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Clinical lea ning p ocess o su gical echnologis s uden s: A
g ounded heo y
Mos a a Roshanzadeh1, Mina Shi ani1, Fa emeh Ma aki1 Ali Taj2 Somayeh Mohammadi3*
1Depa men o nu sing & ope a ing oom, Facul y o nu sing, Shah eko d Uni e si y o Medical Sciences, Shah ehko d, I an.
2Depa men o Medical Eme gencies, School o Allied Medical Sciences, I anian Resea ch Cen e on Heal hy Aging, Sabze a Uni e si y
o Medical Sciences, Sabze a , I an.
3Depa men o nu sing, S uden Resea ch Commi ee, Shi az Uni e si y o Medical Sciences, Shi az, I an
A icle in o Abs ac
In oduc ion
A i al componen o many heal h- ela ed ields is
clinical lea ning, in which s uden s in e ac wi h hei
en i onmen and pu newly acqui ed knowledge in o
p ac ice [1, 2]. In con as o class oom ins uc ion,
clinical lea ning occu s in a complica ed social se ing
whe e clinical educa o s mus concu en ly a end o he
needs o pa ien s, s uden s, and o he medical
p o essionals. The e o e, encou aging clinical lea ning
du ing p ac ice equi es imp o ing he quali y o he
clinical lea ning en i onmen [2]. Gi en his, i is c i ical
o emembe ha clinical educa ion is a complex p ocess
whe e s uden s apply hei scien i ic knowledge and a e
impac ed by a wide ange o ci cums ances [3].
The esul s o he s udies e eal a gap be ween he
heo e ical and clinical aining p ocesses. Consequen ly,
he cu en clinical aining needs o equip s uden s wi h
he necessa y abili ies o a ain clinical compe ence and
skills [3, 4]. As su gical echnologis s uden s spend mos
o hei lea ning ime a he bedside, i is c ucial o
unde s and he ex en and manne o a ious ac o s
in luencing hei lea ning p ocess [5]. Meanwhile,
nu sing s uden s' comp ehension o he clinical lea ning
A icle his o y:
Recei ed 3 Feb. 2024
Accep ed 28 No . 2025
Published 14 Ap . 2025
Roshanzadeh e al. J Med Edu De . 2025; 18(1): 96-105 Jou nal o Medical Educa ion
De elopmen
Backg ound & Objec i e: Iden i ying he lea ning p ocess o su gical echnologis s uden s
in he ope a ing oom en i onmen can e ec i ely e eal he ac o s and s a egies hey use o
lea n and enhance he quali y o hei educa ion. This s udy aimed o elucida e he clinical
lea ning p ocess o su gical echnologis s uden s.
Ma e ials & Me hods: This quali a i e s udy employed a g ounded heo y app oach a
Shah eko d Uni e si y o Medical Sciences in 2022. Da a we e ga he ed h ough six in-dep h
indi idual in e iews and h ee ocus g oups. Pu pose ul and heo e ical sampling pe sis ed
un il heo e ical sa u a ion was achie ed. Da a analysis was conduc ed using MAXQDA10
so wa e.
Resul s: Thi een subca ego ies and ou main ca ego ies we e ound. The co e a iable was
sel -p o ec ion. S uden s ea making mis akes in he unce ain lea ning en i onmen and
employ lexible s a egies, u ilizing ela ionship-o ien ed app oaches o achie e success while
a oiding pe o mance ha could hinde lea ning, he eby p e en ing issues ha would p o ec
hemsel es.
Conclusion: I is essen ial o enhance s uden s' lea ning by employing s a egies ha boos
hei sel -con idence and a oid adhe ing o he cu en app oach solely o he sa is ac ion o
he aining eam, he eby p e en ing nume ous nega i e consequences. Clinical manage s a e
also encou aged o os e an educa ional a mosphe e in he ope a ing oom and o cul i a e a
posi i e a i ude among employees o suppo s uden educa ion in hese se ings. Es ablishing
cons uc i e communica ion be ween he clinical en i onmen and he educa ional sys em and
emphasizing he signi icance o s uden educa ion can imp o e he educa ional a mosphe e in
clinical se ings.
Keywo ds: clinical lea ning, su gical echnologis s uden s, sel -p o ec ion, g ounded heo y
*Co esponding au ho :
Somayeh Mohammadi, Depa men o
nu sing, S uden Resea ch Commi ee,
Shi az Uni e si y o Medical
Sciences, Shi az, I an
Email: s.mohammadi.n [email protected]
O iginal A icle
How o ci e his a icle:
Roshanzadeh M, Shi ani M, Ma aki
F, Taj A, Mohammadi S. Clinical
lea ning p ocess o su gical
echnologis s uden s: a g ounded
heo y. J Med Edu De . 2025; 18(1):
96-105.
