The influence of structural and institutional change on teaching and culture in clinical settings: an exploratory...

Learning in clinical settings is a function of activity, context and culture. Glasgow University's Medical School has undergone significant curricular change in recent years. This has coincided with change to National Health Service consultants' contracts, the introduction of the European Working Time Directive and the Modernising Medical Careers training initiative. We wished to explore teachers' and students' perspectives on the effects of change on our clinical teachers' capacity for teaching and on medical culture.

A qualitative approach using individual interviews with educational supervisors and focus groups with senior clinical students was used. Data were analysed using a "framework" technique.

Curricular change has led to shorter clinical attachments in the senior clinical rotation, which combined with more centralised teaching have had adverse effects on both formal and informal teaching during attachments. Consultants' NHS contract changes the implementation of the European Working Time Directive and changes to postgraduate training have adversely affected consultants' teaching capacity, which has had a detrimental effect on their relationships with students. Medical culture has also changed as a result of these and other societal influences.

The apprenticeship model was still felt to be relevant in clinical settings. This has to be balanced against the need for systematic teaching. Structural and institutional change affects learning. Faculty needs to be aware of the socio-historical context of their institutions.