Publish at March 26 2025 Updated March 26 2025
The healthcare professions are among the most demanding in the world. Doctors, nurses, physiotherapists, midwives... these professionals hold the lives of others in their hands. It's a huge responsibility, and one that requires not only solid theoretical training, but also an ironclad practical preparation. Immersion courses, practical work, simulation exercises... To varying degrees, all health-care training courses incorporate these professional situations.
But how exactly do theory and practice fit together in these very special curricula? What exactly is the role of experimentation in building the skills of future caregivers? Which teaching methods are the most effective? These are the questions we propose to address in this article, adopting a resolutely multidisciplinary approach.
Our ambition here is not to draw up an exhaustive panorama of training practices, nor to hand out good and bad points, but to sketch out a reasoned cartography of the issues, strengths and limits of practical application in health studies. In the course of our reflection, we shall keep one central question in mind: how do practical courses prepare future healthcare professionals, in all their dimensions, for the human, technical and ethical challenges that await them?
This question leads us to consider practical training beyond the simple acquisition of technical skills. We'll see that confrontation with real or realistic situations develops a much wider range of knowledge, know-how and interpersonal skills that will form the core of the nursing identity. Interpersonal relations, reflective posture, stress management, ability to work as part of a team... These are all essential skills that are cultivated through experience.
But we won't gloss over the difficulties of this pedagogy of action, which overturns the classic didactic contract. We will question the conditions for successful companionship, the fragile balance between autonomy and supervision, the potential tensions between the logic of training and the imperative of safe care... We will also explore the way in which digital technology renews the possibilities of practical application, without replacing experience in the field.
At the end of this course, we hope to contribute to a better understanding of what is essential, for students and trainers alike, in this constantly renegotiated alliance between theory and practice at the heart of healthcare training. It's a crucial pedagogical and human challenge for shaping the competent, empathetic caregivers our society so desperately needs.
Health studies are characterized by high academic standards. For years, future doctors, pharmacists or dental surgeons follow one lecture after another to assimilate a dizzying array of scientific knowledge in biology, physiology, anatomy, pharmacology... Nursing, physiotherapy and midwifery students are not to be outdone, with dense curricula combining fundamental sciences with more specialized knowledge.(1) But what all these curricula have in common is their emphasis on practical training from an early stage.
As early as the first year, nursing students take part in several internships lasting several weeks. Carabinieri spend many hours in the laboratory doing practical work. As their training progresses, practical work becomes increasingly important. A final-year nursing student spends more time on placement than on university benches. This immersion in professional life is more than just an added bonus: it's an integral part of the learning process.
It's one thing to assimilate theoretical knowledge; it's quite another to apply it in a meaningful way. It is precisely the aim of practical training to make the link between "bookish" knowledge and the actual practice of the profession. In the field, students are called upon to apply what they have learned to solve tangible problems. For example, it's during an internship that student nurses practice spotting clinical signs in a patient, by matching their symptoms with their knowledge of semiology [the study of disease symptoms].
In this way, practical experience gives depth and meaning to theoretical knowledge, which would otherwise often remain abstract.(2) It plays a fundamental role in the integration of knowledge, by enabling us to experiment with it, question it and nuance it through contact with the realities of the profession. It's often during internships or practical work that knowledge is solidified and links made. For example, it's by inserting an infusion for the first time that a student nurse will finally understand what all those hours of lectures on superficial arm veins were actually for.
If practice is so fundamental, it's because it's rooted in a very specific conception of learning. For the educational sciences, and in particular the currents of Piagetian constructivism, knowledge is not transmitted but constructed through the interaction of the subject with his or her environment.(3) In other words, we learn by doing. Knowledge is not a static object that can simply be "poured" into the student's head: it is the fruit of a dynamic process that involves all his or her cognitive activity.
With this in mind, it's easy to see why practical lessons are essential. They offer students the opportunity to be active, to manipulate concepts in concrete situations, to better appropriate them. It is by solving real-life problems that future caregivers build their skills, step by step, in a constant to-and-fro between action and reflection, experience and analysis. The challenge for training engineers is to find the best way to combine theoretical and practical teaching.