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en i onmen s can signi ican ly impac hei
unde s anding o he na u e and p ocess o clinical
lea ning [6]. The poin o con ac be ween he s uden
and he lea ning en i onmen is he s uden 's g asp o he
clinical lea ning se ings, and his unde s anding a ec s
hei lea ning in he clinical con ex [7]. The ac ual
clinical con ex equen ly di e s om wha s uden s
expec om he clinical lea ning en i onmen .
The e o e, when es ablishing a clinical educa ion
p og am, i is essen ial o iden i y e ec i e elemen s
in luencing clinical lea ning om he s uden s'
pe spec i e [8, 9]. Analyzing hei pe cep ions and
unde s anding o clinical educa ion can help hem
iden i y he ad an ages and disad an ages o lea ning in
clinical se ings, which will imp o e educa ional
p og ams and aise educa ional s anda ds. S uden s'
expe iences can be he mos essen ial componen s o
clinical educa ion since hey a e he p ima y means o
es ablishing p o essional a i udes, alues, and no ms
[10–12].
Nume ous con ibu ing ac o s cause s uden s'
comp ehension o he clinical en i onmen o a y,
which is a majo di icul y in clinical lea ning, acco ding
o s udies. Due o his a ia ion, di e en clinical
educa ion app oaches and heo ies ha e a ying deg ees
o e icacy in s uden s' clinical lea ning. In o he wo ds,
while many ac o s impac ing clinical lea ning a e well-
documen ed, he p ocesses o hei in luence and
in e ac ion in os e ing s uden lea ning emain
ambiguous [14, 13]. Consequen ly, despi e he
a ailabili y o di e se models and heo ies in lea ning
and clinical educa ion, subs an ial gaps pe sis be ween
heo e ical educa ion and i s applica ion in clinical
se ings [8, 15]. Conside ing he signi icance and
challenges in his domain, i is essen ial o analyze he
lea ning p ocess om he s uden s' iewpoin o cla i y
a ious ambiguous elemen s, he eby imp o ing and
ad ancing his coho 's clinical educa ion. Many s udies
ha e been conduc ed on he clinical educa ion
en i onmen o nu sing and medical s uden s and he
associa ed challenges; howe e , s uden s' clinical
lea ning expe iences ha e been less ega ded as a c ucial
componen in he clinical educa ion p ocess [16, 3, 17].
Eks ed e al. no ed in hei s udy ha a posi i e clinical
lea ning en i onmen elies on an educa ional se ing
whe e s a is engaged in supe ising s uden s, and he e
is e ec i e in e ac ion be ween lec u e s and clinical
educa o s [18]. Mbakaya e al. also no ed ha nu sing
and midwi e y s uden s aced a ious challenges,
including a lack o educa ional acili ies, poo
communica ion wi h clinical pe sonnel, and insu icien
suppo om clinical educa o s, all o which nega i ely
impac ed hei clinical lea ning expe iences [19]. In hei
s udy o nu sing s uden s' expe iences in clinical lea ning
en i onmen s, Naja i Kalyani e al. ound ha s uden s
had "iden i y con usion" due o an inadequa e
educa ional se ing [20].
The analysis o he s udies abo e indica es ha he
lea ning expe iences o nu sing s uden s in he clinical
en i onmen a e signi ican , and i s a ious dimensions
s ill equi e u he in es iga ion. G ounded heo y
s udies conduc ed on nu sing s uden s ha e illus a ed
how hey lea n in clinical se ings; howe e , i is
impo an o ecognize ha di e en lea ning con ex s
play a c ucial ole in shaping s uden s' lea ning
expe iences. In his ega d, i is no ewo hy ha su gical
echnologis s uden s, like nu ses, unde go clinical
aining in hospi al en i onmen s and pa a-clinical
depa men s, esul ing in a simila clinical lea ning
en i onmen . Ne e heless, i mus be emphasized ha ,
despi e hese simila i ies, he ope a ing oom
en i onmen p esen s dis inc con ex ual di e ences and
le els o ca e compa ed o o he hospi al depa men s.
Consequen ly, gi en ha he lea ning p ocess o his
g oup o s uden s has ye o be adequa ely add essed in
p e ious s udies, his esea ch will elucida e how
su gical echnologis s uden s lea n and he na u e o
hei lea ning p ocess.
Ma e ials & Me hods
Design and se ing(s)
The p esen quali a i e s udy was conduc ed a
Sha eko d Uni e si y o Medical Sciences in 2022. The
esea ch se ing was he Bo ujen Facul y o Medical
Sciences. Gi en ha lea ning is undamen ally a p ocess,
his s udy aims o explo e how he clinical lea ning
p ocess a ec s su gical echnologis s uden s, mainly
since his g oup's clinical lea ning p ocess is o en
o e looked wi hin he I anian educa ional sys em.
Consequen ly, a g ounded heo y echnique was used o
analyze he s udy ques ion.
