• Gaining clinical experience for an extended period of time in teaching hospitals is one of the enduring strengths of medical education. • Teaching hospitals have recently faced significant challenges, with increasing specialisation of services and workload pressures reducing clinical learning opportunities. • New clinical teaching environments have been established in Australia, particularly in rural and regional areas; these are proving to be ideal contexts for student learning. • The new clinical teaching environments have shown the importance of developing symbiotic relationships between universities and health services. Symbiotic clinical learning is built around longitudinal, patientbased learning emphasising priority health concerns. • The symbiotic framework provides a basis for reconstructing clinical teaching in teaching hospitals so that they continue to play a vital role in Australian medical education, with additional clinical experience provided by primary care and community, rural and regional hospitals.