Experience based learning (ExBL): clinical teaching for the twenty-first century: Experience based learning

The need for a pedagogy of clinical workplace learning
Many new doctors report that they are ill-prepared to enter practice and research confirms that their inexperience distresses them and harms patients. This situation persists because, whilst curriculum design, competency-based education, assessment, and simulation have progressed apace, medical education lacks a contemporary, pedagogy to guide students’ workplace learning. This Guide assembles contemporary theory and best evidence into a practical pedagogy for the present age and gives clinicians, students, faculty developers, and curriculum leaders practical guidance.

How the pedagogy developed
A first-generation pedagogic model of Experience-based Learning (ExBL) was developed from empirical research. Then, evidence from 167 articles published between 2000-6 that provided valid information about how medical students learn in workplaces guided a redesign. The third-generation model presented in this Guide was informed by best evidence contained in a further 124 articles published in the years 2007-18, the expert opinion of a panel of 23 education scholars from five continents, an in-depth analysis of our own programmatic research on ExBL, and experiential evidence from a team comprising an academic medical student, junior resident, senior resident, curriculum leader, and consultant. Team members have had clinical experience in primary, secondary, and tertiary care.

ExBL - the model
ExBL results in students being capable - ready to do the job of a doctor. Capability results from real patient learning (RPL), which results from participating in practice within the triad of clinician, patient and student. Clinicians’ supportive behaviour creates the conditions for participation, RPL, and the development of capability. Clinicians: 1) model good practice and engage students into its provision; 2) encourage students to extend their current capability; 3) empower patients to co-participate in students’ learning. Clinicians engage students into the dialogic ‘talk’ of workplaces, help them interact with patients receiving clinical care, and support their reflection on experience. SPaRC summarises ExBL: Support; Participation; Real patient learning; Capability.

Evaluating ExBL
The Manchester Clinical Placement Index (MCPI) is a parsimonious (8-item) mixed methods measure, which evaluates learning environments and the support given to students’ participatory learning. This is theoretically congruent with ExBL and its reliability and validity are comparable to the best available alternatives.

Implications and future directions
ExBL is widely applicable since it is based on best available theory and evidence and informed by international opinion as well as multiple perspectives within a team of authors. It is clearly specified and flexible enough to be used in any clinical workplace curriculum. We advocate that ExBL be adopted alongside competence-based medical education (CBME) to support students’ learning, within practice, of the all-important capabilities that equip them to practise.