The clinical learning environment is equivalent to a classroom for students during their

practicums (Chan, 2004), yet few clinical agencies resemble traditional classrooms. In
their clinical classrooms, learners hope to integrate into agency routines and feel a sense
of belongingness (Levett-Jones, Lathlean, Higgins & McMillan, 2008). Learners want to
feel welcome and accepted by staff and they want staff to help teach them how to
practice confidently and competently (Courtney-Pratt, FitzGerald, Ford, Marsden &
Marlow, 2011; Henderson, Cooke, Creedy & Walker, 2012). Students expect and require
feedback on their performance and they must have opportunities for non-evaluated
student–teacher discussion time (Melrose & Shapiro, 1999) and critical reflection (Duffy,
2009; Forneris & Peden-McAlpine, 2009; Mohide & Matthew-Maich, 2007). Learners
need time to progress from one level of proficiency to another (Benner, 2001). Just as
learners in classroom environments need support to develop competence in their chosen
professions, learners in clinical practicums need a supportive clinical learning
environment.

While supportive clinical classrooms are hoped for, clinical teachers must also be well
prepared for unplanned experiences that raise barriers to learning. Research suggests
that clinical learning environments may not be as supportive as learners would like. For
example, Brown et al.’s (2011) work with undergraduate students from ten different
health disciplines reveals significant differences between learners’ descriptions of their
ideal learning environment and what they experience during their actual clinical
practicums. Although participants in Brown et al.’s study express satisfaction with their
learning experiences, they describe a mismatch between what they hoped for and what
actually occurred. Similarly, recently graduated nurses indicate significant differences
between the kinds of practicums they deem good preparation for practice and those they
actually attended (Hickey, 2010).

Investigations into experiences of physical therapy students were unable to conclusively

define a quality learning environment, in part because of the diverse instructional
practices by different community agencies overseeing students’ practicums (McCallum
et al., 2013). Over the last decade and in several different countries, student nurses
rated their clinical experiences highly for their sense of achieving tasks but much lower
for accommodating individual needs and views (Henderson, Cooke, Creedy & Walker,
2012). Although university students are encouraged to question existing practice and
the status quo, students find that staff in their clinical placements are seldom open to
innovation or challenges to routine practices (Henderson, Cooke, Creedy & Walker,
2012).
Staff shortages, and other issues with which clinical agencies struggle, can leave
students feeling that they are not receiving the direction they need and that they are a
burden to staff (Robinson, Andrews-Hall & Fassett, 2007). Students may feel alienation
rather than the sense of belongingness they hope for (Levett-Jones, Higgins & McMillan,
2009). Students may express fear and discomfort in their relationships with staff
(Cederbaum & Klusaritz, 2009, p. 423). Clinical learners have felt rejected, ignored,
devalued and invisible (Curtis, Bowen & Reid, 2007). These findings suggest that in
some instances health care students are not receiving the support they need.

Clinical Learning Environment Inventory. Surveys to measure the quality of clinical

learning environments are available. For example, the Clinical Learning Environment
Inventory (CLEI) was developed in Australia by Chan (2001, 2002, 2003) to measure
student nurses’ perceptions of psychosocial elements in clinical practicums. The CLEI
consists of an Actual form that assesses the actual learning environment and
a Preferred form that assesses what the student would ideally like in a learning
environment. The CLEI is a self-report instrument with 42 items classified into six
scales: personalization, student involvement, task orientation, innovation, satisfaction
and individualization. Students respond using a four-point Likert scale with the
response options Strongly Agree, Agree, Disagree and Strongly Disagree. Inventory
factors of the instrument have been modified to include student centredness (Newton,
Jolly, Ockerby & Cross, 2010).

The CLEI has also been abbreviated to a 19-item scale measuring students’ satisfaction
with their actual learning environment in two aspects of their clinical experience—
clinical facilitator support of learning and the clinical learning environment. The Clinical
Learning Environment Inventory-19 (CLEI-19; Salamonson, Bourgeois, Everett, Weaver,
Peters & Jackson, 2011) is shown in Table 1. The CLEI-19 can be used in formal
evaluation processes implemented by university program evaluators. It can also be used
more informally by agency staff and clinical teachers interested in strengthening their
own clinical classroom environments.

Table 1. Abbreviated Clinical Learning Environment Inventory (CLEI-19)

Reproduced with permission (Salamonson, Bourgeois, Everett, Weaver, Peters &

Jackson, 2011)
Clinical facilitator support of learning component: Items 1, 2R, 4, 6, 8R, 9, 10, 12R,
14R, 16, 17R, 18R.
Satisfaction with clinical placement: Items 3,5R, 7, 11R, 13R, 15, 19.
Items are scored 5, 4, 2 or 1 respectively for responses SA, A, D, and SD. Items marked
with R are scored in the reverse manner. Omitted or invalidly answered items are scored
3.

Instructions: We would like to know what your last clinical placement was
ACTUALLY like.
Indicate your opinion about each statement by selecting your response
 Strongly Strongly
No Item Agree Disagree
agree disagree

The clinical facilitator was

1 SA A D SD
considerate of my feelings.

The clinical facilitator talked to,

2 SA A D SD
rather than listened to me.

I enjoyed going to my clinical

3 SA A D SD
placement

The clinical facilitator talked

4 SA A D SD
individually with me.

I was dissatisfied with my clinical

5 SA A D SD
experiences on the ward/facility.

The clinical facilitator went out of

6 SA A D SD
his/her way to help me.

After the shift, I had a sense of

7 SA A D SD
satisfaction.

The clinical facilitator often got

8 sidetracked instead of sticking to SA A D SD
the point.

The clinical facilitator thought up

9 SA A D SD
innovative activities for students.

The clinical facilitator helped me

10 if I was having trouble with the SA A D SD
work.

This clinical placement was a

11 SA A D SD
waste of time.

The clinical facilitator seldom got

12 around to the ward/facility to talk SA A D SD
to me.

This clinical placement was

13 SA A D SD
boring.

The clinical facilitator was not

14 interested in the issues that I SA A D SD
raised.
 Strongly Strongly
No Item Agree Disagree
agree disagree

I enjoyed coming to this

15 SA A D SD
ward/facility.

The clinical facilitator often

16 SA A D SD
thought of interesting activities.

The clinical facilitator was

17 unfriendly and inconsiderate SA A D SD
towards me.

The clinical facilitator dominated

18 SA A D SD
debriefing sessions.

This clinical placement was

19 SA A D SD
interesting.