Examination of students’ perspectives regarding the effectiveness of clinical training: A research endeavor congruent with social responsibility

Abstract

BACKGROUND:

Clinical education is a fundamental component of medical training. This study examines the experiences of clinical students across various health professions to provide valuable insights for educational planners involved in designing effective and socially relevant clinical training curricula.

MATERIALS AND METHODS:

This descriptive-analytical study employed a stratified random sampling method to select clinical students from the disciplines of nursing, midwifery, operating room technology, and pre-hospital emergency medicine at educational institutions in Shoushtar. Data were gathered using a standardized questionnaire designed to evaluate factors affecting the quality of clinical education. The data were analyzed using Pearson correlation, Chi-square tests, independent t-tests, and analysis of variance (ANOVA).

RESULTS:

A total of 190 students participated in the study, including 60 males and 130 females, with ages ranging from 18 to 39 years. Participants were enrolled in nursing (n = 105), operating room technology (n = 30), midwifery (n = 40), and emergency medicine (n = 15) programs. Male students reported significantly lower scores in areas related to student–teacher interactions, the learning environment, and evaluation criteria. Notably, overall clinical education scores demonstrated a decreasing trend with increasing age. Emergency medicine students achieved the highest scores, while those in nursing and operating room programs recorded the lowest.

CONCLUSIONS:

The mean scores related to educational objectives, instructor quality, student–teacher interactions, and the learning environment were lower among male students, older participants, and those enrolled in nursing and operating room programs. These findings highlight the need for targeted educational interventions to improve clinical training objectives, enhance the involvement of qualified instructors, and foster more supportive learning environments.

Introduction

Clinical education plays a pivotal role in the development of healthcare professionals, comprising more than half of their formal training and forming the foundation of their clinical competence. Through direct patient care experiences, students bridge the gap between theoretical knowledge and practical application, cultivating the cognitive and psychomotor skills essential for delivering high-quality care.[1] Medical education possesses distinctive characteristics compared to other fields of study, owing to the necessity of addressing a broad spectrum of knowledge areas related to human health and disease.[2] Clinical education represents a fundamental and essential component of medical training; without it, the development of competent and effective healthcare professionals would be extremely challenging, if not impossible.[3] The primary goal of clinical education is to equip students with the knowledge and skills necessary to deliver high-quality patient care.[4] It serves as the core of professional medical training, preparing students to perform clinical tasks across diverse healthcare settings.[5] The effectiveness of clinical education is largely shaped by the educational environment in which learning occurs. Key components influencing this environment include the clinical instructor, the clinical setting itself, individual student characteristics, assessment methods, and the implementation of contextually appropriate educational models.[6] In this setting, effective communication skills among clinical instructors are particularly critical—often proving more impactful than technical proficiency or theoretical knowledge—in facilitating student learning. Instructors who can engage students effectively enhance the opportunities for meaningful clinical experiences.[7] Despite having a strong theoretical foundation, many students struggle to translate their knowledge into clinical practice. This disconnect often leads to uncertainty and a lack of confidence. Identifying and addressing deficiencies in clinical education is essential for improving the overall quality of medical training and, consequently, healthcare delivery. Doing so allows educational leaders to obtain an accurate understanding of current clinical training conditions and to formulate future strategies for improvement, including the assumption of greater responsibility for patient care.[8] Creating supportive clinical learning environments—equipped with rest areas, conference spaces, and mechanisms for collaboration among instructors, staff, and surgeons—can significantly enhance the quality of clinical education.[9] Research consistently points to a persistent gap between theoretical knowledge and clinical competence. Accordingly, universities must prioritize the development of graduates who are not only knowledgeable but also capable of delivering evidence-based, high-quality patient care.[10]

It is often challenging for students to learn and develop practical skills, particularly those related to psychomotor, cognitive, and affective domains. These skills are acquired through a complex process in which students must integrate functional performance with knowledge and critical thinking.[11] It can be argued that the low quality of healthcare services may result from ineffective medical education planning by universities and a lack of understanding among healthcare providers regarding community needs in clinical care. Enhancing the quality of clinical education requires addressing these challenges. A deep understanding of the experiences of clinical students as a segment of society can, on the one hand, help policymakers and educational stakeholders design more effective and socially responsive programs within clinical training. On the other hand, it can guide researchers in conducting further studies to more accurately investigate existing issues in this field. It is also necessary to mention that in previous studies on this subject, the components of the questionnaire (educational goals and programs, instructor, interaction with students, educational environment, evaluation) were assessed in only one or two clinical disciplines. However, considering the variety of clinical disciplines at Shushtar University of Medical Sciences, the present study has taken all clinical disciplines of the university into account. Additionally, in this research, the relationship between variables such as age, gender, and field of study with the overall score of clinical education has been evaluated. It should be noted that a regression model was used in this study to determine the relationship between the scores of the research components. Given these points, this study can play an important role in improving clinical education and enhancing the social accountability of Shushtar University of Medical Sciences.

