Clinical Judgement in Pre-Service Teacher Education: An Opportunity for Enhanced Professionalism?

Abstract

Clinical models inform initial teacher education programs at several sites globally. Such models, and the term ‘clinical,’ along with related but not synonymous evidence-based forms of teaching, are advocated by some and criticised by others. Advocates emphasise an integration of evidence, theory, and research with contextualised clinical judgement that centres on students and teachers. Critics raise concerns over the privileging of ‘scientific’ or ‘medicalised’ ways of knowing that undermine teachers’ professional and moral judgement. This paper draws on focus group data exploring understandings of clinical judgement among 20 teacher educators in a well-established clinical teacher education course. Findings reveal that while there were tensions in the use of ‘clinical’, participants saw value in the language of clinical judgement in teaching. Clinical judgement positioned teaching as a profoundly intellectual activity in which the synthesis and evaluation of observations, research, context, and student learning evidence informed teacher decision making. Findings suggest that, when framed in this way, clinical judgement and clinical teaching models can enhance teachers’ professionalism and confidence in professional decisions. The perspectives of participants reveal an often-overlooked aspect of the clinical teaching debate—the experiences of teacher educators working within such a model.

1. Introduction

Initial teacher education (ITE) courses vary by structure, emphasis, vision, and conception. In many countries, approaches to ITE are subject to considerable political debate, drawing the attention of the media, public, and politicians invested in ‘quality teaching’ (e.g., Australian Government, 2021; Clarke & Parker, 2021; O’Brien, 2023). In the Australian context, upon which this paper focuses, there are many divisive issues in ITE, including debate on the worth of ‘clinical’ approaches to teaching and learning.

There are several ways to chart the international ITE landscape, and the most common is by location and sequencing. Broadly, ITE courses fall into the categories of university-based and school-based, yet there are variations, with courses organised differently in relation to subject matter and teaching approaches. University-based programs generally assume to varying extents that theory precedes experience in school settings. School-based programs are less easily summarised, but often build from an apprentice-master assumption and seek to address a perceived ‘disconnect between the campus and school-based components of programs’ (Zeichner, 2010, p. 89). Some programs offer alternative certification that can be classified as school-based, including Teach First in the UK and Teach for Australia, with participants taking on sole responsibility for teaching during their training, alongside regular mentor support and instruction.

ITE in England has traversed a seismic shift from university-based to school-based training, resulting in a significant emphasis on practice-based learning (Mutton & Burn, 2024), but Australia has not followed this shift. School-based programs are generally founded on a view that prospective teachers must be inducted into the profession, which can assume that reproduction of current practices is desired. Conversely, some university programs aspire to produce teachers who will contribute to system transformation. Importantly, whether school-based or university-based, ITE may position learners as research consumers or partners in research (Tatto, 2021). Each of these orientations has its affordances and challenges, and program design depends on the ideological position of the designers, the policy framework, and the needs of the prospective teachers.

The study underpinning this paper is situated in a course that interleaves school- and university-based teaching experiences, constructing teachers’ roles as transformational and seeking to build prospective teachers’ capacity to be critical consumers of research and to research their practice. The course’s conceptual foundations lie in the notion of ‘clinical teaching.’

The course’s clinical model emphasises the combination of evidence, experience, research, and theory to determine how to intervene with a student in a specific context to advance their learning (Kriewaldt et al., 2017; Kriewaldt & Turnidge, 2013; McLean Davies et al., 2013). Clinical models of teacher education seek to connect theory and practice, build teacher capacity to determine learning needs, enhance differentiated learning for individual students, and position evidence as central in informing decisions about what to teach, when, and how (Burn & Mutton, 2015; Kriewaldt et al., 2017). To enact clinical teaching, teachers must learn to exercise clinical judgement in every situation of the teaching process where it is needed, drawing on their knowledge and observation of practice and theory, evidence, context, and experience to assess students’ learning—including their starting points—and determine the most appropriate teaching interventions. Clinical judgement is therefore a key practice through which the clinical model is enacted.

