Mind the gap(s): The case for junior doctor involvement in change and innovation

Abstract

We proposed that greater emphasis on experiencebased learning (ExBL), as a broad approach to clinical education, would allow medical students to assume clinical responsibility incrementally over time, thus approximating the role of senior medical student and newly qualified doctor.1 The recently published Association for Medical Education in Europe guide on ExBL describes it as a ‘21st century pedagogy of practicebased learning derived from the best current theory and evidence.’4 Experience-based learning espouses supported participation in clinical practice to develop student capability and facilitate professional identity formation, with the coparticipation of clinicians and patients. The provision of organisational and clinicianled support is a cornerstone of ExBL, enabling students to participate in practice, observing, rehearsing and contributing to patient care, based on their individual capabilities. This model of workplace learning, with cognitive, affective and practical support, can be applied throughout undergraduate clinical experience, including early patient contact, thus mitigating the apprehension of junior medical students transitioning to senior clinical clerkships, referred to by Davidson and Davidson.2 The wealth of evidence underpinning ExBL shows that facilitating students to experience responsibility for real patients in a supportive clinical context leads to affective capabilities. These include positive feelings (eg happiness, inspiration, greater motivation and confidence, empathy and compassion) as well as recognising and responding appropriately to ambiguous or negative feelings such as stress or anxiety. Through ExBL, medical students become capable doctors and the abrupt nature of the assumption of responsibility seen in our study is reduced.