Material and Methods

Study design and setting

The present study is a descriptive-analytical cross-sectional study conducted at Shoushtar Faculty of Medical Sciences.

Study participants and sampling

The study population included of clinical students (nursing, midwifery, operating room technology, and pre-hospital emergency medicine), from training centers in Shoushter County. According to the population size of 310 people and the Cochran formula, and (α = 0.05), (P = 0.5) and (d = 0.05) and 10% attrition, the sample size of 190 people was calculated. The sampling method was randomly classified according to the field of study of clinical students. The inclusion criteria were a willingness to participate and completion of at least one clinical internship. The exclusion criteria were unwillingness to participate or to continue in the study [Figure 1].

Figure 1.

The Research Process Diagram

Data collection tool and technique

Data were collected using a two-part questionnaire. The first part included demographic information such as age, academic level, field of study and gender. The second part consisted of a standardized questionnaire on factors influencing the quality of clinical education, whose validity and reliability had been previously established.[12] This questionnaire, consisting of 33 Likert-scale items (agree, moderate, and disagree), assessed five dimensions: educational objectives and programs, preceptors, student-preceptor interactions, learning environment, and evaluation. The total score ranged from 0 to 66, with scores below 22 indicating poor quality, 22–44 indicating moderate quality, and above 44 indicating high quality.

Statistics

The Kolmogorov–Smirnov test was used to assess the normality of data. Independent t-tests were used to compare means, and ANOVA was used to compare means across multiple groups multiple linear regression model was used. Statistical significance was set at P value < 0.05 with a 95% confidence interval. The statistical analysis was conducted using IBM SPSS (version 21).

Ethical consideration

This research received ethics approval from the Shoushtar Faculty of Medical Sciences (IR.SHOUSHTAR.REC.1403.001). In addition, written informed consent was obtained from all participants.

Result

A total of 190 students participated in this study, of whom 60 (31.6%) were male and 130 (68.4%) were female. The mean age of the participants was 23.38 ± 2.25 years, ranging from 18 to 39 years. Among the participants, 105 (55.3%) were nursing students, 30 (15.8%) were operating room technicians, 40 (21.1%) were midwifery students, and 15 (7.9%) were emergency medical technicians. Analysis of student responses revealed that the mean overall rating of clinical education was 35.13 ± 72.38, with scores ranging from 0 to 66. Of the participants, 24 students (12.6%) gave negative feedback, 99 students (52.1%) provided neutral feedback, and 67 students (35.3%) gave positive feedback. The mean scores for the subscales were as: Goals and objectives: 14.5 ± 28.13 (range: 0–22), Tutor: 15.4 ± 3.13 (range: 0–18), Student interaction: 9.2 ± 11.4 (range: 0–8), Learning environment: 40.3 ± 27.5 (range: 0–22), Assessment: 8.1 ± 1.3 (range: 0–6). According to the Kolmogorov-Smirnov test, the data were normally distributed (P = 0.200). A significant difference was observed in the overall clinical education scores between male and female students (P = 0.016). Male students rated student interaction, the learning environment, and assessment significantly lower than female students (P = 0.022, P = 0.006, and P = 0.041, respectively) [Tables 1–3].

Table 1.

Gender-based comparison of student perspectives on clinical training

		Gender				Independent Samples T-Test		P
		Man 130 (% 4/68)		Woman 60 (% 6/31)
		Standard Deviation±Average		Standard Deviation±Average
Educational goals and programs		12/26±5/48		13/75±4/92		1/86		0/064
Coach		12/53±4/82		13/26±3/81		1/13		0/258
Dealing with a student		3/60±2/12		4/34±2/04		2/30		0/022*
Educational environment		4/28±3/07		5/73±3/46		2/78		0/006**
Evaluation		2/61±1/95		3/19±1/71		2/05		0/041*
Total clinical training score		35/30±14/40		40/30±1/58		2/43		0/016*

*P<0.05, **P<0.01, ***P<0.001. The total clinical education score decreased with increasing age (P<0/001)

Table 3.