There are important concerns about the use of ‘clinical’ approaches in teaching, with detractors noting that the unquestioning application of findings from specific kinds of science-based or ‘big data’ studies is problematic (e.g., G. Biesta, 2017; McKnight & Morgan, 2020, 2023). Part of the concern, we suggest, emerges from the fact that clinical judgement is ill-defined in the education literature—there has been little research attention to practitioner understandings and applications of notions of judgement within clinical models—and this limits our capacity to develop and act on a shared understanding of the concept.

In this paper, we report on the views of key staff implementing a clinical teaching model in an ITE course (the Master of Teaching qualification) to examine understandings of clinical judgement within the model of teaching—the clinical teaching cycle—that underpins it. This research was situated within an ITE course that had been based on a clinical model for 10 years. We aimed to identify areas of consensus and disagreement and consider the affordances and drawbacks of fostering clinical judgement. Hearing educators’ perspectives allowed some insight into their practices, because we know that perceptions inform or influence practice (OECD, 2009).

More recently, the faculty in which this research is based has shifted to a language of ‘evidence-based teaching,’ while retaining the core aspects of the clinical model in course design and delivery. In this paper, we reflect on data collected at a time in which the clinical model was explicitly prioritised, reflecting on whether clinical judgement can be a valuable concept in ITE.

2. Literature Review

Understandings of clinical judgement in early childhood and school teaching are routinely drawn from medicine, where the term has also been the subject of much debate (e.g., Ashcraft & Opton, 2009; Kienle & Kiene, 2011; McKnight & Morgan, 2020). With limited space, we have elected to focus in this paper on the concept of ‘clinical judgement,’ recognising that there is an extensive literature on other theoretical constructs—including teacher professional judgement more broadly—that deserve more attention than we can offer here.

Common definitions emphasise that clinical judgement involves integrating knowledge, observation, experience, and data to determine how best to respond to a patient’s needs. Explanations of clinical judgement in medicine characterise judgement as a set of interconnected processes (Ashcraft & Opton, 2009; Levett-Jones et al., 2010; Tanner, 2006). Clinical judgement is problematic if a blanket assumption is made about the appropriateness of an intervention regardless of context. On the other hand, clinical judgement is central to quality medical provision and can result in life-changing improvements (Levett-Jones et al., 2010). Nonetheless, the application of the clinical in any context is improved by critical reflection upon societal tendencies to lionise science over all other kinds of knowledge, although that does not mean we should discard what science has to offer.

In the context of medicine, clinical judgement is a complex process requiring considerable professionalism. Montgomery (2006) describes both clinical judgement and a model in which research evidence wholly determines action—which is an understanding prevalent in criticisms of clinical approaches to teaching—as common practices in medicine. Montgomery (2006) writes:

To some, the days of clinical judgment are numbered. For them, evidence-based medicine (EBM) and its emphasis on the results of clinical research promise to clarify and rationalize clinical reasoning to the point of certainty… while it is true that EBM’s statistical sophistication enables physicians to apply research with more subtlety and precision to an individual patient, it will not turn medicine into a science. Neither EBM’s method nor the information it yields can do the work of clinical thinking alone.

(pp. 42–43)

There is, therefore, a central question that remains to be answered in relation to clinical judgement in teaching: do educators view it as the unproblematised application of research evidence in the classroom, or is space allowed for teachers to make clinical judgements that are nuanced, evidenced, and contextualised?

As Becher and Lefstein (2021) suggest, ‘to strengthen the clinical grounds of teaching, we need to shift the debate from endorsing or rejecting the medical model to how it might be best adapted to the realities of school teaching and the nature of teachers’ classroom work’ (p. 484). What is meant by clinical judgement among educators who use the term—and the knowledge, practices, and dispositions that represent it—requires further investigation to establish common understandings (McLean Davies et al., 2015). As Burn and Mutton (2015) note, while the focus of research in this area has often been on the design and efficacy of clinical programs for teacher candidates, less attention has been given to how the tenets of clinical teaching—including clinical judgement—are constructed and demonstrated in such programs.

