Nurse Education in Practice 16 (2016) 269e273

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Nurse Education in Practice

journal homepage: www.elsevier.com/nepr

In defense of clinical conferences in clinical nursing education

Toni M. Vezeau*
Seattle University College of Nursing, 901 12th Avenue, Seattle, WA 98122, USA

a r t i c l e i n f o a b s t r a c t

Article history: Clinical conferencing has been a consistent feature of clinical education, but the current clinical edu-
Accepted 6 October 2015 cation environment poses many challenges to its continuance. The paper raises concern regarding the
current state of clinical conferencing as part of clinical practice education in nursing. This topic is of great
Keywords: concern, but has there is little direction for clinical educators. The paper reviews the literature on
Clinical conference conferencing and recommends avenues for future research.
Learning environment
© 2015 Elsevier Ltd. All rights reserved.
Clinical students
Nursing
Baccalaureate education
Clinical education

As a nurse educator for over two decades, I am often frustrated
by lost opportunities and by a general lack of an evidence-based
approach in nursing education. In recent years nursing research is
attempting to build a knowledge base through which educators can
determine best practices. The area most in need of investigation
and evaluation is in clinical education. Benner et al. (2010) call for a
transformation of nursing education, both highlighting clinical
education as a key focus. There is scant literature to support or shed
specific practices, and the current clinical education environment is
changing so rapidly, educators are adjusting teaching strategies in
response. In my local environment there is discussion about the
relative value of clinical conferences, particularly from novice fac-
ulty who are frustrated with the logistics, constraints, and novelty
of this clinical education component. I worry that educators may
dismiss the clinical conference as historical artifact, when in fact, it
accomplishes those very goals that we are called upon to improve
in clinical education. This paper attempts to revisit the opportu-
nities that clinical conferencing offers, and discuss the current ob-
stacles and challenges for the nurse educator in facilitating effective
conferences.
Clinical conferences have been a prominent and challenging
aspect of nursing clinical education (Ascano-Martin, 2008; Hsu,
2007; Yehle and Royal, 2010). The clinical conference has been
designed to fulfill multiple aspects of student learning: integration
of theoretical concepts and practice experiences, support in the
affective domain, and professional role development (Hsu, 2007;
* Tel.: þ1 206-296-2215; fax: þ1 206 296 5544.
E-mail address: tvezeau@seattleu.edu.
Ironside, 1999; Letizia, 1998; Wink, 1993, 1995). Current trends in
the delivery of clinical education, however, provides certain ob-
stacles that call into question the usefulness and feasibility of this
and other standards in clinical education (Adegbola, 2011; Tanner,
2006). Not only has the clinical learning environment changed,
but so has the learner; contemporary students may require alter-
nate approaches to reflective knowledge and professional devel-
opment (Pardue and Morgan, 2008; Rassool and Rawaf, 2007;
Tanner, 2006).
Clinical conferences in format are as varied as the faculty
teaching them. Conferences often are held during or following the
clinical experience. For convenience, they are often held at the
clinical site in a private setting. Conferences often have students
review their clinical day, highlighting key learning experiences,
inclusive of positive and concerning experiences. Typically student
members of the group comment on these shared experiences.
However, the purposes of clinical conferences have been reported
consistently in the literature: exploring connections between
theoretical knowledge and lived experiences as learning nurses,
expression and integration of feelings and experiences, support and
recommendations for coping, and planning for future learning
(Yehle and Royal, 2010).
This conceptual article draws on the author's teaching and
mentoring experiences and recent student and faculty evaluations.
The goal is to examine the original purposes of clinical conferences
in light of today's constraints to propose that the benefits of
conferencing outweigh the costs. Recommendations for pedagogy
and research are offered to further a scholarly approach in clinical
nursing education.

http://dx.doi.org/10.1016/j.nepr.2015.10.006
1471-5953/© 2015 Elsevier Ltd. All rights reserved.
270 T.M. Vezeau / Nurse Education in Practice 16 (2016) 269e273
Literature on clinical conferences
Research and discussion about clinical conferences has been
minimal in nursing literature. A large portion of the clinical hours
typically are typically represented by clinical conference time.
