Redesigning logbooks to separate administrative tracking from reflective practice, supported by deliberate, structured feedback conversations, may better align their use with the realities of clinical learning and the needs of students.
Abstract
Clinical placement logbooks are widely used to guide learning, document clinical exposure, and support student–tutor feedback. Despite their ubiquity, little is known about how logbooks shape medical students’ learning behaviours, particularly the tension between their reflective and administrative functions. This study explores how students and tutors experience logbooks and how these experiences influence engagement during clinical placements.
A qualitative study was conducted at a single university-affiliated teaching hospital. Six third-year medical students and two clinical tutors participated in one-to-one semi-structured interviews. Convenience sampling was used for students and purposive sampling for tutors. Interviews were transcribed verbatim and analysed inductively using reflexive thematic analysis, supported by NVivo. A reflexive, interpretivist approach underpinned the analysis, with iterative development of themes informed by an audit trail and researcher positionality.
Three themes were generated.
Logbooks as reflective tools versus administrative tasks
captured the tension between students’ desire for narrative reflection and the restrictive, checklist-driven format of logbooks.
The Goldilocks balance of structure
described how logbooks provided orientation early in placements yet later constrained learning by directing behaviour toward predefined tasks.
Logbooks as motivators for participation
illustrated how signatures and checklist completion prompted engagement, particularly among less confident students, but also fostered superficial documentation and extrinsic motivation, with meaningful feedback often limited by clinical workload.
Logbooks influence learning behaviours in complex and sometimes unintended ways. While they can support orientation and prompt participation, their administrative demands may constrain autonomy, limit meaningful reflection, and contribute to task-driven engagement. Redesigning logbooks to separate administrative tracking from reflective practice, supported by deliberate, structured feedback conversations, may better align their use with the realities of clinical learning and the needs of students.
Abstract: Clinical placements are an essential part of medical education. However, they can differ in quality, educational value and student engagement. This study uses a thematic analysis of semi-structured interviews conducted directly after a clinical placement to identify qualities that make placements engaging for medical students.
Five themes were uncovered: clear structure enhances engagement, team culture and psychological safety, active involvement and work-integrated learning, feedback and supervision matter, and disengaging experiences: the wallflower effect.
Clear expectations, active participation and regular feedback from invested supervisors were found to underpin high-value learning experiences.
This study is limited by its small sample size, which may reduce the generalisability of findings. Despite the small sample size, the themes of this study are transferable to other students in clinical learning contexts. Further research could seek to explore these views across a more diverse range of institutions.
Keywords: clinical placements, student engagement, structure, psychological safety, work-integrated learning
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Early clinical placements are a crucial stage in undergraduate medical education, helping students integrate theoretical knowledge with clinical practice while developing confidence and professional identity. This mixed-methods cross-sectional study explored the experiences of 32 third-year medical students at Brunel Medical School during their first clinical placements across five NHS Trusts. Data were collected using an online questionnaire with Likert-scale and open-ended questions and analysed using descriptive statistics and thematic analysis.Most students perceived the clinical environment as welcoming (94%) and supportive (88%), with 78% reporting that clinicians’ teaching enhanced learning. Although students initially experienced uncertainty, a steep learning curve, and challenges balancing academic and clinical responsibilities, these experiences promoted independence and self-directed learning. Early clinical exposure increased confidence in patient interactions (88%), strengthened professional identity (94%), and improved the application of theoretical knowledge to practice (88%). Qualitative findings highlighted the value of supportive supervision, constructive feedback, authentic patient encounters, and an inclusive learning environment. Students recommended more simulation-based training, structured bedside teaching, consistent feedback, better integration of academic and clinical learning, and formal mentorship. Overall, supportive and well-structured early clinical placements are essential for preparing medical students for clinical practice.
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The findings may inform educational approaches involving communication skills training, supervised reflective learning, and guidance for emotionally challenging encounters, which may support students’ perceived confidence in providing compassionate, person-centred and holistic care.
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