Pa icipan s and sampling
Pa icipan s in his s udy included su gical echnologis
s uden s who unde wen clinical lea ning expe iences in
he ope a ing oom. They we e ca e ully chosen based on
speci ic cha ac e is ics, such as hei abili y o
communica e hei expe iences and p e ious exposu e o
he ope a ing oom a mosphe e. The sampling p ocess
occu ed concu en ly wi h he esea ch s ages, which
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in ol ed ga he ing in o ma ion, analyzing i , classi ying
concep s, and iden i ying hemes. The esea che
selec ed samples as he heo y de eloped. Sampling and
da a collec ion con inued un il da a sa u a ion and
heo e ical sa u a ion we e achie ed. To gua an ee
maximum a ie y in sampling, olun ee s o a ious
ages, gende s, and academic semes e s we e chosen. The
schedule and enue o he ace- o- ace in e iews we e
decided based on he s uden s' p e e ences and
ag eemen . In his s udy, he esea che s se ed as
in e iewe s, ca ying ou he esea ch and assessing he
da a.
Da a collec ion me hods
Da a o his s udy we e collec ed h ough ace- o- ace
indi idual in e iews and ocus g oups. The in e iews
we e conduc ed by he i s au ho (a male wi h a PhD in
nu sing). Ini ially, wo in e iews we e conduc ed as a
p o o ype, esul ing in he c ea ion o an in e iew guide.
The i s in e iew was wi h an eigh h-semes e s uden
om he ope a ing oom p og am. Da a collec ion began
wi h in-dep h semi-s uc u ed in e iews, ollowed by
s uc u ed in e iews ha asked inc easingly
sophis ica ed and specialized ques ions on he a ea o
in e es . The in e iew began wi h open-ended ques ions
such as, "Please desc ibe how you lea n in a clinical
en i onmen du ing a day o aining" and "How do you
lea n as a s uden in an ope a ing oom en i onmen ?"
Mo e speci ic ques ions we e posed based on he
esponses p o ided by pa icipan s. To cla i y he
pa icipan s' commen s, p obing ques ions such as
"Please explain u he " and "Wha does his mean?"
we e used. As he s udy p og essed, he in e iews we e
led by he c ea ed heo y, wi h he esea che asking
ques ions based on he p ominen and ele an hemes
unco e ed. The in e iews' leng h a ied acco ding o he
in e iew p ocedu e and he pa icipan s' desi e and
abili y o pa icipa e. Following each in e iew,
pa icipan s we e asked o pe mission o do ollow-up
in e iews in pe son o o e he phone.
Addi ionally, ocus g oups we e used in his
in es iga ion. The pa icipan s we e al eady amilia
wi h he s udy's goal be o e pa icipa ing in g oup
in e iews. The in e iewe asked ques ions, and he
pa icipan s ga e hei commen s. The p esence o o he
pa icipan s p omp ed hem o complemen one ano he 's
ideas and expound on hei esponses. They o en ag eed
wi h each o he 's poin s o iew, al hough hey also
disag eed a imes. The esea che ollowed he p ocesses
p o ided and inco po a ed he acqui ed da a while
eading he in e iew ex se e al imes o unde s and i s
subs ance ho oughly. The seman ic uni s o he
in e iew ex we e hen iden i ied, and coding was
conduc ed. Du ing he coding p ocess, pa icipan s'
ph ases and exp essions we e e alua ed, and di e en
indi iduals in es iga ed he meanings o hese
exp essions in a ious ci cums ances. The codes we e
compa ed and ca ego ized acco ding o hei simila i ies,
di e ences, and con en . Due o a lack o da a, sampling
was ini ially pu pose ul. Howe e , a e assessing he
ini ial in e iews, he heo e ical sampling p ocedu e
p oceeded o comple e and in eg a e he s udy concep s
in acco dance wi h he desi ed heo y. The heo e ical
sampling p ocess also pe sis ed in in eg a ing
subca ego ies o he o ma ion and sa u a ion o
ca ego ies un il heo e ical sa u a ion was eached; a his
poin , he ca ego ies and hei dimensions and
cha ac e is ics we e in eg a ed in o he co e a iable.
In e iews con inued un il da a sa u a ion was achie ed.
Fu he mo e, he analysis o he ini ial in e iews se ed
as a guide o ongoing sampling in he di ec ion o
heo e ical sampling, which con inued un il heo e ical
sa u a ion was accomplished. Th oughou all da a
in e p e a ion and coding s ages, memos we e u ilized o
aid in o ming ca ego ies and heo y. A digi al audio
eco de was employed o cap u e he in e iews.
Da a analysis
The in e iews we e analyzed concu en ly wi h he da a
collec ion p ocess. The S auss and Co bin (2015)
me hod was employed o da a analysis [22]. These s eps
include open coding, iden i ying concep s and
de eloping concep s in e ms o hei p ope ies and
dimensions, analyzing da a o con ex , inco po a ing
p ocesses in o he analysis, and in eg a ing ca ego ies.
MAXQDA 10 so wa e was u ilized o manage
quali a i e da a.