Clinical judgement is a central component of clinical teaching models, with teachers making decisions based on a range of considerations. The model analysed for this paper was based on the premise that ‘teaching is a clinical profession—that is, one that requires teachers to be able to assess the learning and learning needs of every student and provide appropriate interventions to move that learning forward’ (McLean Davies et al., 2013, p. 96). Evidence is central to this model:

teachers must be expert in gathering evidence and using sound clinical judgement to create appropriate learning strategies to meet each learner’s needs. Clinical judgement is only possible if the practice is underpinned by a well-defined body of knowledge, keen observational skills and highly developed analytical skills.

(McLean Davies et al., 2013, p. 96)

Clinical teaching, thus defined, sets a high standard for decision-making in the classroom by requiring that teachers reflexively use evidence and professional insight to improve learning (McLean Davies et al., 2013). What actually constitutes ‘evidence’ in clinical judgement in teaching is less clear.

Some criticisms of clinical models argue that they use narrow definitions of ‘strong scientific evidence’; that is, findings from ‘large scale experimental studies’ (G. Biesta, 2017, p. 446, see also McKnight & Morgan, 2020, 2023). This is similar to what Montgomery (2006) identifies as ‘evidence-based medicine’ (p. 42). When the focus for evidence is limited to big-data-style research findings, we risk overlooking more diverse kinds of information that can inform practice, and de-professionalising teachers. McKnight and Morgan (2023) suggest that this is common in clinical approaches to teaching, describing the ‘unquestioning adoption of evidence-based practice’ (p. 8). McKnight and Morgan (2020) further argue that ‘the clinical teacher in education is the latest iteration of a recursive patriarchal fantasy of scientific authority and control that deliberately functions through its medical antecedents, even though they may be ignored or disclaimed’ (p. 95).

As G. Biesta (2017) notes, a ‘particular kind of judgement is needed in education’ because of the multidimensionality of its purpose (p. 442). Biesta’s concept of subjectification is particularly relevant here, in that ‘we always aim for [teacher candidates] to end up as subjects in their own right; as individuals who can make up their own mind, draw their own conclusions, and take responsibility for their actions’ (G. J. J. Biesta & van Braak, 2020, p. 451). Thus, teachers must be able to make ‘situated judgements about what is educationally desirable in relation to these three dimensions’ (G. Biesta, 2017, p. 444).

Concerns about the blunt use of narrowly defined evidence find support in the way certain types of educational research—like meta-analyses—are promoted in relation to clinical models (e.g., Hattie, 2009; as critiqued by McKnight & Morgan, 2023). There is, though, some incongruity here with the way clinical judgement is described in literature supportive of clinical models—and with our own experiences as educators working within such a model and with medical discourses of clinical judgement—in that ‘evidence,’ in these instances, is more broadly defined and more critically and reflexively used (e.g., Kriewaldt et al., 2017; Alter & Coggshall, 2009).

Kriewaldt et al. (2017) propose four sources of evidence teachers should use in making instructional decisions: classroom-based (e.g., observations, formal and informal assessments); para-classroom (e.g., knowledge of what is happening in a student’s life that may affect learning); external assessments; and research. Making sense of these different forms of evidence requires the use of clinical judgement. Kriewaldt et al. (2017) write, ‘evidence itself cannot be used without judgment, and… the collection of evidence in no way compromises teachers’ professional responsibility to analyse, synthesise and make decisions about the relevance of the data they have collected’ (p. 157). Additionally, Alter and Coggshall (2009) note that, in clinical practice in medicine, ‘determining the best course of treatment requires knowing an individual client (through observation, questioning, and other diagnostic or evidence collection techniques) as well as knowing what research has shown to work with other clients in similar situations’ (p. 3). Where there is no certainty—that is, in most cases in teaching—expert judgement is critical. Thus, clinical models do not suggest the blanket application of research findings. Instead, they demand considerable professional knowledge, insight, and judgement to find the best strategies for specific situations and a willingness to monitor and change as further evidence is produced.