Wink in 1995 stated that up to 30% of clinical hours were allocated
to conferencing. Currently, this figure is closer to 10e15% of clinical
hours in our region (Dean Stauffer, personal communication).
Despite this significant use of clinical time, there is little reported
on typical patterns and approaches.
The first specific discussion of clinical postconference by Lister
(1966) and Matheny (1969) laid a foundation identifying the pur-
poses of clinical conferences and are still cited today. In the 1980s
calls for research to better understand this important component of
clinical teaching (McCabe, 1985; Mitchell and Krainovich, 1982;
Woolley and Costello, 1988) have largely gone unheeded. In a re-
view of healthcare literature from 1995 to 2012 in PubMed and
CINAHL, only twelve articles were found, using MeSH heading
“Education, Nursing/methods,” “Nursing Education Research,”
alone and in combination with keywords: conference, clinical,
seminar. Of the 12 articles, 9 addressed nursing education, 5 were
data-based, and 4 were descriptive. The articles provides evaluative
information (Hsu, 2007; Rossignol, 2000); showcase specific tech-
niques, such as audio teleconferencing (Adegbola, 2011), and use of
higher level questions (Wink, 1993), and activities to stimulate
discussion (Letizia, 1998). In sum, the available information,
particularly evidence-based, is sparse, given the number of hours
allotted to conferencing.
Nursing educators throughout the country continue the practice
of postconferencing without empirical evidence supporting the
educational benefits of this activity. Although many authors
have published ideas, techniques, and opinions regarding the
use of postconference time in nursing education, there is a
fundamental lack of data-based research regarding this issue.
(Letizia and Jennrich, 1998, p. 317)
Despite paucity of empirical evidence, conventional wisdom
suggests that conferencing enhances student learning (Hermann,
2006; Letizia and Jennrich, 1998). In response to this gap, Letizia
and Jennrich developed the Post-Conference Learning Environment
Survey, a self-report instrument aimed at measuring aspects of the
post-conference learning environment as perceived by under-
graduate nursing students and faculty. The tool had multi-site
validation, but sadly, this structured and interesting approach to
developing our knowledge and expertise on effective conferencing
has not been replicated.
The scant literature on clinical conferencing does come to some
conclusions. An effective clinical conference is essential to clinical
learning, and may be in part what distinguishes an effective
educator (Hermann, 2006; Wink, 1993, 1995). Clinical conferences
should be intentional, with attention to timing, environmental, and
the student as a whole person, addressing not only cognitive as-
pects of learning, but affective aspects as well. The purposes of
clinical conferences are better accomplished with students as
engaged actors, rather than fatigued, passive recipients (Adegbola,
2011; Wink, 1995; Yehle and Royal, 2010).
Purposes of clinical conferences
Clinical conference is one of the primary vehicles for linking
theory taught in the classroom to the experiences students have in
clinical settings. Faculty help the student report on the day's ex-
periences and actively help in the student's identify whether the
practices they participated in were congruent or dissonant with the
didactic content (Corlett, 2000). For example, in my own area of
childbearing families, classroom content presents the most current
evidence-based care modalities, but what the student experiences
is often at odds: poor patient advocacy and common use of un-
necessary or dangerous interventions. Students report distress
when there is a seeming mismatch between the broad and seem-
ingly straightforward content taught in the classroom and the
messy, very human, clinical experiences (Corlett, 2000).
Conferences can help students in a public venue apply theo-
retical concepts to the particularity of a deeply nuanced patient
situation, flavored by cultural, economic, political, and historical
variables e and most especially flavored by constant change. Skilled
faculty are needed to interpret the setting and to help the student
discover the context that drives the dissonance. Clinical settings
that are changing to more evidence-based approaches have to
resolve conflicts from many constituencies and contextual vari-
ables, and, essentially, takes time to put into place. While we hope
as faculty to place students in the most up-to-date settings, ne-
cessity dictates that what students actually experience are clinical
sites in the constant process of change. Faculty can assist the stu-
dents in the integration of their knowledge sets in the service of
understanding a particular patient situation; students are helped to
bring multiple lens - biological, medical, sociocultural, ethical,
historical, political e to clarify how the patient context evolved, and
how it will be affected in healthcare.