Rigo
To e alua e he accu acy and scien i ic alidi y o he
indings, he c i e ia es ablished by Lincoln and Guba
we e employed [23]. To enhance he c edibili y o he
indings, long- e m engagemen wi h he esea ch opic
and alida ion we e conduc ed wi h he esea ch
pa icipan s. In his s udy, he esea che was deeply
in ol ed wi h he esea ch opic and da a o e an
ex ended pe iod. Fu he mo e, he ex o he in e iew
and he esul ing open codes we e sha ed wi h he
a ailable pa icipan s, and he deg ee o alignmen o he
ideas ex ac ed om he da a was compa ed wi h he
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pa icipan s' opinions. Any co ec ions hey sugges ed
we e aken in o accoun . Pee e iew was also u ilized as
a means o bols e he c edibili y o he da a. Fo his
pu pose, he comple e ex o he conduc ed in e iews
and he ele an codes, concep s, and eme ging
ca ego ies we e sen o e e ees and colleagues o hei
e iew and c i ique o he coding and analysis p ocess.
Th oughou he esea ch, he codes, concep s, and
eme ging ca ego ies we e epea edly sha ed wi h expe s
amilia wi h quali a i e esea ch o solici hei
eedback, leading o c i icism and con en e isions.
Pa icipan s we e selec ed o ensu e maximum di e si y
in demog aphic cha ac e is ics. Accu a e documen a ion
o esea ch s eps and p ocesses was also p io i ized o
enhance he alidi y o he esul s. In his s udy, all s ages
o da a collec ion, coding, da a analysis, and p esen a ion
o indings we e a icula ed in de ail and dep h whene e
possible. Addi ionally, all in e iews we e eco ded,
ansc ibed, and analyzed. The me iculous and s ep-by-
s ep documen a ion o he esea ch p ocess acili a ed
audi ing and ollow-up o he esea ch ac i i ies. Table
1 shows he p ocess o o ming a ca ego y om he
pa icipan s' s a emen s.
Resul s
The in e iew p ocess las ed 6 mon hs, wi h an a e age
du a ion o 40 minu es. Nine ace- o- ace in e iews (6
indi idual in e iews and h ee ocus g oups) we e
conduc ed wi h 16 pa icipan s. The cha ac e is ics o
he pa icipan s a e de ailed in Table 2.
Table 1. An example o he p ocess o o ma ion o ca ego y om he pa icipan s' s a emen s
Ca ego y
Subca ego ies
Ini ial code
S a emen s
Lea ning dis ess
Disappoin men
Feelings o ailu e ollowed by a oidance o
acing he ea
I did no pa icipa e in he su ge y due o he
ea o acing he doc o and he e o e I eel like
a ailu e
Remaining
conce n
The possibili y o no achie ing lea ning
goals in he u u e
My bigges ea is ha I won' know any hing
a e g adua ion, and his wo ies me
Hidden ea
P e ending o be success ul in lea ning
When my eache asked me o go o a
caesa ean sec ion, I old him o go o ano he
one and I know... A e a while, I panicked
because i wasn' eally like ha .
Table 2. Cha ac e is ics o s udy pa icipan s
In e iew
Pa icipan
Age
Sex
Academic semes e
Ma iage
1
1
22
Male
4
Ma ied
2
23
Female
6
Single
3
22
Female
4
Single
4
28
Female
8
Ma ied
2
5
21
Female
4
Single
6
26
Female
8
Single
7
24
Female
6
Single
3
8
28
Female
7
Single
9
25
Female
5
Single
10
24
Female
3
Ma ied
4
11
22
Male
6
Single
5
12
21
Male
5
Single
6
13
23
Male
6
Single
7
14
21
Female
7
Single
8
15
29
Female
7
Ma ied
9
16
21
Female
5
Single
1- Open coding and iden i ying concep s and
de eloping concep s in e ms o hei p ope ies and
dimensions
The analysis o aw da a esul ed in he iden i ica ion o
112 p ima y codes. A e me ging simila codes, 80
codes we e included in he analysis p ocess. This
classi ica ion o p ima y codes led o he de elopmen o
13 subca ego ies and ul ima ely 4 ca ego ies (Table 3).
By he end o his s age, he main conce n was iden i ied.
The mos signi ican conce n, which was he ea o
making mis akes, was exp essed by s uden s ega ding
hei lea ning in he ope a ing oom en i onmen . They
indica ed ha hey we e e y app ehensi e abou being
ha med by he sys em while lea ning clinical p ocedu es.
This u gen issue equi es immedia e a en ion and
ac ion.
Pa icipan numbe 7, a 24-yea -old emale in he 6 h
semes e , said: "When I'm in he d essing oom and my
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shi is abou o s a , I'm a aid ha i I don' do
some hing, I'll ha e a p oblem... "
Pa icipan numbe 11, a 22-yea -old male in he 6 h
semes e , said: "I once made a se non-s e ilized... and
hen I'm a aid ha i I make a mis ake again, i will
cause me p oblems.”