The literature also highlights the integration of theory and practice as central to the development of clinical models in education (Conroy et al., 2013; McLean Davies et al., 2013). In their influential review of clinical practice, Burn and Mutton (2015) emphasise the intersection between theoretical and practical sources of knowledge, advocating that research-informed perspectives and insights from classroom practice be brought into dialogue. In a context that engages with the complex linking of theory and practice, claims about ‘what works’ should be problematised (Alter & Coggshall, 2009). That is, the use of evidence must be contextualised, accommodating diversity, and clinical judgement is exercised to theorise and test research- and theory-informed strategies for teaching.

The utility of clinical models in teacher education presents a significant tension in the literature. It is not clear whether, in practice, clinical teaching models follow the processes described by proponents of the approach—with clinical judgement informed by evidence, theory, and research—or align with the reductive use of big data evident in more critical perspectives. This paper explores this central idea.

3. Background

This project was conducted at the Faculty of Education at an Australian university. Like Stanford University in the United States and the University of Glasgow in Scotland, the Faculty of Education that was the subject of the research underpinning this paper sought to implement clinical models in teacher education. Its ITE course, the Master of Teaching (MTeach), was established in 2008 and founded on a clinical teaching model to prepare teachers for work in early childhood settings, and primary and secondary schools. It immersed pre-service teachers in classrooms in partner schools early, with students undertaking placements two days a week and campus-based classes on the other three days for most of the semester, and an intensive two- or three-week placement mid-semester. Students were supported by school-based experts (Teaching Fellows), who held a sessional role with the university but were primarily employed by placement schools, and university-based experts (Clinical Specialists) employed by the university to make connections between school experiences and coursework to develop clinical judgement. Teaching Fellows and Clinical Specialists had a supervisory role with teacher candidates and conducted seminars in one of a cluster of placement schools. Clinical Specialists often also taught subjects on campus. The model emphasises the development of teacher candidates’ capacity to draw on theory, research, assessment, understanding of context, and reflection on practice to make decisions about teaching.

The university provided Teaching Fellows with professional learning to familiarise them with the research and theoretical ideas teacher candidates studied at university. The clinical teaching cycle was embedded in curriculum and assessment. It posed five questions for teachers to consider in sequence:

• What is the student ready to learn and what evidence supports this?
• What are the possible evidence-based interventions?
• What is the preferred intervention and how will it be resourced and implemented?
• What is the expected impact on learning and how will this be evaluated?
• What happened and how can this be interpreted?

For each question, teacher judgement is required. Crucially, each question must be answered in relation to the social, professional, and individual context for the student or students. That is, teacher candidates consider who the student/s is/are, the resources available, the contextual barriers or enablers, policy and curriculum requirements, and so on.

The course asks MTeach candidates to apply this cycle regularly to guide their teaching, students’ learning, and their own learning. The final stage of the cycle—after the implementation of strategies—requires teacher candidates to reflect on the outcomes of their practices and use this evidence to inform future interventions, thus continuing a cycle of practice based on clinical judgement.

The research questions for the study were:

What are the main features of clinical judgement as understood by teaching staff delivering teacher preparation through a clinical model? What similarities and differences are there between their understandings?

What do educators working to develop clinical judgement in teacher candidates view as the affordances and drawbacks of clinical teaching models and the notion of clinical judgement?

4. Methods

Clinical Specialists and Teaching Fellows were invited to participate in one of four 60-min focus groups, each including staff in each of these roles, as part of a single-site qualitative research project investigating educator beliefs about clinical judgement. A focus group methodology offered an opportunity to engage a group of educators in dialogue (Acocella & Cataldi, 2021), allowing insight into the collective professional understandings and explanations of clinical judgement. There is an important limitation to this approach in that it did not offer opportunities for triangulation of data; we cannot, therefore, make any strong claims about whether participants acted in accordance with their stated beliefs. However, our priority was to gather evidence of the uses and explanations for ‘clinical judgement’ within this context, and focus groups were an ideal way to do this because of their capacity to showcase professional discourse.

A semi-structured interview approach within the focus group model sought ‘to obtain descriptions of the interviewees’ lived world with respect to interpretation of the meaning of the described phenomena’ (Kvale, 2007, p. 11). As such, the facilitator of each focus group asked a series of questions that explored:

• understandings of the concept of clinical judgement;
• affordances of clinical judgement and clinical teaching models; and
• the drawbacks of clinical judgement and clinical teaching models.