In many ways, clinical conferences represent a pure form of
problem-based learning, wherein the “problems,” patient situa-
tions, have been engaged in the real world and student has had to
grapple with real-time discernment and decision-making. This
discernment is aligned with Tanner's (2006) call for nurse educa-
tors to not waste precious student clinical time and to develop
specific strategies that actively encourage enhanced critical
reasoning. Adept questioning in conferences can assist this devel-
opment. Wink's (1995) and Hermann's (2006) work offer ap-
proaches to identify high level questioning by faculty in
conferencing. High level cognitive questioning can develop critical
reasoning in an open venue with inherent feedback opportunities.
Conferences offer breadth as well as depth. Students who are
often enmeshed in a single patient care situation can benefit from
hearing about their peers' experiences, and encouraged to see
similarities and differences, hence gaining increased knowledge
from peer reporting and analysis. This provides faculty an oppor-
tunity to help students use particular situations to construct
models that parallel their didactic models; concept mapping is one
common strategy used to achieve this outcome (Pilcher, 2011).
Beyond cognitive development, clinical conference can assist
the student in the affective domain. Clinical experiences can be
challenging, frightening, and overwhelming to students. Students
who witness birth have strong personal reactions as do those stu-
dents who witness death for the first time in their professional role.
Clinical conference can provide a safe environment for the student
to disclose personal feelings and to gain peer support in what are
often difficult learning situations. Students can discuss their own
triumphs and fears in learning the reality aspects of the profession.
Faculty can help students contextualize these discussions in
broader picture of professional development. Innovation can be
sparked by encouraging students to move beyond acceptance of
what they experienced to imagining better use of evidence-based
approaches in creative ways.
Finally, in clinical conferences students can form more con-
nected relationships with their faculty, who can provide leadership
and role-modeling for professional nursing. Clinical conference is
often where students spend the majority of their time with their
clinical faculty in deep and public discernment and highlight this
connection as pivotal to clinical learning (Gillespie, 2005). Gillespie
 T.M. Vezeau / Nurse Education in Practice 16 (2016) 269e273
and Allison-Jones and Hirt (2004) emphasize the transformative
possibilities in studentefaculty relationships. Students can be
publicly affirmed and develop an understanding of their potential
professional abilities. The setting of clear ground rules for confer-
ences, such as required attendance, critiquing ideas rather than the
person, the acknowledgment and acceptance of feedback, the
expectation that all persons participate help students understand
professional norms and develop local leadership.
This author is quite concerned should clinical conferencing be
entirely deleted or relegated to purely virtual, that is, electronic
discussion, post facto. Students and faculty can best process diffi-
cult learning situations in a timely and contextualized manner.
Discussions that occur many hours or days after the clinical expe-
rience have lost their immediacy and importance in lieu of more
pressing immediate school concerns. Intervening conversations are
likely to occur without faculty input and guidance, which likely
would alter what would be shared in an online chat/discussion
group, for example. Nonverbal communication of the group is lost
when the discussion moves to an electronic venue. The opportunity
for a faculty to move fluidly from discussion to didactic clarification
and back to the group would be entirely lost. Most important to this
author, is the missing and timely support that clinical conferencing
affords the student, which role-models future professional behav-
iors to students.
The clinical conference can help the student to integrate and
contextualize their clinical experiences and to help them become
professional nurses. This is not easily accomplished, however, in
today's clinical education environment.
Constraints and challenges
The typical pattern of clinical conference often does not work in
today's clinical environment. Historically, conferences have been
held after an eight-hour day shift experience at the clinical site.
Students often report on their experiences and housekeeping items
are reviewed. Students and faculty both are often physically and
mentally fatigued (Adegbola, 2011; Yehle and Royal, 2010). It is
difficult to find private meeting spaces on site, and literature sug-
gests that completing clinical work to even attend the conference is
a constant challenge.
