Teaching and learning in out-patient clinics.

BACKGROUND: Out-patient clinics offer trainees one of the most varied clinical experiences within the hospital setting, but they are often chaotic and over-stretched, with limited time for teaching. An awareness of how to improve this learning environment by both trainers and trainees may enhance learning opportunities.

CONTEXT: Clinical supervisors need to balance educational and service commitments, while maintaining a high quality of patient care. Supervision features observation and the sharing of clinical and continual feedback, which can improve clinical performance. Trainers must closely monitor the abilities of the trainee and gradually increase their responsibility and clinical load.

INNOVATION: The application of learning theory to the workplace can improve learning opportunities. Trainers should have some control over the environment, both the physical attributes (room availability, staffing levels and allocated consultation time) and the harder to measure aspects, such as the ethos of the department and attitudes to teaching. The creation of a community of practice within out-patient clinics can strengthen both the collective knowledge of the team and its role in treating patients. The active involvement of trainees within this social environment (for example, by performing independent consultations) validates their role in the care of patients and enhances their learning.

IMPLICATIONS: To maximise the learning opportunities within out-patient clinics there needs to be a shift in culture to promote learning in a safe and non-threatening environment. The establishment of a community of practice may validate the role of trainees in the management of patients and facilitate social learning by all members of the clinical team.