Facilitators focused on themes without rigidly sticking to preprepared questions, in keeping with the thematic focus and open questioning characteristic of semi-structured interviews (Kvale, 2007).

5. Ethics

Ethics approval was granted by the university Human Ethics Advisory Group (HEAG Approval number: 1442752). Participants were provided with a plain language statement and consent form, informing them of the nature of the research and their participation. Participants were advised that participation was voluntary and that they would be identified only by pseudonyms in publications and that, given the small sample size, it would not be possible to guarantee confidentiality. The research team has removed identifying information in reporting to protect participant privacy.

An important ethical point for the study also relates to the authors’ roles within the MTeach course. All of us were employed by the faculty at the time of data collection and analysis. As such, our insider status gives us ‘intrinsic knowledge’ that allows us to interpret participants’ ideas in context (Kirpitchenko & Voloder, 2014)—as Costley et al. (2010) note, ‘Some work issues are beset with paradox and ambiguity, but an insider is often able to unravel and comprehend such intricacies and complications’ (3). Conversely, our insider status also presents an important limitation, as it likely risks ‘a lack of impartiality, a vested interest’ (Costley et al., 2010, p. 7)—and this is something we have recognised and made efforts to monitor closely.

6. Sample

Twenty participants contributed to the focus groups. They comprised:

• Twelve Clinical Specialists, nine of whom were also tenure-track academic subject leaders (coordinating and teaching subjects on campus), who regularly visited schools; and
• Eight Teaching Fellows who were based in schools.

Participants self-selected to take part in the study. The differences between participant roles were not a focus of this study because the two groups tended to be part of the same conversation about clinical teaching practice, and their responses reflected no significant disparity related to their roles. The sample consisted of 35% male participants and 65% female participants. This was representative of the overall population of staff in these roles. The age profile of the participants is outlined in

Table 1. Age profile of participants.

Age Range	30–39	40–49	50–59	60 and Above
n	3	8	7	2

.

Some participants were more experienced in teaching the course than others (

Table 2. Participants’ years of experience teaching in the course.

Years of Experience Teaching the Course	0–3	4–6	7–9
n	5	7	8

).

7. Analysis

Data were analysed using a thematic framework approach (Huberman & Miles, 2002), involving ‘a systematic process of sifting, charting and sorting material according to key issues and themes’ (p. 310). The focus group discussion points formed the initial themes, and emergent themes accommodated ideas raised by participants, because ‘the coding frame should be flexible enough to incorporate themes introduced by focus group participants’ (Barbour, 2007, p. 117).

In a two-stage process, recordings were first transcribed to enable the researchers to begin the process of analysis and interpretation. The transcripts were then coded into the key themes and clusters. Emergent themes were refined in an iterative process, with a minimum of two of the research team checking the fidelity of interpretation from the data to ensure that our analysis was accurate. For example, a theme drawn from the discussion prompts related to participants’ understanding of clinical judgement. Within this discussion, a focus on the specific uses of language emerged, and so this was added to the themes under analysis.

8. Results

Participant discussion of the meaning and practices of clinical judgement focused on the use of evidence, theory, and research in informing the decisions teachers make about the interventions and strategies they used in the classroom. Participants identified both affordances and drawbacks of the clinical model and its use of clinical judgement.

8.1. Understandings of Clinical Judgement

Participants generally agreed upon the key features of clinical judgement. The understandings of participants in all focus groups were similar in that they shared a belief that clinical judgement required pre-service teachers to collect evidence that enabled the identification of students’ abilities and learning to inform teaching. As one participant noted, ‘it’s about being able to assess and diagnose and plan effective teaching practices for the benefit of the student’ (Jessica). There was no indication that ‘evidence’ was only construed as large-scale research findings, and participants more often spoke about classroom observations and theory than meta-analyses or ‘what works.’ As Jessica noted, teachers should ‘go into a classroom and with an open mind and observe what’s going on without pre-judging it, and then sit down and work through the events.’

