The clinical placement learning environment: a cross-sectional study of the perception of third- and fourth-year medical imaging students in Ghana | BMC Medical Education

The findings from this study provide valuable insights into the perceptions of medical imaging students regarding their clinical placement learning environments in Ghana. The results highlighted key findings related to supervision and support, learning integration, and the overall environment and equity experienced by students. The study achieved its minimum sample size of 252, with the majority (65.2%) of respondents being males.

The majority (85.8%) of the participants were aged 18–24 years, followed by 13.0% aged 25–30 years. The male dominance reported in this study is consistent with related literature [37, 38]. and the relatively smaller proportion of females than males in science-based careers, such as radiography, in Ghana [39, 40]. The age distribution revealed that the majority of the participants were between 18 and 24 years of age, which aligns with the findings of Van et al., [41] who argued that students typically graduate before age 25. The University of Cape Coast (UCC) had the highest response rate, possibly influenced by UCC’s larger student population.

Supervision and support

The findings revealed that students generally perceive supervision and support during clinical placements as adequate, with the majority rating their experiences positively. This emphasised the critical role of adequate clinical supervision in fostering competence and professionalism among students, as highlighted in the literature [10, 15]. Students value supervisors who provide guidance, constructive feedback, and consistent support, which are essential for bridging classroom learning with practical application. The result of a Spearman’s correlation between SS and LI (r =.811, p =.001) as well as SS and EE (r =.771, p =.001) showed a strong positive correlation. This indicates that as supervision and support improve, students’ ability to integrate learning and engage academically also increases significantly. The finding corroborates this evidence that 58.5% of students agreed to having sufficient access to supervision.

To address disparities and enhance student outcomes, investing in supervisor training and addressing systemic challenges, such as overcrowding, are essential steps toward a more effective and equitable clinical education framework.

Environment and equity

The clinical environment and equity received generally positive perceptions among the students, with the majority rating their experiences favourably. This is consistent with the literature that emphasises the importance of fostering inclusivity and fairness within clinical settings to enhance students’ professional growth [16, 42]. However, the moderate percentage of neutral responses highlights the variability in students’ experiences across clinical sites, suggesting that some may feel marginalised or unsupported. This echo concerns previous studies, such as those by Kyei et al. [43] Salifu et al. [44] identified resource limitations, overcrowding, and insufficient supervisor training as systemic challenges that hinder equitable learning environments.

The strong positive correlations between supervision and support, learning integration, and the environment and equity highlight the interconnected nature of these factors. Improvements in one area are likely to benefit others, reinforcing the need for a holistic approach to enhancing student experiences during clinical placements. This finding is supported by research indicating that a supportive learning environment positively influences student satisfaction and retention [45].

Learning and integration

Most participants appeared satisfied with the alignment between theoretical knowledge and practical experience. This is an encouraging outcome, as the integration of classroom learning with clinical practice is crucial for developing competent healthcare professionals. Clinical preceptors must continually work to optimise teaching opportunities and address the diverse learning needs of students while ensuring the delivery of safe, high-quality, patient-centered care in a challenging clinical environment [46]. Research consistently shows that when students perceive a strong connection between theory and practice, they are more likely to engage with their education and feel prepared for real-world challenges [47,48,49,50]. However, the significant percentage of neutral responses highlights existing gaps in the integration process, indicating areas for improvement.

The predictive model conducted in Table 5 revealed that both SS and EE exert a significant positive influence on LI among medical imaging students in Ghana. The analysis shows a 74.4% predictive rate (R² = 0.744; Adjusted R² = 0.742). This suggests that enhanced supervision, combined with inclusivity and fairness, promotes greater engagement and integration. This aligns with prior literature [26, 51,52,53] emphasizing the role of structural support and an equitable environment in mitigating the theory-practice gap.

Perceived challenges

The study revealed key challenges, including overcrowding, limited supervision, and a lack of motivation among supervisors, highlighting significant concerns related to capacity and student well-being. These challenges can be attributed to the increasing number of students in radiography training institutions, while clinical placement training sites remain the same, a common feature in low-resource settings. Overcrowding significantly impacts supervision quality because an increased student-to-supervisor ratio often exceeds manageable levels, thereby reducing student-supervisor contact times. Overcrowding due to limited placement could also reduce opportunities for sufficient hands-on practice [54, 55]. This concern aligns with previous studies suggesting that inadequate supervisory practices can lead to feelings of inadequacy and hinder students’ professional development [45, 56].

Furthermore, 34.4% of the respondents highlighted a lack of motivation among supervisors, indicating the need for formalised training programs to equip supervisors with mentoring skills and strategies for maintaining engagement. It is also essential for supervisors to be motivated by academic institutions to continue providing this critical service. Some of the ways could be the facilitation of free, continued professional development programmes for designated staff at clinical placement sites.

Poor coordination and communication between academic institutions and clinical sites also result in unclear expectations, leaving supervisors unaware of students’ specific learning goals and hindering the ability of supervisors to provide targeted and meaningful support. Additionally, the presence of neutral responses in the data suggests variability in experiences across different clinical settings, emphasising the need for standardised supervisory practices. This finding supports findings in the literature, indicating the need to implement structured feedback mechanisms that could further enhance the learning experience, as timely and constructive feedback remains a critical yet underdeveloped component in many clinical placements [42, 57].

Also, challenges associated with theory-practice integration were found to be consistent with findings from the literature, which highlights a pervasive gap in healthcare education. The students in this study reported issues such as insufficient time for practical application, overcrowding, and inadequate infrastructure, all of which hinder their ability to integrate theoretical knowledge effectively into clinical practice. These concerns align with findings by Salifu et al. [44] Manson et al. [58] and Botwe et al. [19] who identified resource limitations, poorly equipped skills laboratories, and heavy workloads as significant barriers to practical skills acquisition.

Limitations of the study

Notably, the research focused exclusively on students from public universities in Ghana, limiting the generalisability of the results to private institutions. Additionally, the cross-sectional design captures only a snapshot of students’ perceptions at a single point in time, making it difficult to assess changes or trends over time. Also, while multiple institutions were included, some universities had relatively low representation, which may have skewed the findings and limited the diversity of perspectives. Furthermore, as the data was self-reported, the study may be subject to information and recall bias, which could have influenced the accuracy of participants’ responses.

Recommendation

To enhance the clinical learning environment, academic institutions and clinical sites require coordinated efforts to address the issues of overcrowding, frequent equipment breakdowns and insufficient infrastructure with the help of policymakers. Additionally, effective communication and collaboration between universities and clinical sites will help align expectations and improve the degree of integration between theoretical knowledge and practical training. Structural orientation and mentorship programs for clinical educators can improve motivation and ensure consistency in teaching practices. It is also recommended that institutions invest in simulation laboratories to help bridge the theory and practice gap.