Exploring Clinical Learning Environments

Exploring the opportunities and challenges associated with high quality clinical learning environments

This project, titled "Exploring Clinical Learning Environments for Postgraduate Medical Education and Training", is led by Dr. Deirdre Bennett, Head, Medical Education Unit, University College Cork. It started in July 2015 and examines how trainee doctors learn in clinical environments.

Using methodologies that have not previously been applied to this topic, we aim to produce a holistic view of the opportunities and challenges associated with providing high quality clinical learning environments for postgraduate medical education and training.

The project examines learning at all stages of postgraduate medical education and training, from internship to completion of Higher Specialist Training.

Our findings will inform practice and policy in postgraduate medical education and training, both in Ireland and internationally, with the potential to improve patient care.

The project has received €150,000 in funding from the Health Research Board, the Medical Council and the Health Service Executive’s National Doctors Training and Planning unit.

The day to day running of the project is based at the Medical Education Unit at University College Cork.

Why It Matters

Doctors complete most of their postgraduate training ‘on the job’, caring for patients in clinical environments including hospital wards, the Emergency Department, outpatient clinics, operating theatres and Intensive Care Units.

By their very nature, these environments are often extremely busy and high-pressured.

Clinical learning environments matter as they have a direct impact on the competence, satisfaction and professional development of trainee doctors. However, designing supportive clinical learning environments is challenging due to their dynamic and complex nature, where multiple activities, including learning, happen simultaneously.

Postgraduate medical education and training matters because it lies at the intersection of the interests of multiple stakeholders, including patients and future clinical leaders.

Study Methods

We are carrying out three separate studies on learning in clinical environments:

1. Realist Synthesis of the Literature

This will examine how clinical learning environments for postgraduate medical education and training can be optimised. It is an interpretive, theory-driven narrative summary of the literature seeking to describe what works, why and in what circumstances.

This will feed into an interim report Optimising Clinical Learning Environments for PGMET.

2. Group Concept Mapping

This examines stakeholders’ perspectives on current clinical learning environments and opportunities for improvement.

This study uses an integrated mixed method, using qualitative and quantitative measures in a structured approach to identify each group’s understanding of the topic. Patient involvement in the study also is key, as the delivery of clinical care and the training of junior doctors are inseparable.

As a result of this work we have produced a report on 'Stakeholder Perspectives on Irish Clinical Learning Environments', which is awaiting publication.

3. Activity Systems Analysis

This will examine the relationship between postgraduate medical education and training and the competing activities happening in clinical learning environments.

Activity Systems Analysis is a methodology that maps and evaluates learning through participation in social activity, in cultural and historical contexts.

Our findings will be discussed in a report on Learning and Competing Activities in Clinical Environments.


Anél Wiese	Ph.D. student
Caroline Kilty	Post-doctoral researcher


Prof. Mary Horgan	Dean, School of Medicine, UCC
Prof. Colm Bergin	Dean of Postgraduate Training, Royal College of Physicians of Ireland
Prof. Patrick Flood	Professor of Organisational Psychology, DCU
Dr. Siun O’Flynn	Medical Education Unit, UCC
Dr. Dubhfeasa Slattery	Consultant Paediatrician, Children’s University Hospital, Temple St


Prof. Martina Kelly	Dept. of Family Medicine, University of Calgary
Prof. Agnes Higgins	School of Nursing, TCD
Dr. Mike O’Connor	Clinical Director, Cork University Hospital
Dr. Bridget Maher	Senior Lecturer, Medical Education Unit, UCC
Mrs. Margaret Murphy	Patient Advocate
Dr. Na Fu	Business School, Dublin City University
Dr. Grainne O’Kane, Chair	Collegiate Members Committee, RCPI
Dr. Michelle Reardon	Mercy University Hospital
Dr Slavi Stoyanov	Open University of the Netherlands