By: Courtney Lewis & Alivia English

When you hear the word “incivility” what comes to mind? Do you think of situations of being treated unfairly or in an unprofessional way? Do you associate the word with something negative or unpleasant? These are common responses to the word incivility, which was defined by Godfred Boateng and Tracey Adams (2016) as behaviors in the workplace that have negative impacts on safety, integrity, and dignity. Now, when you hear the word incivility, do you think of clinical education?

Unfortunately, these unfair and unpleasant experiences defined as incivility are often experienced in higher education in general. More specifically, research shows that incivility is commonly being experienced within clinical education as students engage in different learning experiences with clinical educators. Incivility is not isolated to any one discipline. The research indicates that this is a problem in programs such as nursing, athletic training, social work, and speech-language pathology, among many others. 

Incivility in clinical education can take many forms, including excessive monitoring of work, withholding information affecting performance, having opinions ignored, and being exposed to unmanageable workloads (Bolding et al., 2020). These things can have a major impact on the clinical learner and their experiences in the clinical setting, and can range from personal, such as decreased student confidence and learning, to more external aspects, such as missed doses of medications due to gaps in communication (Anthony & Yastik, 2011). 

Fortunately, Anthony & Yastik (2011) report that students generally experience more positive interactions with their clinical educators than negative. However, positive and negative experiences do not hold equal weight. It is said that it takes multiple positive interactions to “cancel out” a negative one, and this would be especially true within clinical education.

We know from the literature, and anecdotally, that students want to feel like they belong at their clinical education sites. Quite the opposite of experiencing incivility, students want to feel accepted, appreciated, and needed. They need a place to safely ask questions, make mistakes, and be socialized into the field they are studying. Tracy Levett-Jones and colleagues (2008) found that students believed this idea of belonging was related to how their clinical educators included or excluded them in the clinical environment. They found that relationships are a key influence on how students experience belonging. In a similar article, Levett-Jones and Lathlean (2008) found that when students feel that they belong, they are more empowered to take advantage of the learning environment; furthermore, when students felt accepted by their clinical educators, they were more motivated to learn. 

Eastern Michigan University has a strong history of facilitating the development of close bonds between students and faculty. Just in the past year, the EMU Faculty Development Center has been running a learning community called Teaching and Learning Together (TaLT) that is aimed at building up and restoring these relationships as we emerge from the jolt that COVID threw into higher education. 

It is time to put that same energy into clinical experiences and facilitate these bonds between students and clinical educators. When students feel like they belong and have positive clinical education experiences, they are more confident and motivated to remain in programs and persist until graduation. In an effort to work toward this, we are excited to introduce a new learning community that will take place during the 2023-24 academic year that focuses solely on clinical education. We believe that a positive clinical experience is vital for both students and clinicians, and this begins with strong partnerships between the two. These relationships foster growth, confidence, and learning, all of which are valuable characteristics of clinicians.

This learning community will expand on the findings of TaLT and focus on identifying mechanisms for increasing belonging in clinical education with an emphasis on the areas of (1) receptiveness; (2) inclusion and exclusion;(3)  legitimization of the student role; (4) recognition and appreciation; and (5) challenge and support, the major themes that Levett-Jones and colleagues (2008) introduced. These themes will serve as a model for this learning community, with the integration of other critical elements from similar research. 

If you are a clinical instructor who is currently supervising students in a clinical setting, whether it be on-campus or off-campus, and you are interested in engaging with a group of students and educators to explore this idea further, consider applying to be a member of this learning community. 

We have a unique opportunity with this learning community to create change and be a leader within the world of clinical education. By taking part in this initiative, clinical instructors can dig deeper into what a positive relationship between them and their students looks like, learn how to implement these topics into practice, and develop an artifact to teach others how to facilitate these partnerships. We hope you will consider joining us on this journey.