This alchemy requires crucial pedagogical and organizational choices. In what order should courses and internships be organized? What is the right rhythm for alternating academic input and field experience? What form should regroupings take between practical periods to facilitate reflective feedback? These are all parameters that need to be fine-tuned according to training objectives, logistical constraints and learner profiles. Practical experience is not just the icing on the cake to be reserved for the end of the course: it must permeate the curriculum from start to finish, in constant dialogue with theory.(4)
When they take their first steps on the job, healthcare students discover a world of very specific rituals.(5) Wearing a white coat and a badge around their neck, they wander through the labyrinth of hospital corridors, getting their bearings in the incessant ballet of nurses, stretcher-bearers, families... He must quickly assimilate a whole set of codes, values and "ways of doing things" specific to the medical and paramedical environment. Respecting a quasi-military hierarchy, using a precise technical vocabulary, respecting the confidentiality of information... These are all practices that need to be decoded and adopted to find one's rightful place.
As sociologist Everett C. Hughes in his classic study of the making of doctors, this familiarization with hospital "culture" is a dimension of training in its own right.(6) Over and above knowledge and techniques, health studies are also a process of socialization through which the individual gradually internalizes the norms and values of his future professional community.(7) This acculturation is largely implicit, in day-to-day interactions with care teams and patients. Hence the importance of regular immersion in the practice.
Another decisive aspect of training, which takes place mainly in situations, is the relationship with the patient. Conducting a clinical interview, breaking bad news, obtaining consent for treatment... All these relational tasks are at the heart of the healthcare professions, but they cannot be improvised. They require complex skills that go far beyond mastery of communication techniques. Empathy, listening skills, the ability to decipher non-verbal communication, adapting to the person you're talking to... It's in the field that students will gradually forge their caring posture in their relationship with others.
A balancing act if ever there was one! It's all about finding the right distance from the patient, in a subtle compromise between benevolent closeness and necessary self-protection. Too much emotional involvement exposes you to the risk of burnout. Too much detachment leads to a loss of humanity. It is through repeated confrontation with care situations, with the support of experienced practitioners, that students will adjust their position in the relationship over time. It's an often uncomfortable process, but one that is highly instructive both personally and professionally.
Injecting a model is one thing. Injecting a "real" patient for the first time is quite another. In the field, healthcare students are confronted with responsibilities and emotional stakes that are often very high.(8) In some departments, pain and the end of life are part of everyday life. You have to learn to cope with suffering, grief and fear, without becoming overwhelmed or hardened. It's a major psychological challenge, and one that calls for compassionate support.
For while practical experience helps build confidence and dexterity, it can also be destabilizing and even trying for students. Fear of doing things wrong, of not being up to the job, of feeling "useless"... The feeling of imposture is never far away, especially in the early stages of an internship. Not to mention the shock of the "first time" for certain significant gestures such as intimate hygiene. These are moments that can deeply shake novice caregivers if they are not properly prepared and supported(9).
Fortunately, more and more healthcare training courses now include modules on stress and emotion management. Discussion groups, relaxation techniques, practice analysis... A whole range of tools is being developed to help students gain perspective on the situations they encounter. The aim is not to evacuate affects, but rather to welcome them so as to better identify and regulate them. Here again, it is in the back-and-forth between singular experience and collective elaboration that future caregivers gradually build their inner strength.
As we can see, field experience not only builds skills, it also forges a professional identity in its own right.(10) It is by taking on the role of doctor, nurse or physiotherapist in real-life settings that students gradually build a coherent image of themselves as caregivers. Internships are an opportunity to experiment with different "ways of being" with patients, to physically embody their future posture, to test different registers of authority or communication... These are just some of the ways in which you can gradually take on your role and establish your legitimacy.
But this identity is not invented ex nihilo: for many, it is nurtured by the models observed on the job. By rubbing shoulders with experienced practitioners, healthcare students internalize ways of doing things, forging an ideal of the "good" professional... even if it means shattering a few illusions! It's when they come into contact with the "real life" of the departments that they learn to distinguish between their initial representations of the profession and its reality. A discrepancy that can lead to healthy questioning, new perspectives and fruitful adjustments.
