The BPCLE Framework sets out six elements that are the essential underpinnings for a quality clinical learning environment. Each element is necessary but not sufficient and several of the elements overlap or are interrelated.
This section provides an overview of the six framework elements. More detailed information can be found in the BPCLE Framework document.
Element 1: An organisational culture that values learning
In the context of a health service, an organisational culture that values learning has the following characteristics:
- Education is valued
- Educators are valued
- Students/learners are valued
- There is a career structure for educators
- Education is included in all aspects of planning
- The use of facilities and resources is optimised for all educational purposes
The value an organisation places on learning and education will be reflected in its internal policies and procedures and in the way the organisation communicates internally and to the wider community about educational activities.
Element 2: Best practice clinical practice
Best practice clinical practice is the goal of every health service, irrespective of whether the health service is directly involved in clinical education of health professionals, and is a reflection of three main factors:
- An organisational commitment to quality of care and continuous quality improvement
- The skill, knowledge and competency of clinical staff
- The adoption of best evidence into practice
For a health service involved in clinical education, best practice clinical practice also has an educational significance. Not only is the health service aiming to deliver the best possible patient/client care, it needs to model the behaviours, processes and practices to learners so they might understand how best practice is achieved. In fact, the term ‘best practice’ is something of a misnomer, since it implies finality. One of the most important messages that must be communicated to learners is that achieving best practice is an ongoing process of identifying, implementing and testing the best available evidence.
Element 3: A positive learning environment
Although it is not difficult to understand at an intuitive level, the positive learning environment concept is complex to define, in part because it is a subjective concept. That is, the elements that might make a learning environment positive from a clinical educator’s perspective might not be the same elements that make it positive from a learner’s perspective.
The following list summarises input from learners and educators on what makes a positive learning environment for all stakeholders. Responsibility for some of these issues may be shared between the health service and other stakeholders.
- A welcoming environment
- A safe environment
- Appropriate learning opportunities
- Clarity of objectives
- High quality clinical education staff
- Well-prepared learners
- Appropriate ratios of learners to educators
- Appropriate ratios of learners to patients/clients
- Continuity of learning experiences
- Structured learning programmes and assessment
Element 4: An effective health service - education provider relationship
Clinical education and training is a collaborative arrangement between education providers and health services that draws on the complementary skills, experience, resources and expertise of the two sectors. Although each health service-education provider relationship will be unique, effective relationships – that is, relationships that equitably serve the needs and interests of the partners – have several features in common.
- Mutual respect and understanding between the partners.
- Practical mechanisms to assist each partner to optimise their contribution to the training of health professionals.
- Open communication at all levels.
- Existence of relationship agreements, which codify expectations and responsibilities of the partners in the delivery of clinical education.
Element 5: Effective communication processes
Effective communication is a key component of most activities within any organisation and, indeed, underpins each element of this framework. From a clinical education perspective, effective communication involves the whole health service organisation, not just those domains or individuals directly involved in educational activities.
In the context of clinical education, communication serves three main objectives:
- Improve teaching and learning
- Inform actions, behaviours and decision-making
- Provide feedback
The focus of effective communication processes is on maintaining an active dialogue, rather than addressing failures of communication. Processes need to be carefully constructed to ensure inherently unequal power relationships – particularly those between learners and educators – do not compromise communication.
Element 6: Appropriate resources and facilities
The resources and facilities that are required to enhance or facilitate clinical learning will vary between health professions, health services and levels of learners. Therefore, the general principle is that learners – and clinical educators – should have access to the facilities and materials needed to optimise the clinical education experience.
Resources and facilities fall into six broad categories, not all of which are relevant to all health professional disciplines or all clinical education settings:
- Capital infrastructure educational facilities
- Personnel resources
- Teaching and learning resources
- IT and communication resources
- Accommodation, work and travel support
Capital infrastructure is the most problematic category to address, since space is a relatively fixed resource and once buildings are built, it is difficult to incorporate new facilities. Therefore, it is important that educational requirements are taken into account in the planning phase for new buildings and that educational facilities are not always the first to be eliminated when budget constraints bring about a review and modification of the plans.
Importantly, access to facilities and resources should be equitable (i.e. between disciplines and learner levels) and the calculation of resources available to learners should reflect reality.