Transitioning to Clinical Clerkships: Student Readiness for Competency-Based Health Profession Education is Key!

By: Marije P. Hennus

Transitioning from preclinical classroom studies to clinical clerkships is a transformative moment in medical education. For students, it’s a shift from structured, predictable learning environments to the dynamic and often unpredictable realities of clinical practice. While this phase offers invaluable opportunities to learn from real-world patient care, it presents challenges that require deliberate preparation. With this transition, students often enter the realm of Competency-Based Health Profession Education (CBHPE), which emphasizes the mastery of competencies (knowledge, skills, attitudes, and behaviors) necessary for effective clinical performance. CBHPE differs from traditional time-based education by focusing on outcomes, ensuring learners can demonstrate their abilities in authentic, workplace-based contexts. To thrive in CBHPE, students must not only possess theoretical knowledge but also be prepared to apply it effectively in real-world settings that are often unpredictable and complex. This raises an essential question: how can we equip students to succeed in this clinical environment often dominated by workplace-based learning and harness the full potential of CBHPE?

Clerkships immerse students in hands-on patient care, offering invaluable opportunities for practical learning. However, unlike the structured nature of classroom education, workplace-based learning is largely informal, occurring through observation, active participation, and discussions during daily clinical activities.¹ Despite its central role in clinical education, this informal learning is often underutilized. Many students (and supervisors alike for that matter) fail to recognize its value or understand how to engage with it effectively. The demands of clinical environments add further complexity. Students must balance patient care responsibilities with their own learning goals while adapting to shifting schedules, multiple supervisors, and unexpected (clinical) challenges. Limited guidance from supervisors, often constrained by time, compounds these difficulties. For those new to clinical settings, this can feel overwhelming and difficult to navigate without adequate preparation. To fully benefit from the predominantly informal learning at the workplace, students must develop the skills to identify and capitalize on these opportunities. This requires readiness—the ability to actively engage with the demands of informal workplace-based learning.

Research highlights three levels of informal learning: implicit (unintentional), reactive (spontaneous), and deliberative (planned).¹ While supporting students in recognizing learning opportunities and advancing from implicit to reactive learning is important, it is not sufficient. The critical step lies in transitioning from reactive to deliberative learning. This shift moves students from passively encountering learning moments to actively planning and engaging with their environment, enabling them to maximize their learning potential in complex clinical settings. Such a transition is essential for achieving the competencies outlined in CBHPE. Developing this level of readiness requires a structured approach that nurtures self-regulated learning (SRL), a process encompassing goal setting, planning, monitoring progress, and reflecting on outcomes.² While students often acquire and practice SRL skills during preclinical education, applying them in the fast-paced and multifaceted clinical setting requires tailored preparation and support.

To prepare students for workplace-based learning, emphasis should thus be placed on refining self-regulated learning (SRL) skills tailored to the clinical environment. These include:

• Recognizing Learning Opportunities: Encouraging students to identify valuable moments beyond direct clinical tasks, such as observing procedures, attending outpatient clinics, or participating in multidisciplinary meetings. Engaging in discussions with supervisors can further enhance these opportunities.
• Setting Clear Goals: Guiding students to establish realistic, specific objectives that align with their individual learning needs and the opportunities available in their clinical context.
• Asking Questions Effectively: Supporting students in formulating thoughtful questions that deepen understanding. Sharing their own context with supervisors helps align discussions with their current knowledge and skills.
• Embracing Feedback and Reflection: Teaching students to actively seek constructive feedback and use it to refine their practice, improve skills, and set new learning objectives. Reflection on this feedback helps reinforce growth and adaptability, aligning with Carol Dweck’s growth mindset, which emphasizes that abilities can be developed through effort, learning, and persistence.³

These SRL competencies are not innate but can be developed through deliberate training and support.

Preparing students for informal learning in clinical settings goes hand-in-hand with fostering a supportive clinical environment. When students are equipped to engage effectively in workplace-based learning, they not only enhance their own education but also contribute to a positive and collaborative culture within the clinical team. Proactive, well-prepared learners can enrich the experience of supervisors and colleagues, encouraging mutual support and shared learning. However, achieving this synergy requires alignment between educational strategies and clinical practice. Supervisors play a pivotal role in cultivating environments that promote informal learning and self-regulation. By equipping supervisors with tools and training to guide student learning effectively, we can ensure CBHPE thrives across the spectrum of medical education. Supporting both learners and educators is critical to creating an ecosystem where clinical education flourishes and competencies are developed in real-world contexts.

In summary, incorporating readiness-focused strategies into medical curricula is vital for seamless integration of preclinical and clinical education. These approaches not only enhance students’ capacity to navigate the complexities of CBHPE but also prepare them to excel in dynamic clinical settings. By fostering self-regulated learning, adaptability, and a growth mindset, we equip students not only for clerkships but for lifelong professional growth. Ultimately, this contributes to shaping healthcare professionals who are confident, competent, and prepared to deliver high quality patient care, ensuring a brighter future for both medical education and the healthcare field.

About the Author:

Marije Hennus, MD, PhD, MClinEd, FHEA, is a pediatric intensivist, PICU program director and Associate Professor of Teaching at the Wilhelmina Children’s Hospital, University Medical Center Utrecht. Her educational research and innovations focus on Competency-Based Education (CBE), with a particular interest in workplace-based learning and EPAs.

References

1. Eraut M. Informal learning in the workplace. Studies in Continuing Education. 2004;26(2):247-273. doi:10.1080/158037042000225245
2. Zimmerman BJ. Becoming a Self-Regulated Learner: An Overview. Theory Into Practice. 2002;41(2):64-70. doi:10.1207/s15430421tip4102_2
3. Dweck CS. Mindset: The New Psychology of Success. New York: Random House, 2006.

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