Exploring sterile processing technology program students’ and preceptors’ perceptions of the clinical learning environment

Due to their vital role, SP technicians need both theoretical grasp and practical skills. Consequently, clinical education is vital for shaping capable and confident practitioners.^[5] A key part of clinical education that promotes student learning is the Clinical Learning Environment (CLE). It represents a dynamic, complex system of impacts that strongly influences students’ clinical learning results.^{[6, 7]} In health professional training, CLE is essential because it provides students with a space to apply theoretical knowledge in real-world settings and enhance their clinical skills. Despite the importance of sterile processing in the health care system and the emphasis on the value of immersive clinical exposure for allied health professionals’ education, few studies have examined the learning experiences of SPT students. There is limited research on how SPT students view their clinical learning environments. Therefore, this literature review draws on studies involving nurses and other healthcare professionals to address the research gap in students’ perceptions of sterile processing.

The reviewed literature indicates that students across healthcare disciplines, including medicine, radiology, and nursing, regard the CLE as essential to their training and clinical education. It enhances hands-on experience, builds confidence, fosters social interaction, and promotes personal connections. Studies emphasise the importance of a supportive CLE that features experienced clinical instructors, opportunities to develop clinical skills, preparation for real-life situations, and appropriate facilities.^[7] Additionally, it delivers numerous benefits, such as increased motivation, active engagement, self-confidence, and student satisfaction. Moreover, it helps students meet their educational needs and improves their clinical skills.^[5]

Students’ perceptions of their clinical experience and learning vary with the quality of the clinical learning environment, which is influenced by many factors that may enhance or impede students’ clinical learning.^[7] Numerous studies have explored the factors that improve student learning in clinical settings. These include support from peers and instructors, a well-organised setting with advanced facilities, student preparedness, qualified instructors and preceptors with positive communication skills, and opportunities for independent practice. However, only a few studies have focused on preceptors’ perceptions.

A cross-sectional study by Maalouf and El Zaatari^[8] involving 217 undergraduate nursing students in the United Arab Emirates found that peer and instructor support were seen as the main factors promoting a positive learning experience. Similarly, Ergezen et al.^[9] report that students viewed the CLE as supportive due to clear instructor guidance, opportunities for active participation, a caring attitude, and meaningful feedback. Bawadi et al.^[10] also found that nursing students and clinical instructors shared perceptions about the CLE. Their results aligned with earlier studies by Ergezen et al.^[9] and Maalouf and El Zaatari,^[8] emphasising the importance of flexible, supportive instructors, positive role models, and hands-on practice. Conversely, Yan^[11] observed that physiotherapy and speech therapy students had positive views when supported by preceptors, while medical students expressed negative perceptions due to insufficient supervision and inadequate feedback.

Clinical preceptors and educators have also reported similar facilitators in clinical settings, as noted by Kagawa et al.^[12] The clinical educators emphasised key factors in the clinical environment that support effective clinical education, including strong partnerships between academic institutions and clinical settings, well-organised placements, and regular student feedback. This finding was consistent with other studies that examined preceptors’ and educators’ perceptions of clinical learning environments, such as Koy^[13] and D’Souza et al.^[14]

While the CLE is widely recognised as vital to healthcare professionals’ education and provides considerable benefits and support, it also entails significant barriers for students. These barriers hindered students’ learning and clinical placement experiences. These barriers include uncooperative preceptors or staff, very busy units or heavy workloads, limited access to learning resources, insufficient clinical facilities and equipment, and communication.^[6]

A common challenge reported by students in nursing, midwifery, and radiologic technology programs was the lack of autonomy. In Singapore, Woo and Li^[15] noted that nursing trainees felt demotivated due to passive roles and limited opportunities to make clinical decisions or influence their learning. Similarly, Ergezen et al.^[9] reported that nursing students in Turkey experienced the same issues. Radiography students in Zimbabwe faced comparable difficulties, such as financial constraints, insufficient institutional support, poor facilities and supervision, disruptive interpersonal behaviours, and pandemic-related stress, all of which negatively impacted their clinical learning.^[16] From the preceptors’ perspective, the main challenges were limited training time, heavy workloads, and, at times, inadequate facilities.^[17]

Another obstacle is the quality of educators and the level of supervision. Mbakaya et al.^[18] found in their study on nursing and midwifery students’ perceptions of their CLE that students viewed insufficient supervision as a major challenge that impeded their clinical training. Similarly, Jacob et al.^[19] in Tanzania reported multiple issues, for example, inadequate and infrequent supervision by overburdened instructors.

These findings correspond with those of Ziba et al.^[20] in Ghana, indicating that students are less satisfied when supervision is inconsistent. Additionally, Baghdadi et al.^[21] found that not only inadequate supervision, but also inconsistent feedback serve as barriers to learning in clinical environments. All the studies underline the key role of instructor-led training and continuous feedback. In this context, preceptors in D’Souza’s (2013) study recognised the significance of feedback for effective clinical learning.