2- Analyzing da a o con ex
The esul s a his s age e ealed ha he unce ain
lea ning en i onmen is a sou ce o s uden s' ea o
making mis akes. In o he wo ds, ope a ing oom
s uden s a e a aid o ge ing hu in his unp edic able
lea ning se ing. The unce ain lea ning en i onmen is
also a ec ed by ac o s such as he dispa i y be ween
heo y and p ac ice and he non-educa ional con ex ,
which con ibu es o s uden s' ea o making e o s.
Pa icipan numbe 6, a 26-yea -old emale in he 8 h
semes e , said: "Du ing a su ge y, one o he pe sonnel
made a mis ake, and hey blamed he mis ake on me. Isn'
his educa ional, and we ha e o ha e he oppo uni y o
make mis akes o lea n? This makes me a aid o making
mis akes."
Pa icipan numbe 13, a 23-yea -old male in he 6 h
semes e , said: "Once I was washing hands wi h a s a
membe ... I saw he was doing some hing e y di e en
om wha hey old us in he class oom. I was a aid ha
I was doing some hing w ong.
Table 3: Ca ego ies and subca ego ies o clinical lea ning p ocess o su gical echnologis s uden s
Ca ego ies
Subca ego ies
Unce ain lea ning en i onmen
The di e ence be ween heo y and p ac ice
Ambiguous lea ning en i onmen
Fea o making a mis ake
Doc o 's opinion p e e ed
T us building
A oiding pe o mance leading o lea ning o p e en p oblems
Rela ionship-o ien ed s a egy o achie e success
Educa ional p og ess
Imagina ion
S i e o op imal lea ning
E ec i e educa ional in as uc u e
Being lexible
Lea ning dis ess
Disappoin men
Remaining conce n
Hidden ea
3- B inging p ocess in o he analysis
Examining he da a o he s udy e ealed ha in he ace
o he ea o mis akes, he ope a ing oom s uden s used
s a egies such as being lexible, using ela ionship-
o ien ed s a egy o achie e success, and a oiding
pe o mance, leading o lea ning o p e en p oblems.
These s a egies we e acili a ed by a sui able
educa ional in as uc u e and con ounded by he
doc o 's opinion e e al. S uden s' use o hese s a egies
esul ed in lea ning dis ess in hem.
3-1- S uden s' lea ning s a egies
Due o hei ea o mis akes, s uden s use s a egies o
a oid ha m. In his ega d, s uden s use he h ee
s a egies o being lexible and ela ionship-o ien ed o
achie e success and a oid pe o mance, leading o
lea ning o p e en p oblems. The s a egy o being
lexible helps hem o adap o exis ing un a o able
condi ions. Using he ela ionship-o ien ed s a egy o
achie e success, s uden s y o o e come hei ea s by
c ea ing posi i e and good ela ionships wi h o he s and
in luen ial people. Using he s a egy o a oiding
pe o mance leading o lea ning o p e en p oblems,
s uden s y o a oid si ua ions ha hey hink will c ea e
p oblems o hem and, in o he wo ds, do no hing.
Pa icipan numbe 2, a 23-yea -old emale in he 6 h
semes e , said:“E e since I made a mis ake du ing he
su ge y, I ha e become e y cau ious, and I y o be
gen le in e e y ope a ion... This is good o me.”
Pa icipan numbe 10, a 24-yea -old emale in he 3 h
semes e , said: “E e since I made a mis ake du ing he
su ge y, I ha e become e y cau ious, and I y o be
gen le in e e y ope a ion... This is good o me. I didn'
say any hing o one o he s a who insul ed me and I
didn' answe him.... ”
3-2- Facili a ing and con ounding ac o s a ec ing he
p ocess: App op ia e educa ional in as uc u e,
doc o 's opinion p e e ed.
S uden s use s a egies o p e en ha m o hemsel es.
Fac o s such as sui able educa ional in as uc u e can
acili a e hese s a egies, and he doc o 's opinion
in as uc u e in his educa ional sys em con ounds hem.
The exis ence o sui able educa ional in as uc u e,
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including he app op ia e eache and en i onmen , and
he educa ional beha io o he ca e eam can acili a e
s uden s' use o hese s a egies. On he o he hand, he
doc o 's opinion p e e ence in he clinical educa ion
sys em can dis o hese s a egies.
Pa icipan numbe 15, a 24-yea -old emale in he 7 h
semes e , said: “One o he pe sonnel, who was also ou
aine , suppo ed me when we we e in su ge y wi h he
doc o and he doc o complained abou me, and in his
way, he ela ionship be ween he doc o and me
imp o ed.”
Pa icipan numbe 9, a 25-yea -old emale in he 5 h
semes e , said: “Du ing an ope a ion, he su geon made
a mis ake... he did no each he s a , he s uck wi h me...
