Table 1.

Clustering and theming COILEs and SILE with illustrative quotes and frequency values

Immersion in authentic clinical environment
COILEs • Acute Medicine on-call • Clinical learning outside of 9–5 • Engaging the acute (sick) patient • Range of patients • Role of uncertainty in medicine • Translating ELM clinical examination to the real thing and presenting SILE illustrative quote “In medicine working in ED with a helpful / enthusiastic registrar being involved, learning from patients / management of patients.”		Learning	Challenge	Affect
	N	109	108	102
	Proportion of student ratings
	High or very high	74%	64%	62%
	Low /negative	7%	5%	11%
Simulated clinical experience
COILE • history taking simulated sessions • simulated GP clinic SILE illustrative quote “. ..., assessing acting patient, given responsibility in a situation which we may be in for real in the future.”		Learning	Challenge	Affect
	N	42	42	52
	Proportion of student ratings
	High or very high	92%	55%	95%
	Low /negative	2%	5%	0%
Specific authentic clinical skills
COILE • A skill such as IV line placement SILE illustrative quote “Taking blood off a patient (rather than a simulation model or a classmate) for the first time.” “Generally when we were asked to function of a member of the team and given tasks to do. Often by the registrar and sometimes in pairs.”		Learning	Challenge	Affect
	N	52	52	52
	Proportion of student ratings
	High or very high	87%	64%	87%
	Low /negative	0%	0%	0%
Specific learning engagement – presenting
COILE • Presentation of a case on ward round • Knowing the basic exam - to do, and to present SILE illustrative quote “Presenting patient histories and examinations findings in a professional setting, with time constraints. “		Learning	Challenge	Affect
	N	21	21	21
	Proportion of student ratings
	High or very high	70%	71%	42%
	Low /negative	5%	5%	21%
Specific learning engagement– questioning
COILE • Questioning by staff SILE illustrative quote “When asked questions by doctors (mainly positive)” “The time when being questioned by the consultants.” “Being quizzed by kind staff. Sometimes individually and sometimes in a group.”		Learning	Challenge	Affect
	N	18	18	18
	Proportion of student ratings
	High or very high	89%	95%	61%
	Low /negative	0%	0%	11%
Administrative/organisational function
COILE • Learning when modules clash • Making choices in a busy time table SILE “Getting told off for not being prepared or for not attending a tutorial when we often had clashing commitments. “		Learning	Challenge	Affect
	N	45	46	45
	Proportion of student ratings
	High or very high	13%	33%	9%
	Low /negative	40%	26%	27%
Balancing learning and patient needs
COILE • Balancing patient needs with learning needs SILE illustrative quote “By the time we left the room he was very short of breath and tired out from the examination. The experience was challenging because I know that I will need to examine unwell patients as a doctor/medical student, and even though the examination may be inconvenient or uncomfortable patient it will be a necessary part of their healthcare. But (especially as it was for teaching purposes and not for the patient’s benefit) I felt a little bit unhappy with the situation at the time.”		Learning	Challenge	Affect
	N	20	20	20
	Proportion of student ratings
	High or very high	25%	40%	25%
	Low /negative	20%	20%	10%
Non-on-the job learning activity
COILE • Reflective essay / assignments SILE illustrative quote “:... many of the assignments were very time consuming but not particularly useful, which meant there was less time to independently learn things specific to the areas that we were working in.” COILE Tutorial based sessions - without patients • Pharmacology • Dermatology • Small group work SILE illustrative quote “A group tutorial about Parkinson’s syndrome. Team tutorial with students (×3) and consultant.”	Reflective essays/assignment
		Learning	Challenge	Affect
	N	19	19	19
	Proportion of student ratings
	High or very high	10%	5%	11%
	Low /negative	74%	47%	26%
	tutorial based sessions
		Learning	Challenge	Affect
	N	51	55	53
	Proportion of student ratings
	High or very high	63%	53%	53%
	Low /negative	6%	4%	4%
Adapting to the work place learning environment
COILE • Parity (variation) of student experience • Observing what goes on around you and your patient • Making choices about where to position yourself in the clinical environment SILE illustrative quote “The transition from rote-learning to the clinical problem solving was challenging.”		Learning	Challenge	Affect
	N	85	85	85
	Proportion of student ratings
	High or very high	51%	51%	37%
	Low /negative	19%	17%	13%
Dealing with emotional components (including death)
COILE • Unexpected or expected death of a patient SILE illustrative quote “Brought together with host GP on an acute call for an unexpected death of a patient (GP run), good exposure and learning by just observing, learning crucial skills involved in dealing with family members.” “The emotional component of the run and all the problems patients have in their lives.”		Learning	Challenge	Affect
	N	13	12	13
	Proportion of student ratings
	High or very high	69%	58%	39%
	Low /negative	8%	8%	39%