Because they confront students with their future working environment, with its real constraints and resources, internships play an absolutely central role in the development of their professional identity. Much more than just a place where academic knowledge is applied, they are a privileged space for integrating the different facets of the profession, and building the self as a potentially autonomous and responsible caregiver. It's a veritable matrix in which to forge a sense of commitment to serving patients.
However, healthcare students are not left to their own devices in the field. Their practice is supervised, accompanied step by step by experienced professionals who act as guides on the sometimes steep paths of clinical practice. Whether we call them trainers, tutors or internship supervisors, these "gatekeepers" play an absolutely central pedagogical role in paramedical and medical curricula. The success of the learning process depends to a large extent on the quality of their support.
But what exactly do they do? Much more than just supervising procedures, they help students to give meaning to their practice by linking it to the knowledge taught. Through their explanations and critical feedback, they shed light on the situations encountered, turning them into "learning" moments. They draw attention to clinical details, suggest gestures, question certainties... These interactions stimulate the novices' reflexivity and consolidate their emerging skills. In the process, tutors also introduce the less technical aspects of the profession: patient relations, teamwork, ethical values...
But this kind of mentoring cannot be improvised; it requires teaching skills in their own right. Being a good carer is not enough to be a good trainer in the field!(11) This implies knowing how to organize work situations for didactic purposes, how to make clinical reasoning explicit, how to set up discussion forums... These are all skills that need to be learned and worked on. Hence the existence of training courses for trainers, reflecting a growing awareness of the challenges of transmission in professional situations(12).
Because supervised practice has its own rules, its own invariants that must be mastered. The medical training model is based on a pedagogy of alternation between two complementary registers of activity: on the one hand, the practice of the profession "in blank" in sequences dedicated to training, and on the other, its real-life realization in supervised care sequences. Two distinct but articulated learning areas, with a gradual progression from "virtual" to "real".
In concrete terms, students begin by observing their tutor at work before taking their turn, first on mannequins and then with real patients. Many practical courses are organized in three stages: demonstration of the procedure by the expert, simulation exercises in the laboratory, then application in a real-life situation. Each time, the challenge is to gradually increase the complexity and stakes, in line with the learner's progress. As each situation is put into practice, the learner gains in dexterity, speed and self-confidence.
Gradually, students develop their autonomy and capacity for initiative within the care team. Periods spent "doubling up" with a professional to supervise his or her actions will become less frequent, leaving him or her to take on ever wider swathes of the activity. It's up to him to activate the resources of his environment to help him manage tricky situations. This empowerment is the ultimate aim of our training courses, which should ideally result in professionals capable of making informed decisions in a given context.
But the path is paved with pitfalls, and beginners are not immune to mistakes. A badly positioned needle, awkward communication with a patient... There's no shortage of opportunities to make mistakes when learning a profession as technical and relational as nursing. And that's perfectly normal! Mistakes are an integral part of the learning process... as long as we turn them into an opportunity for progress and not a source of stigmatization.
That's what internship tutors are all about: playing down failures so as to learn constructive lessons from them. Rather than pointing out shortcomings, it's more important to highlight what has been achieved and encourage the student to get back on track. Good-natured support is essential to secure the first steps and establish a climate of trust conducive to learning. Debriefing sessions in particular are key moments for looking back at the difficulties encountered and mapping out new avenues to investigate.
Of course, not all errors are created equal, and some may jeopardize patient safety. But here again, a positive approach to mistakes can be fruitful. Rather than making the offending student feel guilty, it's better to help them analyze the causes of their failure, so that they can adjust their practice. If properly exploited, mistakes become the breeding ground for in-depth learning, solidifying skills by anchoring them in real-life experience. A virtuous approach, provided that the organization of work and the workload allow teams the time for reflective feedback.
For this is the very heart of practice-based teaching: using real-life activity as a starting point, in all its richness and hazards, to build living, embodied knowledge. Whether in the form of internships, simulated situations or role-playing games, practical training relies on the power of experience as a vector for learning.(13) It relies on the student's active involvement, curiosity and creativity to help him or her develop professional skills.
