Table 4 Underlying shared understanding and structural challenges and conflicts

School guidelines

- Lack of clarity about who’s responsibility it is to carry out and know school regulations

Learning opportunities

- When necessary, priority of patient care over learning

- Students learn by a process of graded autonomy

- Students should take increasing responsibility in their learning process

- The subordinate and temporary position of students hinders them in their freedom to develop in their own way

Focus supervisor

- Relationship of mutual trust, acknowledgement and expressed expectations between student and supervisor is essential

- Boosting students’ confidence creates ‘space’ to learn.

Supervisors face a few challenges:

- To balance between being supportive yet giving responsibility

- to balance between giving constructive (corrective) feedback and promote safety

- to practice supervision within time and training constraints

- to balance between ‘challenging students to think and ‘questioning/testing students’

Desirable outcomes of clinical learning

- The subjective experience of clinical learning is important, to have ‘a good feeling’ about a shift

- It is challenging to develop a critical attitude while in training

- Following individual pace can be at odds with assessment standards

Peers

- Peers are sources of help and support and mutual learning, yet can be competitors