INTRODUCTION The quality of the educational environment has frequently been identified as crucial to effective learning. Aspects of the clinical context differ from those of other higher education environments. This study explored the educational climate (the environment perceived by students) at a single medical school. The article focuses on the perceptions of students in the early stages of their clinical course. METHODS A longitudinal study of the school was carried out over a 5-year period from 1995 to 2000, using ethnographic methods. Data collection methods included participant observation, in-depth interviews, focus groups, and collection of written documentation. Analysis was conducted using a grounded theory approach. RESULTS At the beginning of their clinical course, students were motivated by the patient contact and enjoyed clinical teaching. However, they also felt daunted because the earlier years of the course had not prepared them in terms of the knowledge or style of learning required. Aspects of the hospital environment were perceived as being unhelpful to learning, for example, doctors' frequent late arrival for, or cancellation of, teaching. Students often perceived that they were 'in the way', and that their individuality was not valued. Maturity, gender and ethnicity impacted on students' perceptions and on their career aspirations and expectations. DISCUSSION Students' transition to the hospital environment was difficult. This may become less of an issue as medical curricula become more integrated. Specific strategies to induct students into the hospital, and increased staff awareness of their needs, could also help. Ensuring an inclusive atmosphere may be more difficult, requiring cultural change.