In this respect, training through practice is part of what is known as active pedagogy.(14) Unlike the magisterial model, where knowledge is held by the teacher, here knowledge is built in and through the learner's activity. The learner is at the heart of the training process, the actor in his or her own professional development. Trainers are there to organize learning situations, support reflexivity, facilitate interaction... Ultimately, however, it is the student's own experience that is the main driver of learning.
This paradigm has many pedagogical advantages. By anchoring the acquisition of skills in authentic situations, it gives meaning to knowledge and reinforces motivation to learn. It enables learning to be more durable and transferable than learning through discourse and memorization alone. It also fosters analytical and questioning postures that prepare students for lifelong learning. After all, in the care professions, you're never done learning from your own practice!
However, this approach also has its limits and points to watch out for. Immersion in a clinical environment can be destabilizing if not sufficiently prepared and emotionally supported. It can generate stress and a feeling of incompetence in students who have to "fend for themselves". On the other hand, overly prescriptive supervision can curb initiative and keep students in the position of executors. The challenge is to strike a subtle balance between prescription and autonomy, reflexive work and letting go in action.
Above all, the pedagogy of practice only makes sense if it is integrated into a more global training program that links knowledge and experience. Internships and practical work are not enough to train competent professionals; they need to be the subject of collective regulations that enable empirical learning to be conceptualized. They must also be able to draw on more academic input both upstream and downstream. Only in this way can they foster a genuine dynamic of professional development throughout the course and beyond.
At the heart of practical training lies a fundamental tension: how can we learn to care without endangering patients? How can we give students the opportunity to practice without entrusting them with overly risky procedures? This is the eternal dilemma of medical and paramedical training, torn between the imperative of learning and the principle of safety. It's as much an ethical dilemma as a pedagogical one, requiring the development of safeguards to ensure the safety of care.
Many curricula have chosen to introduce a progression in supervised practice. Students begin by observing, before participating in certain procedures, then carrying them out themselves under the guidance of a professional. At each stage, regulatory milestones define which tasks are permitted, depending on the level of training. An intern, for example, may not perform a major surgical procedure alone without the presence of a senior member of staff. These regulations are designed to guide the trainee's progress, while guaranteeing the quality of care provided.
Another crucial precaution is the use of simulated situations prior to confrontation with patients.(15) More and more healthcare training programs today rely on high-fidelity mannequins, software or role-playing to give students the opportunity to practice "in the field". Perfusions on dummy arms, auscultations on a standardized patient, announcing a diagnosis to a peer who plays the patient? These are just some of the situations in which students can develop their technical and interpersonal skills in a safe, risk-free environment.
But however valuable they may be, these systems must not lead to a sanitized practice, disconnected from the human challenges of care. Too much simulation can make us lose sight of the uniqueness of each patient and the complexity of clinical work. That's why practical training must always be designed as a dynamic back-and-forth between reconstructed situations and internships. The aim is to learn to act in real-life situations, while reflecting on the ethical implications of one's actions. A subtle balance to be constantly reinvented.
Because in the field, the stakes are not just educational: they also involve the legal liability of those involved in training. Students and tutors alike can be held legally liable for any damage caused to patients. The main grounds invoked: failure to supervise or negligence in supervising acts entrusted to novices. These failings can be costly in both personal and insurance terms.
Of course, the status of learner protects students to some extent. When they act under the responsibility of a professional, it is the latter who is considered the indirect author of the litigious acts. But this protection is not absolute. The courts consider that, from a certain level of study, students should be able to identify risks and seek help in the event of difficulty. Failure to do so may result in a conviction for gross negligence, in addition to sanctions imposed by the law.
Trainers, on the other hand, have a dual responsibility: as caregivers, responsible for performing procedures in accordance with the rules of the art, and as educators, responsible for vigilantly supervising students. They can be held directly responsible for misjudging their students' degree of autonomy, or supervising their actions from too far away. This is a criminal risk that can lead to caporalism or even withdrawal on the part of certain teams, who are reluctant to act as training supervisors.
To guard against this, some training establishments require students to sign a charter setting out precisely what they are allowed to do. Others set up stringent quality procedures and systematically report any undesirable events. However, the growing trend towards litigation is worrying the medical community, who see it as a potential brake on the transmission of best practices. How can we gradually let go of the reins if the slightest misstep can have serious consequences?
