Objectives

• To define clinical learning

• Identify the strengths, problems, and challenges in
clinical learning
• Define learning
• List the domains of learning
• Relate components of case presentation with domains
of learning
 Clinical learning
• Clinical teaching
—that is, teaching and learning focused on, and usually
directly involving, patients and their problems lies at
the heart of medical education.(Spencer. J,2003)
 Strengths of clinical learning
• Focused on real problems in the context of
professional practice.
• Learners get motivated by its relevance and through
active participation.
• Teachers model professional thinking, behaviour and
attitudes.
Problems with clinical teaching and learning

• Lack of clear objectives and expectations

• Focus on factual recall rather than on development of
problem solving skills and attitudes
• Teaching pitched at the wrong level (usually too high)
• Passive observation rather than active participation of
learners
• Inadequate supervision and provision of feedback
• Little opportunity for reflection and discussion
• “Teaching by humiliation”
• Informed consent not sought from patients
• Lack of respect for privacy and dignity of patients
• Lack of congruence or continuity with the rest of the
curriculum
 Challenges in clinical learning
• Time pressures
• Competing demands—clinical; administrative;
research
• Often opportunistic—makes planning more difficult
• Increasing numbers of students
• Fewer patients
• Often under-resourced
• Clinical environment not “teaching friendly”.
• Rewards and recognition for teachers poor.
Although subject expertise is important, it is not
sufficient. Effective clinical teaching involves use of
several distinct and overlapping forms of knowledge.
Understanding the learning process will help clinical
teachers to be more effective. (Spencer. J,2003)
 Learning
• It is a continuous process
• Based upon a goal
• Intended to bring desirable changes in learners
• On a relatively permanent basis.
• Is measured for the acquisition of knowledge,
proficiency of skills and development of attitude.
Learning can generally be categorized into three
domains: (Hoque, M. E, 2016)
 Cognitive,
 Affective, and
 Psychomotor
 ●
Thinking process
Cognitive domain ●
Head

Physical skills
●

Psychomotor domain ●Hand

●
Emotions and Values
Affective domain ●
Heart
 Components of a the case presentation in
relation with the Domains of learning

• Preliminary data
• Chief complaint
• History of present medical illness
• Past medical and treatment history
• Patient’s family history
• Patient’s personal information
• Physical examination of the patient
• Laboratory and other investigations
 Interpretation of case
• Classify the disease according to Hahnemann’s
classification of diseases
• Identification of appropriate school of philosophy
• Dake’s hypothesis on the scope of homoeopathy.
 Presentation of the information to make a
decision

• Disease diagnosis
• Phase of disease
• Nature of disease
• Pace and prognosis of disease
• Level of disease in the Health-Disease Paradigm
• Susceptibility of the person to disease
• Patient as a person
• Vitality of the patient in disease
• Identification of the problem
• Problem solving Strategies
• Projection of expected outcomes
• Review of the case
 Bibiliography
• Hoque, M. E. (2016). Three Domains of Learning:
Cognitive, Affective and Psychomotor. The Journal of
EFL Education and Research, 2(2), 45-52.
• Spencer, J. (2003). Learning and teaching in the
clinical environment. BmJ, 326(7389), 591-594. doi: 
https://doi.org/10.1136/bmj.326.7389.591