Absorbing and being absorbed, learning to learn in the clinical environment.

Introduction
Health professions education is often referred to as a journey where students are prepared for seamless progression from one year to the next. The reality for students is they navigate complex and ambiguous contexts, particularly when transitioning into the health system.
Aimed at understanding how students optimise clinical learning in complex health environments, this PhD study examined experiences from a medical student and clinical supervisor perspective.

Methods
The research was undertaken using a qualitative case study approach. The context for the study was the third year of a four year medical course, where learning involves full immersion in clinical settings in different Rural, Remote and Metropolitan contexts. Data was collected from 26 participants via in-depth interviews:14 students (interviewed twice) and 12 supervisors (interviewed once). This resulted in a total of 40 interviews. Themes were developed by iteratively coding and thematically analysing data.

Results
Optimising clinical learning involved students understanding what skills and knowledge were valued in different environments. This study identified 4 themes relating to how students optimise learning in complex health environments. Including, integrating into the team, understanding expectations, relational conditions for learning, and transitional role development.
As expectations and implicit knowledge was acquired and practiced, students reported learning gains. They continued to enact and adjust certain skills as they transitioned through different learning landscapes. Learning gains and opportunities proportionately increased as students demonstrated these abilities. Developing and applying these abilities underpinned a ‘learning investment criteria’ where optimal learning and teaching takes place in the clinical environment.

Discussion
This study illustrates the multiple ways that students optimise clinical learning through developing relational conditions for learning, uncovering the hidden curriculum, and co-constructing knowledge with supervisors, peers, and others.
It suggests novel ways to view learning transitions, particularly in the first entire clinical year of a health professions course.