Presents a comparative analysis of student perceptions regarding clinical

		Field of study								F value		P
		Nursing 105 (3/55%)		Surgical technology		Midwifery 40 (1/21%)		E.M.S 15 (9/7%)
		Standard Deviation±Average		Standard Deviation±Average		Standard Deviation±Average		Standard Deviation±Average
Educational goals and programs		12/48±5/29		12/73±4/77		13/82±4/45		1853±3/33		6/90		***≤0/001
Coach		12/82±3/93		11/86±4/30		12/95±4/51		17/06±1/66		6/12		*** ≤0/001
Dealing with a student		387/2±2/02		3/26±1/94		4/77±2/16		5/66±1/49		6/70		***≤0/001
Educational environment		5/00±3/54		4/73±3/12		5/85±3/19		3/12±6/80		1/88		0/133
Evaluation		2/90±1/71		1/80±2/70		2/95±1/79		4/53±1/99		4/16		**0/007
Total clinical training score		37/09±12/72		35/30±1336		40/35±13/24		52/60±9/42		7/46		***≤0/001

*P<0.05, **P<0.01, ***P<0.001.

Table 2.

Age-based comparison of student attitudes toward clinical training

		Age						Analysis of Variance F		P
		18–22y (3/35%) 67		22–26 y (0/60%) 114		+26 y (7/4%) 9
		Standard Deviation±Average		Standard Deviation±Average		Standard Deviation±Average
Educational goals and programs		14/97±4/72		12/63±5/05		9/00±5/38		8/21		***≤0/001
Coach		14/28±3/76		12/42±4/17		11/55±4/92		5/03		**0/007
Dealing with a student		4/58±1/79		3/94±2/20		2/66±2/00		4/32		*0/015
Educational environment		5/62±3/60		5/21±3/35		3/44±1/87		1/68		0/189
Evaluation		3/41±1/78		2/86±1/78		1/77±1/71		4/27		*0/015
Total clinical training score		42/88±42/88		37/08±13/37		28/44±12/58		7/21		***≤0/001

*P<0.05, **P<0.01, ***P<0.001. There was a statistically significant difference in overall clinical training scores among the different disciplines (P<0.001). Emergency medical students reported the highest scores, while nursing and operating room students had the lowest

A multiple linear regression model was used to examine the simultaneous effects of the independent variables gender, age, and academic major on clinical training outcomes. The independent variables were entered into the regression equation stepwise, based on their relative contribution to explaining the variance in the dependent variable. The final model demonstrated a good fit (F = 34.14, P < 0.001). As shown in Table 4, all three variables gender, academic major, and age significantly predicted clinical training scores. Specifically, younger age (β = −0.29, P < 0.001), majoring in emergency medicine (β = 0.24, P < 0.001), and female gender (β = 0.21, P = 0.002) were associated with higher clinical training scores. Together, these variables accounted for 21% of the variance in clinical training outcomes (R² = 0.21) [Table 4].

Table 4.

Simultaneous effect of independent variables on clinical training through a multiple linear regression model

Model		Unstandardized coefficients				standardized coefficients		T value		P
		B		Std. Error		Beta
Fixed value		63/60		9/88				6/43		0/000
Age		−1/74		0/39		−0/29		−4/44		0/000
Field of study		3/16		0/86		0/24		3/64		0/000
Gender		6/09		1/90		0/21		3/20		0/002