Most participants described the clinical teaching cycle as an ongoing process characterised by the use of evidence. They noted that teacher candidates needed to understand:

that idea of following a process to get to a point and using your evidence, but then you do need to … reflect on it … if you’ve got evidence, you’ve got to do something with it. So [we are] teaching them a process of how to make a clinical judgement.

(Sam)

Participant understandings were also similar in that many emphasised that the ability to reflect on practice was central to clinical teaching, commenting that to demonstrate clinical judgement, pre-service teachers must ‘stand back a little bit more and reflect on what they’re doing’ (Megan). Participants saw this as the bedrock of what teachers who are clinical practitioners do: ‘we reflect on what we’ve done and what we need to improve and whether we need to make changes’ (Joshua).

Participants also highlighted the centrality of integrating theory, research, and practice within the clinical model to ensure a robust application of ‘evidence-based’ approaches and clinical judgement. Assessment tasks requiring teacher candidates to integrate learning from educational practice, theory, and research were seen as particularly valuable in developing their capacity to critically reflect and act upon evidence collected in learning environments. As Jacqui noted, ‘I saw a really big turning point in their understanding and their learning of what the evidence-based or clinical practice model was’ (in relation to a specific assessment task in the course).

Ultimately, participants presented a relatively consistent definition of clinical judgement. Their responses shared similarities, highlighting that clinical judgement was formed by an integration of research, theory, and broadly defined evidence—from classroom observation, assessment, school data, and knowledge about students—in order to make contextualised and research-informed judgements about the most appropriate interventions to enhance student learning.

8.2. Affordances and Drawbacks of Clinical Teaching Models and Clinical Judgement

There were both affordances and important drawbacks expressed in relation to clinical judgement and the clinical teaching model. One perceived affordance was a perception that the clinical teaching model could increase the professionalism of teaching through the enactment of clinical judgement. One participant observed that,

[I worry about] the lack of professionalism that characterises the [teaching] profession, and a lot of decision making done on the spur of the moment … [teachers] can’t explain why they made a particular decision, and they can’t communicate it to the students, and to me that’s a sin. You want to be able to say what it is that led you to make a particular decision.

(Chris)

This participant’s perspective on teaching, linking professionalism to clinical judgements, supports the idea that teachers should be able to articulate their reasoning for decisions they make by drawing on evidence, research, theory, and contextual knowledge. This was a key finding from the data: that the clinical teaching model afforded teachers both a framework and the language to reflect on and improve practice.

Participants also noted that the clinical model enabled teacher candidates to reconsider their assumptions about teaching and students, addressing the challenge for new teacher candidates of unlearning what they believed. Sam observed, ‘you’ve got to question your own assumptions about what teaching is and undo some of that stuff … I mean it’s quite a process to go from being a student to a teacher and re-imagining what teaching actually is.’

The clinical teaching cycle enabled this reflection. Participants noted that teacher candidates were initially unskilled at reflecting on their own teaching:

they might say [they’re operating a student-centred classroom], but actually their actions in the classroom are really acting out that idea that the teacher is a source of knowledge in the class.

(Tin)

Challenging these types of firmly held but often unconscious beliefs is complex. A number of participant responses showed that the clinical teaching cycle was seen to support such critical reflection through its requirements for evidence, justification of ideas and decisions, and reflection on actions.

A key tension related to the language of clinical judgement. When asked to explain this concern, some participants reported discomfort with the word judgement. Emma stated,

I think the term judgement can be problematic. You don’t want to jump to judgement, and you don’t want to pre-judge it, and you don’t want to bring a whole lot of preconceptions to it that maybe don’t fit the context.

There were differences in the ways participants responded to this point. Whilst several found this language problematic, others distinguished between judgement and clinical judgement, suggesting that adding the word clinical transformed judgement into a professional practice based on evidence and not assumption.

you’ve got that level [of judgement] where you’re observing what’s happening in a classroom, but then at another point, there’s another level of clinical judgement going on because the evidence of what you think you saw actually can change in the discussion.

