title: Medical students' feedback regarding their clinical learning environment in primary healthcare: a qualitative study.
abstract: BACKGROUND
  An increasing part of medical students' learning takes place in primary healthcare (PHC) but little is known about how the students perceive PHC as a clinical learning environment. This study aimed to explore medical students' perceptions of the clinical learning environment in PHC and how these vary with stage of education.
  
  
  METHODS
  Free-text course evaluation comments from students in nine different semesters during spring 2014 were analysed using qualitative content analysis. The students had placements in PHC from the first semester, progressing through the whole 5.5 year medical programme, and this was their main clinical training environment during the final 11thsemester.
  
  
  RESULTS
  In total, 800 students (56%) agreed to participate in the study and 437 of these (54%) provided comments. Two overall themes were identified: the supervisor was the central factor that determined the meaningfulness of the placement at all stages of the education, and basic prerequisites for perceived clinical learning were to have an active role in an authentic clinical context and to be trusted to work independently with patients. The three main categories found under these themes were: i) the perceived relationship with the supervisor; ii) the perceived journey to become a doctor; and iii) the perceived structure and culture.
  
  
  CONCLUSIONS
  The supervisor's role was perceived as central at all stages of the education but the focus changed for other aspects, related to the students' professional development. The need for trust and independence in patient work increased towards the end of the education.
authors.affiliation: Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden. Helena.Salminen@ki.se.
authors.forename: Helena
authors.identifier: http://orcid.org/0000-0003-2073-3861
authors.initials: H
authors.lastname: Salminen
authors.affiliation: Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Öhman
authors.affiliation: Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Solna, Sweden.
authors.forename: Terese
authors.initials: T
authors.lastname: Stenfors-Hayes
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards; D004500:Education, Graduate / Q000592:standards*; D005246:Feedback; D005260:Female; D017144:Focus Groups; D006801:Humans; D007400:Interprofessional Relations; D007858:Learning; D008297:Male; D011320:Primary Health Care / Q000592:standards; D015397:Program Evaluation; D036301:Qualitative Research; D012931:Social Environment; D013337:Students, Medical / Q000523:psychology*
keywords: Clinical learning environment; Primary healthcare; Qualitative study; Students’ perceptions