Discussion

Numerous studies inside and outside the country have been conducted regarding the challenges and status of clinical education in medical universities. Depending on the context, environment, university type, and clinical disciplines, similarities, and differences can be observed. In this study, 190 students participated in evaluating the quality of clinical education based on five questionnaire components: (1) educational objectives and programs, (2) instructor, (3) student interaction, (4) educational environment, and (5) assessment. Among the participants, 31.6% were male and 68.4% were female. Out of all participants, 99 students expressed an average opinion regarding clinical education. Among them, female students showed a more favorable attitude compared to male students. Male students gave lower scores to variables related to student interaction, the educational environment, and evaluation. Using a regression model, the simultaneous effect of gender, age, and academic discipline on clinical education quality was analyzed. The results showed that students in the field of emergency medicine, those with younger ages, and female students gave higher scores to the quality of clinical education at Shushtar University of Medical Sciences. These results were supported by statistical tests and validated by the regression model. No significant gender difference was observed in relation to the variables of “educational objectives and programs” and “instructor,” meaning both male and female students held similar views on these components. However, male students generally showed less interest in clinical education. Factors such as poor scheduling, educational rules and regulations, lack of collaboration between the healthcare team and instructors/students, insufficient time dedicated by supervisors, shortage of experienced instructors, and the growing gap between theory and practice contributed to lower ratings by students. Furthermore, it can be said that the “quality of clinical education” is a variable linked to the type of university, the mode of delivery, and existing infrastructure. Another variable examined was the impact of “students’ age” on their responses to questions about the quality of clinical education. Students aged 18–22 gave higher scores to “evaluation impact on educational quality,” “educational environment,” “student interaction,” and “instructor.” Conversely, students over the age of 26 gave lower scores to all components of clinical education quality. This suggests that older students showed less interest in clinical education, which may relate to employment, work experience, lack of motivation, or academic fatigue. Regarding the educational environment variable, no significant differences were found between age groups. Among students of different disciplines—emergency medicine, midwifery, nursing, and operating room—those in emergency medicine gave higher scores to variables like instructor influence, student interaction, educational objectives and programs, and evaluation. However, no significant differences were observed between the groups concerning the educational environment; all clinical disciplines had similar views on this component. The presence of experienced instructors and a variety of clinical programs may have contributed to higher satisfaction among emergency medicine students by addressing components such as program quality and evaluation methods. Mahdavian et al.,[13] found that nursing and midwifery students had positive views toward self-assessment but were less satisfied with welfare facilities and, to a lesser extent, educational resources, findings that align with our study in terms of the educational environment and programs. In another study by Zadi et al.,[8] 67.9% of students rated the quality of clinical education as average. Significant differences were found between operating room and anesthesia students regarding educational objectives and programs, indicating challenges in this area. While their findings did not align with ours in the “instructor” component, their views on “student interaction” and “educational environment” were consistent with ours. In the study by Keshtgar et al.,[5] 75% of students found the educational atmosphere of the operating room favorable. Among the five dimensions of the educational atmosphere, the instructor component received the highest score, while support and assistance received the lowest. A significant gender difference in educational atmosphere was observed, which did not align with our study. However, their overall educational atmosphere scores were favorable, which was in line with our findings. Their study also found significant differences in support and assistance based on age and academic semester, indicating that older and more advanced students gave higher scores to clinical education. This contrasts with our study, where older students showed a less favorable attitude toward clinical education. Jalali et al.,[14] in a qualitative study exploring the experiences of nursing faculty and students regarding the challenges and complexities of clinical education in intensive care units, found that instructors must be aware of the methodological competencies required for clinical education. This finding aligns with our study, where students gave favorable scores to the instructor and educational program components. In a study in Palestine, Buzia[15] examined the characteristics of effective clinical instructors from the perspective of undergraduate nursing students. The study found that “teaching ability” had the highest mean score (89.79) and was considered the most important characteristic of clinical instructors, consistent with our findings. This was followed by “nursing competency,” “evaluation,” “interpersonal relationships,” and finally, “personality,” which was considered least important. Based on these findings, it was recommended that clinical instructors become familiar with the attributes of effective clinical teaching to serve as effective role models Austen[16] conducted a study in the UK to identify key elements influencing the educational environment in surgical podiatry. The study concluded that a favorable and satisfying educational environment in operating rooms creates excellent opportunities for patient care in podiatric surgery. These findings differed from those in our study. Noviyanti et al.,[17] in their study, examined the impact of instructors’ roles on the quality of nursing students’ education and patient satisfaction. The results of this study showed a significant relationship between the quality of nursing students’ education and patient satisfaction in clinical settings. Based on the findings, it is recommended that necessary educational interventions be implemented to improve clinical educational objectives, employ experienced instructors, ensure proper student interaction, provide an appropriate educational environment, enhance student evaluation processes, and involve proper planning by clinical education managers. Additionally, incorporating students’ suggestions and leveraging successful national and international experiences in clinical education is advised.

Conclusion

The mean scores related to educational objectives, instructor quality, student-teacher interactions, and the learning environment were lower among male students, older students, and participants enrolled in nursing and operating room programs. These findings highlight the need for targeted educational interventions aimed at improving clinical training objectives and engaging expert faculty.

Limitation and recommendation

Since the small sample size was one of the limitations of the present study, it is suggested to conduct a similar study to generalize on a larger scale and include all field clinical.

Declaration of subject consent

The authors certify that all appropriate consent forms have been obtained from the participants. The participants understand that their names and initials will not be published, and every effort will be made to protect their identity.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

The study was financially supported by shoushtar faculty of medical sciences