Faced with these risks, it may be tempting to minimize the role of patients in practical training. To consider them as mere training grounds, bodies to be examined and treated without further ado. A utilitarian drift that many teachers warn against. For it's an obvious fact that is all too often forgotten: the people cared for in a university hospital are also partners in transmission, full-fledged players in clinical learning.
Accepting the presence of a trainee during a consultation gives the latter a unique opportunity to learn about the human and psychological realities of care. It means allowing them to witness their own suffering, and to learn from their own experience of illness. It also means taking the risk of a novice's view of his case, of a clumsy gesture or relationship... It's a generous contribution to the training of future caregivers, but one that shouldn't be taken for granted, but should be the subject of genuine negotiation.
After all, patient consent is an essential prerequisite for any act of care, whether performed by an experienced professional or a student. To imagine that a patient could be used as a "guinea pig" without having any say in the trainee's presence and the nature of the procedures entrusted to him or her, is to deprive the patient of his or her fundamental rights. It means disregarding the trainee's freedom to choose who will treat him/her, and under what conditions. An ethical impasse still all too common in training practices.
And yet, many patients say they are willing to "play the game" of knowledge transmission, as long as the objectives and methods of supervision are clearly explained to them. Some even see their participation as a way of "giving back" a little of what they have received, of helping to train future good caregivers. An altruistic perspective that places practical training under the sign of gift and reciprocity, far from a purely utilitarian logic. Provided it is fully informed and consented to.
Actively involving patients in practical training is a major challenge for teaching teams. By considering them as full partners, and regularly gathering their point of view on transmission situations, we pave the way for a more ethical and more effective approach to care training. An approach that makes supervised practice a space for cooperation and mutual recognition between all stakeholders: students, professionals and beneficiaries.
In recent years, the world of healthcare training has seen a small revolution: the rise of digital technologies dedicated to hands-on learning. High-fidelity simulators that reproduce a patient's vitals, serious games that immerse students in complex clinical cases, virtual reality that lets them practice technical gestures... These tools open up new pedagogical perspectives, halfway between traditional practical work and real-life situations(16).
Their major advantage? Confronting learners with cases that are rare or difficult to observe on the job, in safe, reproducible conditions. Cardiac arrest, anaphylactic shock, delivery hemorrhage... These are just some of the emergency situations for which stress-free preparation is invaluable. Students have the opportunity to practice the chain of technical gestures, to test different options, and to try again if they make a mistake. All this with an ever-increasing degree of realism.
Interactive simulations also encourage the development of interpersonal and communication skills:(17) Talking to a virtual patient programmed to react realistically, delivering bad news to an avatar.... It's an opportunity to work on your posture without fear of harmful consequences. Some games even simulate group dynamics to learn how to cooperate as a team or manage conflicts. These situations are virtually impossible to reproduce on the job.
Used wisely, these technologies are therefore invaluable adjuncts to practical training.(18) They enable us to go further in scripting learning, without replacing real experience. Trainers must learn to cultivate these complementary approaches to get the most out of them. It's up to them to devise hybrid methods that subtly combine simulator sessions, feedback from training courses, theoretical instruction and online guidance!
As exciting as they are, techno-pedagogical innovations are not a panacea. By focusing too much on the realism of simulators, we almost forget the irreducible uncertainty of the living world. Healthcare professionals are not simply technicians applying processes; they are first and foremost clinicians capable of dealing with the singularity of each encounter. This kaïros intelligence, this ability to improvise in a given situation, escapes computer modeling to some extent(19).
Another limitation is the risk of dehumanizing the care relationship. By dint of training in front of screens, we can lose sight of the fact that behind each clinical case lies a suffering person with his or her own history and sensitivity. Digital devices must not be allowed to overshadow the interpersonal dimension that is so central to the care professions. Nor should they force future professionals to adopt overly standardized behaviors that would cut them off from their relational creativity.
We must also consider the practical obstacles to the widespread use of these tools in curricula: their high cost, the need to train teachers in their use, the reluctance of some students who are not very comfortable with technology... These are just some of the reasons why the deployment of these tools is still limited and unevenly distributed between courses and schools. There is a risk of widening disparities between students who are unequally prepared for technological developments in the sector.