Clinical experiences may no longer be the eight-hour shift, but is
often on evenings or nights, and may be any number of hours,
ranging from 4 to 12 (Mariani et al., 2012). Timing of clinical con-
ferences, may now be preclinical, to assess student preparation and
readiness for patient care or held after the clinical experiences are
over. Conferencing may also occur during breaks, often interrupting
the clinical day and potentially limiting the student in their role as
an essential part of the care team. If one adds the increased acuity
and pace of clinical settings with longer and non-daytime hours, it
is easy to understand how the original intents of clinical conference
are challenging to meet. Critical reasoning and deep reflection is
unlikely occur for exhausted clinical group members.
The composition of the group itself in many clinical teaching
environments may not be stable from week to week. The surge in
nursing program enrollment (Terry and Whitman, 2011) and
increased push back from overwhelmed clinical agencies, clinical
groups may be large (over 10), but may only be allowed to have 7e8
students on site at the same time. Students are “spun off” to
observational experiences in or out of the agency; these hidden
students may have hours that differ from the sub-group meeting in
conferences. Essentially, the group itself changes from week to
week, making group process an ever-moving target and the logis-
tics of a clinical conference is very challenging. This has resulted in
some unique problem-solving with use of teleconferencing
(Adegbola, 2011) and online discussion groups (Hermann, 2006).
271
The few studies on the quality of conferencing have questioned
the effectiveness of this component of clinical teaching. Multiple
studies have noted that the level of discussion and rigorous ques-
tioning is typically low level (Hsu, 2007; Rossignol, 2000; Wink,
1995). Description and comprehension level discussion are usu-
ally observed in the typical clinical conference, but higher levels of
reasoning, application and synthesis, may be largely absent.
This lack of strong pedagogy observed in conferences could be
due to the increased use of adjuncts or part-time faculty assigned to
clinical teaching. Use of part-time faculty has increased by 53% from
2005 to 2010 and accounts for half of all nursing faculty (Mangan,
2011; Terry and Whitman, 2011). Kelly (2007) echoes this concern
and states that nursing education programs have diminishing
numbers of experienced faculty and that the “casual” or intermit-
tent nurse educator is poorly prepared. Competency and effec-
tiveness of clinical teaching has been shown to be very different
between full-time and part-time faculty (Allison-Jones and Hirt,
2004).
Clinical conference poses unique teaching challenges for nov-
ices. Conference often responds to the needs of the moment and
often requires improvisation informed by clear purpose. However,
unstructured and unfocused discussion can often be seen as un-
important or boring by students and faculty (Letizia, 1998). Hsu
(2007) recommends that the faculty skills in delivering effective
conferences can be developed through faculty development activ-
ities. Faculty development can develop understanding of the pur-
poses of clinical conferences and group facilitation strategies.
Equally important, observation and feedback to clinical faculty
need to be a core component to faculty development, especially for
the novice clinical faculty.
Finally, the current nursing student may have unique learning
needs and preferences. Literature in the mid-2000s points out that
nursing students themselves are changing variables in clinical ed-
ucation. Rassool and Rawaf (2007) assessed learning styles of un-
dergraduate nursing students and found a strong mismatch
between the teaching styles of nursing faculty and the preferences
of the students. Despite faculty encouragement for participation,
active learning, and experimentation by students, this study indi-
cated that students preferred a more observational style and
seemed more guarded and quiet. Students stated they least
preferred an activist style.
In contrast to these findings, Skiba and Barton (2006) suggest
that students do prefer a very active, multi-modal approach to
learning. They recommend altering our clinical education not only
to address multiple learning styles, but also to address genera-
tional changes e specifically, the unique characteristics of the
millennial or “Net” generation, those students born between 1982
and 1991. This generation seems to be at odds with Rassool's and
Rawaf's assessment in that the millenials may prefer more expe-
riential, less abstract learning, and have a “bias toward action”
(Skiba and Barton, 2006, para. 11). According to Skiba and Barton,
millenials like to express their views and use experiences to
expand their learning, which should add to the potential of
conferencing. Use of technology is seen as a learning style, and is
actively used to fill in the gaps of their knowledge and to validate
the faculty's. Collaborative learning is welcomed by this genera-
tion. Slow, delayed learning is intolerable. Millennials are strong
team players these preferences may indicate is that the typical
round-robin reporting that is often done in conference runs
counter to this learning style.
