title: Factors adversely affecting student learning in the clinical learning environment: a student perspective.
abstract: OBJECTIVE
  To investigate, from the students' perspective, factors that may adversely affect student learning in the clinical environment.
  
  
  METHODS
  Medical students evaluated the perceived effectiveness of the clinical learning environment at the end of various clerkship rotations, such as surgery, gynaecology, paediatrics, ophthalmology. After each clerkship students answered a standard questionnaire containing closed-ended questions about supervision, patient contacts, organisation, learning effectiveness and the learning climate, as well as one open-ended question about the clerkship-site's perceived weaknesses. Because supervision is crucial to the quality of clerkships but often lacking, we compared clerkship-sites with relatively low and high ratings on supervision and analysed students' comments on the weaknesses of their clerkship-sites.
  
  
  RESULTS
  Factors that students perceived were inhibiting learning were too few opportunities for students to examine patients independently and lack of time for supervision. In addition, lack of observation, insufficient feedback, negative attitudes of the staff towards students and teaching, the presence of too many students at one time, too few educational sessions, and poor organisation were mentioned as perceived weaknesses in open-ended comments.
  
  
  CONCLUSIONS
  Based on these students' perceptions, effective clerkships should present students with patients with a variety of health problems who can be examined both independently and with supervision. Continuity of supervision is important and can be addressed by assigning a teacher or mentor to each student.
authors.affiliation: Maastricht University, Dept. of Educational Development & Research, Maastricht, Netherlands. d.dolmans@educ.unimaas.nl
authors.forename: Diana Hjm
authors.initials: DH
authors.lastname: Dolmans
authors.forename: Ineke Hap
authors.initials: IH
authors.lastname: Wolfhagen
authors.forename: Erik
authors.initials: E
authors.lastname: Heineman
authors.forename: Albert Jja
authors.initials: AJ
authors.lastname: Scherpbier
mesh_terms: D002982:Clinical Clerkship / Q000592:standards; D007858:Learning; D008611:Mentors; D013337:Students, Medical; D011795:Surveys and Questionnaires; D013663:Teaching