Lost in translation: barriers to learning in health professional clinical education

Abstract

The perennial debate concerning the so-called 'theory-practice gap' pervades health professional education. It is uncertain whether this gap – the notion that knowledge gained in university does not translate well into the workplace – is unavoidable or if it is a manifestation of the learning approaches used and the cultures operative in the two locations. This paper examines how nursing students' knowledge and skills gained within university clinical laboratories transfer into the reality of the clinical environment. A series of one-on-one interviews were conducted over a two year period with second and third year nursing students (n = 28) participating in a preceptorship clinical placement model at one healthcare organisation. This paper focuses on data from the students' first interview. Data were transcribed and imported into NVivo 8 for thematic analysis. Four key themes emerged, including: 'How I learn' which focuses on students' perceptions of their learning preferences; 'Lack of engagement – it's not real' which concerns a perceived lack of authenticity of clinical laboratories; 'Lack of affordances' relating to the learning opportunities available in the clinical setting; and 'Teacher Impact' which focuses on the influence of individual teachers on student learning. The 'parallel universes' of academia and the workplace create dissonance for students as they juxtapose the authenticity of the clinical laboratories with the reality of professional healthcare practice. Transfer is inextricably linked with the individuals' learning preferences, the affordances the workplace offers to students, and the willingness of staff to provide exciting, engaging learning opportunities. The challenge for health professional education is to provide a model of clinical education that meets not only the needs of university and clinical staff, but most importantly, the needs of students.