Open Access Open Badges Research article

Patients’ approaches to students’ learning at a clinical education ward-an ethnographic study

Katri Manninen1*, Elisabet Welin Henriksson2, Max Scheja3 and Charlotte Silén1

Author Affiliations

1 Department of Learning, Karolinska Institutet, Informatics, Management and Ethics, Stockholm, Sweden

2 Department of Neurobiology, Karolinska Institutet; Care Sciences and Society, Stockholm, Sweden

3 Department of Education, Stockholm University, Stockholm, Sweden

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BMC Medical Education 2014, 14:131  doi:10.1186/1472-6920-14-131

Published: 2 July 2014



It is well known that patients’ involvement in health care students’ learning is essential and gives students opportunities to experience clinical reasoning and practice clinical skills when interacting with patients. Students encounter patients in different contexts throughout their education. However, looking across the research providing evidence about learning related to patient-student encounters reveals a lack of knowledge about the actual learning process that occurs in encounters between patients and students. The aim of this study was to explore patient-student encounters in relation to students’ learning in a patient-centered health-care setting.


An ethnographic approach was used to study the encounters between patients and students. The setting was a clinical education ward for nursing students at a university hospital with eight beds. The study included 10 observations with 11 students and 10 patients. The observer followed one or two students taking care of one patient. During the fieldwork observational and reflective notes were taken. After each observation follow-up interviews were conducted with each patient and student separately. Data were analyzed using an ethnographic approach.


The most striking results showed that patients took different approaches in the encounters with students. When the students managed to create a good atmosphere and a mutual relationship, the patients were active participants in the students’ learning. If the students did not manage to create a good atmosphere, the relationship became one-way and the patients were passive participants, letting the students practice on their bodies but without engaging in a dialogue with the students.


Patient-student encounters, at a clinical education ward with a patient-centred pedagogical framework, can develop into either a learning relationship or an attending relationship. A learning relationship is based on a mutual relationship between patients and students resulting in patients actively participating in students’ learning and they both experience it as a joint action. An attending relationship is based on a one-way relationship between patients and students resulting in patients passively participating by letting students to practice on their bodies but without engaging in a learning dialogue with the students.

Patient-student encounters; Clinical education ward; Patient-centeredness; Learning relationship; Attending relationship