This p ocess caused my ela ionship wi h ha s a and
doc o o become bad, and I became so wi h hem
du ing he ope a ion...”
3-3- Ou come: lea ning dis ess
To o e come hei ea o mis akes, s uden s used
s a egies ha p o ec hem om ha m. Howe e , hese
s a egies caused lea ning dis ess in hem. In o he
wo ds, he s a egies hey used could no emo e he ea
o mis akes in hem, and despi e using hese s a egies,
hey expe ienced dis ess and su e ing in lea ning.
Pa icipan numbe 1, a 22-yea -old male in he 4 h
semes e , said: "Al hough I didn' go o he su ge y due
o he ea o ge ing in o ouble wi h he doc o , I eel
ha I missed a p ope p ocedu e, which makes me sad."
Pa icipan numbe 14, a 21-yea -old emale in he 7 h
semes e , said: "E en hough I imp o ed my ela ionship
wi h he ope a ing oom supe iso and he likes me, ha
day he old me ha i you don' lis en, I won' gi e you a
g ade. A pe son becomes con lic ed abou who is good
and who is bad..."
Pa icipan numbe 12, a 21-yea -old male in he 5 h
semes e , said: "In o de o le me go o su ge y, I
imp o ed my ela ionship wi h he o hopedic doc o , bu
when he became busy, he seemed o o ge ou
ela ionship and ea ed me inapp op ia ely, which made
me eally disappoin ed."
4- In eg a ing ca ego ies
De e mining he co e a iable: Examining he in e iews
as well as analyzing he esul s and memos, e ealed ha
s uden s, in he ace o he ea o ha m as hei p ima y
conce n, use he s a egies o being a lexible and
ela ionship-o ien ed s a egy o achie e success and
a oiding pe o mance and leading o lea ning o p e en
p oblems. Which esul s in lea ning dis ess o hem. A
compa a i e and con inuous s udy o he s a egies used
by s uden s showed ha o educe hei anxie y; s uden s
ac acco ding o he s a ed s a egies o p o ec
hemsel es; in o he wo ds, in an unce ain lea ning
en i onmen , hey ac only o p o ec hemsel es om
he si ua ion. Sel -p o ec ion is a he op o hei lea ning
p ocess, so sel -p o ec ion is conside ed a he highes
le el o hese s a egies.
Pa icipan numbe 6, a 26-yea -old emale in he 8 h
semes e , said: "A he beginning o he ope a ion, I was
in sc ubs, and he s a was explaining some hing w ong.
E en hough I knew i was w ong, I con i med his
ela ionship wi h me so ha he pe son wouldn' eel bad
abou me, and he liked i , oo. I did some hing w ong, bu
I jus wan ed o p o ec mysel and he o he s uden s."
Pa icipan numbe 8, a 28-yea -old emale in he 7 h
semes e , said:
"In he neu ology ope a ing oom, he sc ub nu se made
a mis ake and blamed i on he s uden ... he doc o also
insul ed us... I kep silen so ha my ela ionship wi h he
o he s would no be damaged and hey would le me go
o he ope a ion..."
Because he concep o sel -p o ec ion is a he highes
le el o each o he s a egies, he s o yline can be
o mula ed as ollows: In an unce ain lea ning
en i onmen , s uden s a e a aid o being ha med, so hey
use h ee s a egies: being lexible, using ela ionship-
o ien ed s a egy o achie e success and a oiding
pe o mance leading o lea ning o p e en p oblems.
These s a egies a e all de eloped by s uden s o p o ec
hem om ha m. These s a egies a e acili a ed by
sui able educa ional in as uc u e and dis o ed by
doc o 's opinion e e al. Using hese guides causes
lea ning dis ess in s uden s. In o he wo ds, hei
s a egies aim o educe he ea o ha m; howe e , gi en
a lack o p ope lea ning, i ollows hem wi h dis ess
and su e ing. Finally, acco ding o he posi ion o each
o he s a egies used in ela ion o he concep o sel -
p o ec ion and hei ela ionship wi h each o he , sel -
p o ec ion was chosen as he co e a iable, and o he
a iables we e in eg a ed a ound i . Then, he heo y o
sel -p o ec ion in he lea ning en i onmen was
de eloped as a clinical lea ning p ocess o su gical
echnologis s uden s. The componen s o he heo y a e
shown in Figu e 1.