The literature review indicates that CLE is an essential part of clinical learning for all healthcare professionals. Its impact on students is determined by the clinical settings’ atmosphere and the calibre of instruction provided by instructors or preceptors. Moreover, student and preceptor perceptions vary by environment and profession: medical students valued greater engagement and autonomy, whereas nursing and midwifery students linked their perceptions to patient care and clinical decision-making, and radiology students appreciated more hands-on practice and equipment handling. In general, facilitators of clinical learning identified across studies can be divided into individual factors related to students and preceptors, such as communication, and placement factors, including clinical context, culture, and facilities. Students across all disciplines often reported challenges, including limited hands-on practice, inconsistent instruction, limited resources, and emotional difficulties.

This suggests that we should explore and compare SPTP students’ perceptions with those of students in other disciplines. Thus, this proposed study aims to investigate the perceptions of SPTP students and their preceptors regarding the clinical learning environment and to deepen understanding of their lived experiences and the factors that support or hinder their learning. The study will focus on the facilitators and barriers encountered during clinical placements.

The researchers obtained ethical approval from the Higher Institute of Health Specialities Research Ethical Committee and secured informed consent from participants prior to conducting the interviews.

Participants were recruited using purposive sampling. The sample included eight SPTP students and eight preceptors from six governmental health organisations, all of whom actively participated in teaching SPTP students in clinical settings. Two focus groups were established. The first group comprised SPTP students currently engaged in clinical education, with enrolment in the Diploma in SPTP at HIHS as the inclusion criterion. The second group consisted of preceptors from various hospitals who are actively involved in clinical teaching, with inclusion criteria requiring participation in clinical education activities.

In-depth interviews were audio-recorded using a semi-structured interview guide developed based on existing literature. The focus group questions were piloted with a small sample of students and preceptors similar to the study population. Institutional experts also reviewed the questions, which clarified the wording and intent. Both students and preceptors indicated that the questions were simple, straightforward, and easy to understand. As a result, no major modifications were made to the interview guide.

Data were analysed using interpretive phenomenological analysis to provide detailed examinations of participants’ lived experiences.

Multiple strategies were adopted to ensure rigor within phenomenological focus groups. Reflexivity and bracketing were maintained through the use of a reflexive log, which enabled the recognition and suspension of researchers’ beliefs and assumptions. Participants were selected based on direct experience with the phenomenon, and small, closely matched groups were used to enable deeper investigation.

Focus group discussions were structured to elicit shared understanding and core experiences through guided dialogue. Audio recordings ensured accurate capture of verbal interactions. Data analysis was conducted transparently to identify themes from participants’ descriptions. Credibility was enhanced through peer review and verification. Ethical considerations were addressed by establishing clear ground rules for focus group interviews to minimise conformity influences common in group settings.

Students reported that the initial orientation provided during clinical placements is insufficient and leads to confusion, particularly regarding roles and responsibilities.

“We don’t receive much detailed orientation; everything is quite different, and we will be confused about what we are supposed to do and what our duties are.”

Students experienced ambiguity in their duties during clinical placement, leading to disorganisation and wasted learning opportunities. They recommended a structured orientation and clearly defined roles and responsibilities to enhance learning outcomes.

“Tasks and assignments aren’t always explained to us clearly, good planned orientation program will be more suitable to ensure that we do what we are supposed to do, and do not miss any chances to learn.”

The students explained that the assessment does not align with clinical and theoretical evaluations. Also, competency checklists are seldom signed by preceptors, which limits the reliable tracking of student progress.

“Tests are repetitive and do not match what we learn at the institute.”

"Preceptors rarely sign our competency checklists; this makes them unable to follow our progress in the clinical areas.”

Some students stated that the negative attitudes and behaviours displayed by certain peers create a poor impression, which influences how preceptors perceive subsequent groups of students. Conducting pre-placement meetings between students and preceptors can help students adjust earlier.

“Some students give a bad impression about others; this affects how preceptors see the new batch of students.”

“Meeting preceptors before starting clinical placement will allow us to adapt faster.”

Students stated that ongoing supervision and prompt feedback are crucial. Having a dedicated preceptor at each hospital provides improved guidance, consistent feedback and learning opportunities.

“We need proper supervision by assigning each student a consistent preceptor to ensure stable support and advice and to allow us to receive timely, regular feedback.”

Students favoured continuous placement blocks of 2–3 weeks to help maintain focus and minimise fragmentation.

“Offering full two or three-week blocks could improve our ability to focus and learn more effectively.”

Students stressed that improving communication between the institute and hospitals is essential to ensure that students receive consistent instructions and meet the expectations of the clinical placement.