Faculty may need help to develop a repertoire of interactive
engaging activities that are consistent with this generation's needs
so that conferencing fulfills its many purposes. Faculty who
continue in teacher-centered or passive learning approaches may
misinterpret students' non-participation as unwillingness to share
272 T.M. Vezeau / Nurse Education in Practice 16 (2016) 269e273
or that the conference as itself is a waste of time. Again, novice or
intermittent educators may need development to address the
unique needs of today's learners (Allison-Jones and Hirt, 2004).
Difficulty in researching clinical conferences
The question then becomes so what are best practices that we
can share with interested or novice colleagues that could support
effective conferences? The scant literature on clinical conferences,
like this paper, is descriptive in nature, most often written by highly
experienced faculty. While anecdotal, experiential recommenda-
tions can be very worthwhile, nurse educators need to move to-
ward building evidence for best practices.
There are considerable difficulties in trying to research best
practices for clinical conferences. Some studies have been obser-
vational, investigating the rigor of questions in conference, sharing
of leadership and power with students, and some have gathered
descriptive data on using a particular type of conference delivery,
typically synchronous or non-synchronous technology approaches.
The goal has not been to seek best practices, per se, so educators
wishing to research in this area have little foundation. Wink (1993,
1995) proposed characteristics of effective clinical conferences
(group event, contributes to meeting course objectives, and allows
for discussion of feelings and attitudes), but these have not been
tested as yet. Most studies cited in this paper do not take into ac-
count the skills and background of the faculty or the level of
student.
Best practices on clinical conferences should be highly sensitive
to the level of student learning. Beginning clinical students may be
novice to frank group discussion with public reflection and critical
reasoning, and so a good deal of time is spent in forming and
norming activities. Students near the end of a nursing program may
benefit from a more collaborative approach in which they actively
lead and construct the conference format and content (Rossignol,
2000).
Tanner (2006) calls for aligning our clinical activities to address
specific learning outcomes. The rub with clinical conference is that,
in part, facilitation of clinical conference is improvisational. Faculty
glean from the day highlights that might bring about the integra-
tion of theory and practice; these highlights cannot be anticipated
or prepared prior. There is often a bounty of unique client situations
that students can delve into to explore connections to previous
learning, to understand what occurred, and to imagine alternate
possibilities. For example, one day a student may experience a
highly interventionist birth in the same day as witness a physio-
logic low-technological birth. Another student may experience
tensions related informed consent and advocacy with conflict
among the health care team. The faculty, particularly the novice
faculty, may be challenged in identifying useful discussion areas
and in having the skills to facilitate students bringing depth and
breadth to the dialogue.
The physical environment and timing and have not been
addressed through research. The Post-Conference Learning Envi-
ronment Survey (Letizia and Jennrich, 1998) surveyed student and
faculty perceptions of actual participation and beliefs on the
importance of different aspects the conference demonstrates a
rigorous approach to identify beliefs and attitudes, but it is un-
known to what degree conferencing actually achieved its multiple
purposes.
Next steps
As with many areas of nursing education, there is a need for
educators to develop an evidence-based foundation to our
methods. Our next steps may lie in replication of Rossignol's survey
in today's environment or testing out the earlier statements on
conferencing by experienced faculty. Research can investigate if the
needs of beginning clinical students and close-to-exit students
have differing needs in group conferences. We can test if face-to-
face group meetings are best to capitalize on the immediacy of
the student experiences when conferences immediately follow, or
if there is enhanced reflection and reframing when conducted
outside of the agency when both student and faculty are rested. We
can test if there is improved integration of theory and practice if
conferences are face to face or held with all persons present in real
time and space.
Given the considerable resources used and the potential op-
portunities in clinical conferences, these are important questions
for nurse educators to answer. Of most concern to this writer that
we do not discard a key component of clinical education, because it
is hard to do and we currently lack much empirical evidence as to
its overall effectiveness and best practices. A research program on
clinical conferences would need to be multi-site and multi-faceted
and could yield valuable direction.
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