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Figu e 1: The con ex ual model o clinical lea ning p ocess o su gical echnologis s uden s
Discussion
The cu en s udy sough o unde s and he clinical
lea ning p ocess o su gical echnologis s uden s. The
indings sugges ed ha s uden s a e conce ned abou
po en ial inju y in an unclea lea ning en i onmen . To
sol e his issue, hey used echniques such as lexibili y,
ela ionship-based app oaches o success, and a oiding
pe o mance demands, which esul ed in lea ning ha
would sa egua d hem. Howe e , hese s a egies did no
yield he desi ed ou comes and caused hei lea ning
dis ess. Mi zaei e al., in hei in es iga ion o nu sing
s uden s' unde s anding o he clinical lea ning se ing,
no ed ha a ious s imuli in luence nu sing s uden s'
comp ehension o his en i onmen h ough a ou -s ep
p ocess. These s ages included expe iencing and
p ocessing ini ial expec a ions, engaging wi h he
planned en i onmen , na iga ing he clinical lea ning
se ing, and eeling he de elopmen o pe sonal and
p o essional skills and quali ica ions [16]. Naja i
Kalyani e al., in hei s udy examining nu sing s uden s'
expe iences in he clinical lea ning se ing, e ealed ha
s uden s aced iden i y con usion due o an inadequa e
lea ning en i onmen , which hey iden i ied as hei
p ima y conce n. In esponse o his conce n, hey
employed speci ic s a egies, some o which kep hem
om en e ing uncom o able si ua ions. Un o una ely,
hese solu ions did no esol e hei issues and hinde ed
hei accep ance o p o essional oles and
esponsibili ies. Con e sely, o he s a egies acili a ed
hei p o essional de elopmen and enabled hem o
emb ace hei oles wi hin he clinical se ing [20].
In analyzing hese s udies, i should be no ed ha
s uden s' unde s anding o he clinical en i onmen ,
which o en di e s om he exis ing challenging
en i onmen , equen ly con uses hem and leads o
a ying consequences based on he s a egies hey
employ o cope. Gi en he s ess ul se ing o hei
lea ning, he p ocess o e alua ing he cu en condi ions
by ope a ing oom s uden s should guide hem owa d
posi i e s a egies wi h he suppo o he educa ional
sys em o mi iga e nega i e ou comes such as lea ning
dis ess. Eks ed e al. conduc ed a compa a i e c oss-
sec ional s udy in Sweden o in es iga e nu sing s uden s'
imp essions o he clinical lea ning en i onmen and
supe ision in wo al e na i e supe ision models. The
da a e ealed ha bo h app oaches p o ided pupils wi h
a a o able lea ning en i onmen . An e ec i e lea ning
se ing o s uden s in clinical con ex s elies on a clea
s uc u e o in eg a ing s uden s and an educa ional
a mosphe e whe e s a a e commi ed o supe ising
s uden s and a e eadily accessible, os e ing e ec i e
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: Clinical lea ning p ocess o su gical echnologis s uden s
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in e ac ion and collabo a ion be ween ins uc o s and
s uden s. Clinical aine s o nu ses should be p esen
[18]. Chan e al. asse ha epe i i e opics in he clinical
en i onmen lead o nega i e expe iences o s uden s.
S uden s en e clinics wi h inadequa e p epa a ion and
p econcei ed no ions abou clinics and nu sing. When
con on ed wi h an unsuppo i e a mosphe e, nega i e
beha io s and a i udes om nu ses, e c., hey encoun e
con lic s be ween hei expec a ions, lea ned subjec s,
and he eali y in clinics [15].
In he analysis o his s udy, i should be said ha he use
o suppo models in which s uden s ha e enough
in e ac ion wi h p o esso s and s a can play an e ec i e
ole in s uden s' sa is ac ion and choosing posi i e
lea ning s a egies. Howe e , in he p esen s udy, due o
he dis o ed communica ion be ween he s uden s and
he ca e eam, he s a egies used by he s uden s we e
inapp op ia e and aimed a p o ec ing hemsel es.
Ka imi Monaghi e al., in a quali a i e s udy aimed a he
clinical lea ning expe ience o medical s uden s, ound
11 hemes ha indica ed he clinical expe iences o
medical s uden s. These subjec s include he na u e o
clinical lea ning, no belonging o he medical g oup,
wo y and anxie y caused by he p og am, he
ela ionship be ween he lea ne and he eache , he
di e en pla o ms and sou ces o clinical lea ning,
u ning po en ial abili ies in o ac ual ones, inding
onesel in he clinical se ing, A ac i e aspec s o
clinical expe ience, con lic be ween wo k and lea ning,
dependence and lack o clinical lea ning. Fu he mo e,
he esul s o his s udy showed ha clinical lea ning
leads s uden s o become p o essionals in medicine [24].
Mbakaya e al. (2020) in es iga ed nu sing and
midwi e y s uden s' expe iences and pe cep ions o he
clinical lea ning se ing in Malawi in a mixed-me hods
s udy. The esul s showed ha nu sing and midwi e y
s uden s encoun e ed mul i ace ed challenges, including
lack o esou ces, poo communica ion wi h s a , and
lack o suppo om clinical eache s, which hu hei
clinical lea ning expe iences [19]. In a s udy, Sayadi e
al. in es iga ed nu sing s uden s' iews abou he clinical
lea ning en i onmen and he ac o s a ec ing i . The
esul s o his s udy indica e ha he highes a e age
sco e ob ained ela ed o he a eas o sa is ac ion and
in e pe sonal ela ionships, as well as he a eas o
pa icipa ion and pe sonaliza ion o he clinical lea ning
en i onmen , had weaknesses [25]. Some o he hemes
p esen ed in his s udy a e simila o he ca ego ies o he
p esen s udy and show he con lic be ween heo y and
p ac ice. Also, he s uden 's conce n abou whe he his
lea ning p ocess in he clinical en i onmen can ac ualize
hei alen s and achie e compe en lea ning o he
u u e o hei ca ee s is wo h men ioning, which is in
line wi h he ou come o he p esen s udy.