All the more reason not to give in to the siren calls of a "digital revolution" that would render traditional training methods obsolete.(20) The challenge is rather to think about hybrid teaching scenarios that subtly articulate the respective contributions of distance and face-to-face learning. Simulation is conceived as a complementary training space, upstream and downstream of real-life situations. Without losing sight of the fact that it is in the encounter with patients that the essence of learning takes place.
The boom in simulation technologies is reshuffling the balance between face-to-face and remote training. Until now, practical training has been based almost exclusively on face-to-face training: internships, practical work, group work... The aim was to learn by doing, in direct contact with work situations and professionals. Digital tools open up new possibilities for distance learning, more integrated into students' daily lives and into the timeframe of their course.
We can thus imagine teaching scenarios that are partly free from the time and place constraints of conventional training. For example, students could practice at home on a simulator, at their own pace, before a practical session on the same topic. Or re-enacting a problematic internship situation after the fact, to better analyze the reasons behind it. Distance learning becomes a tool for optimizing face-to-face time, by focusing on high value-added interactions(21).
But this presupposes an in-depth rethink of training engineering, moving towards more personalized training paths. Digital tools offer the possibility of tailoring practical activities to the specific needs of each student, whereas internships impose a fairly standardized framework. Algorithms can be devised to propose targeted situations based on the learner's identified shortcomings. Or applications that support revision in a variety of formats: MCQs, case studies, virtual reality exercises...
The prospect of "made-to-measure" training is seductive, but not without its challenges. How can we avoid the pitfall of isolating students, riveted to their screens to the detriment of collective dynamics? How can we make the most of the tacit, non-simulated learning that takes place in the interstices of departmental life? What place should be given to companionship, to the direct transmission of professional skills in the field? We run the risk of depriving ourselves of the human support that is so precious to novices.
All the more reason to see distance and face-to-face learning as complementary rather than opposites. The future undoubtedly lies in hybrid systems that subtly combine online and face-to-face activities, depending on the pedagogical objectives being pursued. For example, we could imagine a three-phase progression: clinical cases worked on at home beforehand, a training course to put them into practice, then a group debriefing to analyze failures and successes. The art lies in thinking about the fine granularity of the modalities according to the skills to be developed.
And we mustn't lose sight of the fact that learning to care is fundamentally a human adventure. However powerful they may be, technological tools will never be more than a prosthesis at the service of the encounter between student and patient, between novice and tutor. They can enrich interactions, smooth the way, facilitate reflexivity... but they cannot replace the richness of a live exchange, the emotion of a first treatment, the exhilaration of a successful gesture under the benevolent gaze of a peer.
At the end of this reflection, it is clear that practical training represents a major challenge for health studies. Because it confronts students very early on with the complexity of their future profession, in its relational, emotional and ethical dimensions. Because it requires a specific teaching approach, based on supervised experimentation and reflective mentoring. Because it involves the responsibility of all - learners, trainers and patients - in a fragile balance.
The internship or practical training model is much more than just a time for applying knowledge. It's a training space in its own right, mobilizing original learning resources: observation, role-playing, debriefings... It's a demanding approach for those involved, but one that is highly productive when well thought out and supported. For it is in the face of reality that the posture of a caregiver is forged, based on clinical rigor and relational creativity.
Current technological developments are profoundly renewing the engineering of these practical courses. Digital simulation, virtual reality, serious games... These are just some of the tools that open up new possibilities for facilitating experiential learning, in addition to traditional role-playing. But the deployment of these tools must be accompanied by pedagogical and ethical reflection on the aims of training in health care: to develop an understanding of the singularity of each human situation, and not just standardized technical expertise.
This is the challenge for the coming years: to invent new scenarios that skilfully hybridize the contributions of digital technology with the richness of face-to-face transmission. Design tailor-made courses, without abandoning a strong grounding in the realities of the field. Capitalize on the creativity of technology, without losing sight of the fact that the heart of the profession is learned first and foremost at the patient's bedside, in a logic of "caring" that is attentive to the patient's vulnerability and radical otherness.
Illustration: AI-generated - Flavien Albarras
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