Twelve tips for fostering productive struggle in the clinical learning environment

Health professions educators are faced with the pressure of preparing learners for the complexity of patient care within a dynamic clinical learning environment (CLE). Cognition in context recognizes that cognitive learning mechanisms such as productive struggle are transformed by institutional culture, structural constraints, and positive and negative socializing experiences. These experiences are recorded by learners in their evaluation of the CLE as forms of struggle; however, the pressure to create an optimal learning environment may mean eliminating struggle from the learner experience, which could impact negatively the development of adaptive expertise. In this 12 tips paper, we address the issue of cognition in context and offer suggestions on how educators can make fulsome use of learner feedback to recognize productive struggle while addressing contextual constraints to ensure that learners are supported on their journey to become healthcare professionals.