Among he limi a ions o he p esen s udy, i can be
poin ed ou ha since he p o esso s conduc ed he
in e iew, pe haps he s uden s needed o be mo e
com o able exp essing hei expe iences. In his ega d,
a he beginning o he in e iew, i was emphasized o
he s uden s ha hese expe iences and hei s a emen s
would no a ec he p ocess and a i ude o he p o esso
owa ds he s uden s, and an en i onmen was ied o
p o ide he s uden s wi h com o du ing he in e iew.
Conclusion
This s udy was conce ned wi h explaining he clinical
lea ning p ocess o su gical echnologis s uden s. The
esul s sugges ed ha s uden s ea mis akes in he
unce ain lea ning en i onmen and use sel -p o ec ion
s a egies, which cause dis ess in hei lea ning.
S uden s' lea ning p ocess should be imp o ed by using
app op ia e educa ional plans and imp o ing he
ope a ing oom's educa ional a mosphe e. F equen
moni o ing o clinical en i onmen s and iden i ica ion o
p oblems and challenges in he ope a ing oom
en i onmen by educa ional manage s h ough
in e iews and obse a ions by educa ional o icials will
enable app op ia e planning. Ac ions such as using
app op ia e aining models om employees can
imp o e he gaps in he need o acul y aine s.
Iden i ying s uden s' ea and anxie y du ing he lea ning
p ocess will also help o elimina e hem and p e en
nega i e consequences. Because he s a egies used by
he s uden s in dealing wi h hei ea o no lea ning and
making mis akes a e no sui able and because he
s uden s canno deal wi h he exis ing condi ions and
p oblems, i is mo e in line wi h p o ec ing hemsel es
and ge ing g ades and sa is ac ion he en i onmen , i
canno compensa e o hei lea ning gap.
The e o e, i is necessa y o imp o e s uden s' lea ning
by using s a egies such as inc easing s uden s' sel -
con idence and no ollowing he exis ing app oach o
gain he sa is ac ion o he aining eam and a oid many
nega i e consequences. I is also ecommended ha
clinical manage s expand he educa ional a mosphe e in
he ope a ing oom en i onmen and c ea e a posi i e
a i ude among he employees o help educa e s uden s in
hese en i onmen s and ha e heal hy and educa ional
communica ion wi h he educa ional sys em.
Cons uc i e communica ion be ween he clinical
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104 Jou nal o Medical Educa ion De elopmen ¦ Volume 18 ¦ Issue 1 ¦ 2025
en i onmen and he educa ional sys em and
emphasizing he impo ance o s uden educa ion can
help imp o e he educa ional a mosphe e in clinical
en i onmen s.
E hical conside a ions
This s udy was app o ed by he Shah eko d Uni e si y
o Medical Sciences (IR.SKUMS.REC.1400.136). The
e hical p inciples o consen , independence, and
con iden iali y we e obse ed o he pa icipan s.
W i en in o med consen was ob ained om all
pa icipan s, and hei pa icipa ion in he s udy was
olun a y. They we e also assu ed o he con iden iali y
o hei in o ma ion. Be o e conduc ing he in e iew,
he pa icipan s we e in o med abou he pu pose and
me hod o he s udy, and w i en consen was also
ob ained om hem o audio eco ding and no e- aking
du ing he in e iew.
A i icial in elligence u iliza ion o a icle
w i ing
G amma ly is used in his pape .
Acknowledgmen
The p esen s udy is a esea ch p ojec app o ed a
Shah eko d Uni e si y o Medical Sciences (T acking
Code: 5729). The au ho s hank all he dea s uden s who
helped us conduc he esea ch.
Con lic o in e es s a emen
The au ho s decla e ha hey ha e no con lic o in e es .
Au ho con ibu ions
M.R. concep ualized and designed he s udy and
collec ed he da a, M.S. designed he s udy and analyzed
he da a, A.T. analyzed he da a, and S.M. and F.M.
w o e he main manusc ip ex . The au ho s me he
c i e ia o au ho ship and played a ole in p epa ing he
manusc ip . Mo eo e , he au ho s app o ed he inal
manusc ip .
Funding
The Shah eko d Uni e si y o Medical Sciences
suppo ed his a icle.
Da a a ailabili y s a emen
The da ase s used and/o analyzed du ing he cu en
s udy a e a ailable om he co esponding au ho upon
easonable eques .
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