Figure 1.

Model of student experience in learning. This model was developed from the results of our study to highlight factors impacting the learning pathway of students. Since learning is dynamic, students can move between learning path A and learning path B depending on their experiences and progression. From our results there are three key influences on education: the student themselves, the curriculum, and the clinical environment the student is engaging with.

Learning Path A Describes a student that has a thorough grasp of clinical reasoning and understand the rationale behind investigations, treatment, and management. This student can practice aspects of patient-centred care in their placements and consider how to avoid low-value care. The student can describe the concept of overdiagnosis and identify it in the clinical environment; this may not mean the student knows the term overdiagnosis. This student can identify the impacts of emotion and when to ask for help. They have been taught principles of high value care and have witnessed these role-modelled by clinicians. Poor experiences and lack of consistent teaching can push students down to learning path B.

Learning Path B Describes a student that may have limited knowledge or experience, who is not confident in themselves or their clinical reasoning. These students are unaware of the concept of overdiagnosis and may not be able to identify low-value care practices. As a result, students in learning path B cannot intentionally avoid overdiagnosis and low-value care. Limited time and disjointed teaching on placements contribute to deficits in students’ learning. Formal teaching and role-modelling of high-value care and opportunities for students to practice clinical skills and seek feedback can allow students to progress and move up to learning path A