gap, not only in terms of competence but confidence too. This is a learner-focused pedagogy but are the experiences of participants and/or the outcomes for healthcare in general any different to 40 years ago? Direct measurement contrast is futile because there are so many variables, and the healthcare context has evolved.
Pandemic Challenges
LLearning environments have changed, and we now grapple with recruitment and retention challenges, especially as a consequence of the pandemic, where the whole image of nursing, in particular, presents a challenge. We still treat each other badly at times - hostility and burnout still exist, with fatigue management being a focus of many organisations. We are experiencing a turbulent pandemic with undulating challenges, draping a Harry Potter-like ‘invisibility cloak’ over pre-existing challenges.
Experience-Complexity Gap
The experience-complexity gap has taken over from the theory-practice gap – the ageing population and the burden of chronic disease are no longer a future problem but omnipresent (Virkstis, Herleth, & Rewers, 2019). The gap between experience and complexity is not always disadvantageous – a good example of this is the reverse mentoring in clinical learning environments that occurs with new technology. Technology has not made the learning environment any better or worse than in the past – it is both a barrier and enabler to the critical end-point of all the clinical learning environment transactions, which is safe, quality patient care.
Measuring Effectiveness
In an effort to provide ways to measure the effectiveness of clinical learning environments, the Victorian Department of Health introduced the Best Practice Clinical Learning Environment Framework in 2008. The framework sought to provide more measurable data about the clinical learning environment in terms of organisational culture, best practice clinical practice, effective education provider/health service relationships, effective communication and a positive learning environment. Organisations have a means to measure their effectiveness across multiple disciplines and across metropolitan, regional and rural health services. The advent of comparable data allowed for the placing of more tangible ‘value’ on education and learning but is so far limited to public health services within Victoria.
Learners Thriving in 2024
For learners to thrive, what do they really need in 2024 and what does thrive really mean? Although not scientific, I still believe that support through kindness is a human trait that can overcome many a challenge – work is less important than those you work with. A good learning environment is one where there is good educational leadership, kindness and support and where learners play their role as consumers in the process of curriculum design. An effective learning environment recipe is dependent on the right ingredients – I believe those ingredients have not changed over time and constitute three very important human characteristics of kindness, mentoring and engagement. The metaphorical ‘interface’ of theory and practice can only flourish for educators and learners alike when these ingredients are added to the mix.
References
Department of Health, Victoria (2024). Best Practice Clinical Learning Environment. https://www.health.vic.gov.au/education-and-training/best-practice-clinical-learning-environment-bpcle-framework. Accessed April 2024.
Flott E. & Linden L. (2016). The clinical learning environment in nursing education: A concept analysis. Journal of Advanced Nursing, 72, 501-513. https://doi.org/10.1111/jan.12861
Virkstis K, Herleth A, Rewers L. Closing Nursing's Experience-Complexity Gap. J Nurs Adm. 2019 Dec;49(12):580-582. https://pubmed.ncbi.nlm.nih.gov/31725516/ Accessed April 2024.
Yazdankhahfard, M., Ravanipour, M., & Mirzaei, K. (2020). The gap in the clinical learning environment: the viewpoints of nursing students. Journal of Education & Health Promotion, 9, 311. https://dx.doi.org/10.4103/jehp.jehp_438_20
Author
Tony McGillion
Tony McGillion is the Divisional Director of Education & Training at Northern Health and a Registered Nurse with over three decades of experience across various roles. He began his career in the UK, also working in Saudi Arabia, before transitioning to leadership and educational roles in Australia, including positions at Epworth Hospital, Cabrini Health, Austin Health, and as a policy advisor to the Victorian government.
He later joined La Trobe University as an Associate Professor and held multiple directorships. Tony holds a Bachelor of Education, a Master of Health Administration, and adjunct positions at the University of Melbourne and La Trobe University. He currently focuses on leadership development in nursing, serves as Chair for the Australian College of Nursing in Victoria and Melbourne, and mentors mid-career nurse leaders.