(Chris)

Robyn similarly stated, ‘it’s a judgement based on the observable and not the implied,’ relating to the discussions about evidence in the clinical teaching model. One participant added that,

judgement needs to be informed by some evidence base, whether that’s theory … How it is that we actually arrive at the evidence upon which we make that judgement, I think, is quite tricky. You know, to what extent one’s observations or one’s sort of deep-seated values inform that judgement and whether that’s permissible is a really tricky one.

(Heather)

While participants mentioned tensions concerning the use of the word clinical, their comments supported the clinical in teaching if carefully defined, noting that the word could shape a fresh way of thinking about teachers’ practice.

In some instances, this seemed to reflect the idea that teaching could be more objective. Luke supported what he saw as a lack of bias and emotion in the term ‘clinical,’ adding that it made teaching ‘purely professional.’ Other participants expressed concern about this idea, expressing discomfort about the medical roots of the concept. Megan felt that the notion of clinical diagnosis in teaching promoted a ‘pejorative kind of sense… the clinical idea that there’s something sick and… you need to kind of diagnose and then mend the problem, and I think it doesn’t sit well with education to me.’

Discomfort with clinical terms related to a perception that the medical etymology carried a deficit meaning implying a need to ‘fix’ students. However, others felt it was less a question of the language than how it was used. This was summed up by Lee, who noted, ‘that’s where the language can be quite either problematic or powerful, depending on what’s used and how it’s used.’

Some responses assumed that medical diagnosis involved a straightforward application of evidence without discussion or contextual considerations. Participants argued for an emphasis on dialogue with students to identify learning needs, (perhaps falsely) seeing this as a key difference from medical diagnosis. Joshua described the approach as ‘dialogical … we’re communicating with the other person who’s not necessarily a patient who’s got a problem, and we’re trying to work out what the problem is … it’s quite different in the way the evidence is gathered.’

The discussion about affordances and drawbacks of clinical teaching models and clinical judgement reflected greater disparity in understandings about what this looks like in practice, but there remained a clear focus on reflection based on classroom observation and broadly defined evidence, with an integration of theory and research. While there were differences in how participants responded to the language, there was agreement about what a clinical model—and within that, clinical judgement—should involve, as noted in the previous section.

9. Discussion

Participants’ comments about clinical judgement—and the clinical model—illustrated a complex and nuanced approach to teaching. Far from using data findings as a blunt instrument, as indicated in some of the criticism of clinical approaches to teaching, participants described a framework characterised by critical reflection, an emphasis on classroom observation, and the application of ideas from theory and research in teaching. They also noted that problems emerged when evidence was used without reflection. The understanding of clinical judgement is—perhaps unsurprisingly, given the shared professional development participants had—aligned with the argument of McLean Davies et al. (2013), in that ‘clinical judgement is only possible if the practice is underpinned by a well-defined body of knowledge, keen observational skills and highly developed analytical skills’ (p. 96).

The results suggest that the focus on observation, data, evidence, and reflection propelled teacher educators to reflect on their beliefs about what constitutes quality teaching and learning, and how to foster and elicit the teacher candidate’s clinical reasoning. The clinical teaching cycle and clinical judgement were seen as supporting both teacher candidates and teacher educators’ capacity to analyse and reflect on their own teaching and challenge their notions of what a teacher is and does and, importantly, to be able to articulate their beliefs.

The medical roots of the language of the clinical were met with discomfort by some participants, particularly in relation to assumptions about what was involved in ‘diagnosing’ and ‘fixing’ problems in students; that is, that medical diagnosis was a simple matter of consulting the literature and required little interaction with patients. While there are, of course, significant differences in the way we ‘diagnose’ in education compared to medicine, the notion that dialogue is not central to professional medical practice is spurious (Pignone, 2024; Stewart et al., 2013). While Joshua, for example, uses the idea of dialogue to differentiate clinical teaching practice from clinical medical practice, he describes an approach to evidence gathering that relies on communication with students the same way doctors (should) rely on communication with patients.