“Meetings between the institute and preceptors should happen to share even information about our objectives, competencies, and what is expected from the preceptors.”

Students highlighted that some preceptors are hesitant to train them, and they stressed that choosing motivated preceptors who are willing to teach them is needed to s improve their skills.

“Some preceptors demonstrate reluctance to teach us, and we need those who are truly interested in teaching us, as they can add more to our clinical experience.”

The second focus group explored the preceptors’ perceptions of the Clinical Learning Environment. The final analysis revealed several themes:

Preceptors noted that students demonstrated understanding of concepts and terminology but had difficulty applying this knowledge in practice.

“They know the names of instruments and some related information, but when they come to practice, they cannot demonstrate.”

Several participants highlighted that students remained preoccupied with examinations during clinical rotations, limiting their engagement in practical learning.

“Most of the time, they come with their books. They are thinking about exams, not practice. Their mind is busy with theory while they are in clinical.”

Preceptors expressed concerns related to professionalism; they described issues related to punctuality, communication, and professional etiquette.

“Some students come late, leave early, and sometimes go without permission.”

“In our culture, when you enter the department, you say salam, good morning. Some students just enter without saying anything.”

Participants noticed significant differences in student motivation. Some students were praised for their enthusiasm and eagerness to learn, whereas less engaged students seemed to have a greater negative impact on the group’s learning environment than others. Additionally, participants associated the expectation of secure employment after graduation with reduced urgency and effort among certain students.

Most students are highly motivated and eager to learn, putting in their best effort during clinical practice.

Nevertheless, just one or two disengaged students can impact the motivation of the entire group.

Some students do not feel pressured to work harder or improve their performance because they are confident of securing a job after graduation.

The preceptors emphasised that although they are currently not involved in students’ clinical assessment, they believe they should assess and grade a specific component of the overall clinical placement. Participants felt this approach would improve student accountability, motivation, and engagement during clinical practice.

A specific percentage of the marks for clinical evaluation should be determined and directly assessed by the preceptors overseeing the students.

Students who understand that their clinical performance impacts their final grade tend to be more diligent and committed during training.

Although preceptors expressed strong commitment to student learning, many felt inadequately prepared for the teaching role. There was a clear request for short, targeted training sessions focusing on teaching strategies and managing student behaviour.

Our teaching relies solely on our experience, as we did not receive formal training as preceptors.

“Even a brief workshop on handling students can have a significant impact.”

Preceptors emphasised that large student cohorts pose a major obstacle to effective clinical learning. They recommended using smaller groups and implementing block clinical rotations without simultaneous theory exams.

“When the number is large, students have limited opportunities to practice.”

“Clinical time should be reserved for practical activities only, avoiding interruptions for theoretical exams.”

Preceptors noted that informal communication with academic staff was usually positive. However, they pointed out the absence of structured and consistent feedback systems. Participants strongly recommended establishing regular joint meetings involving preceptors, academic staff, and students to evaluate progress, resolve issues, and enhance coordination between the clinical and academic environments.

We communicate with faculty as necessary, but there is no established or consistent system for providing structured feedback.

“Regular scheduled meetings would help us discuss student progress, identify problems early, and find solutions together.”

“Having even one hour per week for joint discussion between students, preceptors, and faculty would make a big difference.”

Participants frequently referred to challenges related to students’ maturity and readiness for professional responsibility.

“This generation is not mature enough. They don’t take responsibility seriously.”

This study emphasises the importance of structured orientation programs, clearly defined roles, and centralised guidance to enhance students’ readiness for clinical placements. The results highlight the need for consistent supervision by trained and motivated preceptors, supported by formal development initiatives. Additionally, workplace assessments should incorporate preceptor grading into the overall academic evaluation to promote accountability, monitor competency, and ensure alignment with learning objectives. The preference for continuous block placements suggests that re-evaluating clinical schedules might improve deeper learning, enhance skill retention, and facilitate better professional integration. Developing stronger academic clinical partnerships through regular communication, joint evaluation approaches, and coordinated placement planning is essential to improve the quality and consistency of clinical education.

A key strength of this study is its incorporation of both students’ and preceptors’ perspectives, offering a well-rounded view of the clinical learning environment. The qualitative phenomenological method allowed for an in-depth examination of lived experiences, leading to rich contextual insights. Nevertheless, the qualitative approach and the sample size could restrict the generalizability of the findings. Additionally, group discussions may have affected individual responses, so the results should be viewed as context-specific rather than universally applicable.

Future research should incorporate mixed-methods and longitudinal designs to assess how structured orientation and preceptor training influence outcomes. Conducting multi-site and cross-institutional studies is essential for broader relevance and comparative analysis. Additionally, future investigations should explore preceptor workload, motivation, institutional support, and the long-term impact of clinical learning environments on graduate preparedness and their integration into the workforce.