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Med Educ. 2002 Aug;36(8):735-41.

Students' perceptions of relationships between some educational variables in the out-patient setting.

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Department of Educational Development and Research, Maastricht University, Maastricht, The Netherlands Department of Obstetrics Gynaecology, Maastricht University, Maastricht, The Netherlands.



Medical education uses the cognitive apprenticeship model of student learning extensively. Students rotate among different hospitals and out- patient clinics where they are exposed to a range of professionally relevant contexts. Here they learn to think and act in different domains under the supervision of experts. Previous research has shown that these learning situations involve little teaching. Students see a narrow range of patient problems and feedback is limited. The aim of this study is to investigate relationships among some educational variables in the out-patient clinic.


This paper provides a theoretical model that specifies the factors influencing the effectiveness of student rotations at out-patient clinics. The model makes distinctions between input variables, such as organizational quality, number of students contemporaneously involved and available space, and process variables, such as patient mix and supervision, and the output variable of the effectiveness of rotations in out-patient clinics.


The model was tested against empirical data from evaluative surveys and showed a reasonable fit. The model offers suggestions for improving the learning environment of clinical rotations.


The strength of this study lies in its process evaluation perspective which investigates interactions between intervening variables rather than the influence of particular variables in isolation from other variables.

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