There was little evidence that this misinterpretation of clinical judgement—in which the assumption is that only large-scale research findings should inform practice (e.g., G. Biesta, 2017; McKnight & Morgan, 2020, 2023)—was applied to practice. However, it is clear that there are spaces into which this big-data discourse could creep. Luke, for example, in discussing the lack of bias and assumption in clinical judgement, seems to suggest that the teacher’s subjectivity is problematic. And it can be, of course, but we agree with G. J. J. Biesta and van Braak (2020) that teachers must be ‘individuals who can make up their own mind’ (p. 451).

Several participants expressed broader concerns about the language of ‘judgement,’ concerned that it carried negative connotations. For the most part though, participants were supportive of the ‘clinical’ in their work as teacher educators and clear that clinical judgement must involve reflection upon evidence from practice, the integration of theory, and assessment of the quality and applicability of research to a given learning situation and student.

Thus, rather than de-centre the teacher’s professional judgement in service of the ‘scientific,’ the teacher’s role is central, and its complexity is foregrounded. Recent research in Australia supports the idea that teachers often feel distrusted in their profession (Mockler, 2022; Dulfer et al., 2023); teachers do not want ‘quick fixes,’ and clinical models should not be seen as such. The supposed quick fixes we have seen in educational policy (such as high-stakes testing programs and paying teachers by student results) often fail to recognise the intellectual work of teaching—the sophisticated, multifaceted reasoning process that enables teachers to make hundreds of decisions every day.

In this sense, our findings echo Wiliam’s (2019) observation that, ‘In educational research, “What works” is usually the wrong question because almost anything works somewhere, and nothing works everywhere. A better question is, “Under what circumstances does this work”’ (p. 138). Wiliam calls for educational stakeholders (including teachers) to become critical consumers of research. Our findings suggest that, if designed thoughtfully, clinical models of teacher education could support teacher educators and candidates to bring this critical stance to research and other forms of evidence. There remain, though, important concerns related to the language of the clinical and what we see as misunderstandings about what clinical judgement requires. As participant Lee noted, the language of the clinical can be both problematic and powerful.

10. Conclusions

Society, in general, represents professions ‘as having a strong technical culture, a specialized knowledge base and shared standards of practice, a service ethic, long periods of training and a high degree of autonomy’ (Hargreaves, 2000, p. 152). De-professionalisation of teachers occurs when teachers are rendered as ‘technical’ implementers of centralised policy (Stronach et al., 2002) instead of professionals who apply their expertise to make discretionary judgements (Hordern, 2024). In holding up to view the importance of clinical judgement, which emerged in this study as a fundamental tenet of teacher professionalism, we configure teachers as professionals whose actions are located within complex practice requiring clinical judgement and informed by moral work. This understanding fosters public trust in the value of teachers’ work.

Far from being an approach to teaching that reduced teachers to cogs in a patriarchal machine (e.g., McKnight & Morgan, 2020), the clinical teaching model described in this paper centred teachers’ decision-making and subjectivity. Our findings suggest that clinical judgement requires teachers and prospective teachers to articulate the reasoning behind their teaching decisions and critically reflect on the evidence they use, including questioning their own assumptions. In some ways, this might simply be seen as ‘good teaching,’ but the clinical—and clinical judgement specifically—seemed to afford educators a language with which to identify and discuss what drove the decisions they made.

While some participants had reservations about the language of judgement, all agreed that the careful assessment of a range of types of evidence was an important expectation in a clinical teaching model. They also discussed the ways the clinical model sought to bring to light assumptions and emphasise a more professional model for teaching. Undoubtedly, clinical models in education can be misused and it was clear that misunderstandings about clinical judgement as objective and without bias are present in the field. However, the participants in this study portrayed a complex, reflective use of evidence and a much more expansive definition of what constitutes evidence in educational contexts.

There are important limitations to this study. Our insider status—while it also has affordances—could make us more disposed to be positive about an approach that we have applied in our own practice. The study does, though, highlight the importance of listening to insiders in this space, because the understandings of participants did not align with the strongest criticisms of clinical models in the literature. This research suggests that clinical judgement offers a way of conceptualising what drives teachers’ decisions; a shared language that can enable more consistent practice when it is well understood. Further research is needed to examine the effects of such practices beyond the ITE stage and to understand the perspectives of pre-service teachers as they learn with and apply the tenets of clinical judgement to practice.