Open Access

How, what and from where to learn? Questions arising from early clinical exposure

Arjuna Thakker[1]

Institution: 1. College of Medical and Dental Sciences, University of Birmingham
Corresponding Author: Mr Arjuna Thakker ([email protected])
Categories: Students/Trainees, Teaching and Learning
Published Date: 31/05/2018
Keywords: ; Medical education; Medical student


The article published in Medical Education by Barret et al. (1), identified the sub-theme of ‘messiness of clinical learning’ as one of many problems faced by medical students when first entering a clinical environment. ‘Messiness’ in this case refers to the ability of early clinical exposure to leave students struggling to identify how and what to learn effectively. As a medical student at the early stages of clinical exposure, I too can resonate with this struggle.

The lack of definitive guidance on this matter is often an unfamiliar challenge that many students must face. Throughout education in the UK, students have always been provided with a structure on which they are able to base their learning. This continues from an early school level, all the way to medical school, where students will often use lectures to direct their way through pre-clinical years. Suddenly then, to be thrust into a clinical environment, without a navigational aid, can be a very overwhelming process.

I agree with the suggestions made by Barret et al. (1), that students need clarification on the best approach to tackling the ‘vast messiness’ (2) of clinical knowledge. At Birmingham medical school, third-year students are provided with a handbook containing key learning outcomes which are to be followed throughout the year. These learning outcomes are also given to those involved in the delivery of clinical education. Student teaching is then optimized to ensure that learning outcomes are being continuously met over the year. This integrated approach between the medical school and teaching hospitals provides students with both clarity and a reference point.

One important issue not addressed in the article is how students decide from where to learn. For the majority of students, the Oxford clinical handbook represents a suitable answer to this question and usually comes recommended by medical schools and older years. However, there are students like myself, who find the handbook either too overloaded with information or simply do not suit the learning style of the handbook. For us, there are few other resources available, let alone made known to us, by either medical school or the hospital.

The ability of medical schools to provide clarity on how, what and from where to learn, is fundamental to a student’s ability to successfully navigate the early clinical environment. It is important then, that medical schools do all that they can to ensure such questions are rightly addressed.


Take Home Messages

Notes On Contributors

Arjuna Thakker is a 4th-year medical student currently studying at the University of Birmingham, UK.



1.  Barrett J, Trumble S, McColl G. Novice students navigating the clinical environment in an early medical clerkship. Medical Education. 2017; 51(10):1014-1024.


2.  Barrett J, Yates L, McColl G. Medical teachers conceptualize a distinctive form of clinical knowledge. Advances in Health Sciences Education. 2014; 20(2):355-369.




There are no conflicts of interest.
This has been published under Creative Commons "CC BY-SA 4.0" (https://creativecommons.org/licenses/by-sa/4.0/)


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Richard Hays - (15/03/2019) Panel Member Icon
This letter provides an interesting perspective from the perspective of a medical student. It reminds us that “education is messy” and that medical programs have little control over the clinical environment, resulting in very different experiences for some learners. This is unlikely to change when learning must take place in the real and dynamic world of health care, particularly in the acute hospital sector, where opportunities must be seized as they arise. However, a key question is: how can we support learning in the absence of a standardised or comprehensive clinical exposure? Suggestions from the learners’erspective for solving the problem would be welcome.
Possible Conflict of Interest:

I am Editor of MedEdPublish

Thomas Puthiaparampil - (12/06/2018)
Thank you for your letter expressing concerns about a not so well organized early clinical exposure. It is indeed overwhelming for an year 2 medical student to be suddenly pushed into the hospital ward without supervision. As a medical teacher myself, I have experienced the concern raised by my students in this respect.
In our medical school in Malaysia, the year 2 medical students get at least one opportunity to meet patients in the wards to take history (they are still not trained to do physical examination). Students are excited to meet real patients and learn about their presentations with various health problems, often multiple problems. The histories are then presented to the whole batch of students and the lecturer explains for all to understand the patient presentations.
Our real clinical exposure starts in year 3 of the curriculum, when students spend lot of time in the wards. They are allocated certain beds to clerk cases. As they are already trained in physical examination, they are excited to do it on real cases. During bedside teaching sessions, the students present their cases and the lecturer discuss the issues further.
P Ravi Shankar - (02/06/2018) Panel Member Icon
I read with interest this brief letter from a fourth-year medical student. I can empathize with him. I had gone through a similar situation during my clinical years nearly three decades ago. We saw a variety of patients and our professors taught us well. However, I and my fellow students often found the amount of information overwhelming. Modern trends in medical education often dictates that students should develop the ability to decide what and from where to learn and to what depth. However, during the early days of medical school this may be a difficult task and guidance in the form of recommended reading may be useful. Also the term ‘early clinical exposure’ is often used to refer to clinical exposure which occurs during the basic science years of the medical course.