Clinical Learning Environment Scale with Teacher Feedback Subscale (CLES+T)
Clinical Learning Environment Scale with Teacher Feedback Subscale · Also known as: CLES, CLES+T Scale, Clinical Learning Environment Supervision Scale
The CLES+T is a 34-item self-report questionnaire measuring nursing students' perceptions of their clinical learning environment and the quality of supervision received from their clinical preceptor or teacher. Originally developed by Saarikoski and colleagues in 2007 and expanded in 2008 to include a specific teacher feedback dimension, the CLES+T evaluates five key domains: Ward Learning Environment, Supervisory Relationship, Feedback and Evaluation, Nurse Teacher's Pedagogical Competence, and Empowerment. The scale is widely used in nursing education to assess the quality of clinical placements and identify areas for educational improvement.
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When to use it
The CLES+T is designed for nursing students (undergraduate and postgraduate) completing clinical placements in hospitals, community health, mental health, aged care, or primary care settings. It is used to evaluate individual clinical placements, compare quality across multiple wards or institutions, and assess the effectiveness of clinical educator training programs. The CLES+T is also valuable for students undergoing rotation through several clinical sites, allowing comparison of the learning environment across placements. It should be administered after sufficient exposure to the ward (minimum 2–4 weeks) to provide a valid assessment.
Strengths & limitations
- Comprehensive domain coverage: five dimensions capture both the structural learning environment (ward) and relational factors (supervision, feedback, teacher competence), providing a holistic picture of clinical learning quality.
- Established psychometric validity: strong Cronbach's α values (>0.75 for all subscales) across multiple countries and healthcare systems, with evidence of factorial validity in Finnish, Swedish, Greek, and other contexts.
- Sensitive to educational interventions: studies show meaningful score improvements following supervisor training programs or ward culture initiatives, supporting use in quality improvement cycles.
- Practical actionability: subscale scores directly suggest interventions (low Feedback & Evaluation scores → formalized feedback protocols; low Pedagogical Competence → supervisor training).
- Widely adopted internationally: used across Europe, Australasia, and beyond, with published norms for various clinical specialties and student populations.
- Student-reported perception only: the CLES+T reflects students' subjective experience, not objective measures of learning quality, clinical competence gain, or patient outcomes.
- Potential supervisor bias in interpretation: if supervisors see results, they may defensively dismiss low scores or misattribute them to student motivation rather than environmental factors.
- Limited predictive validity for employment outcomes: while CLES+T scores correlate with learning satisfaction, evidence that high CLES+T scores predict better clinical practice post-graduation is modest.
- Response burden on busy wards: some clinical educators report low completion rates if students are too fatigued or pressured to complete questionnaires during busy shifts.
Frequently asked
Should students complete CLES+T anonymously?
Yes. Anonymity is essential to ensure honest responses and protect students from potential supervisor retaliation or resentment. If students identify themselves (e.g., for longitudinal tracking), they must be reassured that responses will be separated from their names before sharing with ward managers or supervisors.
What if supervisors challenge low CLES+T scores on their wards?
Frame CLES+T as a system-level measure, not a personal evaluation. Low scores may reflect structural factors (staffing ratios, ward culture, patient acuity) beyond any one supervisor's control. Use results to trigger supportive conversations: 'We have feedback that students feel there are limited learning opportunities here; let's problem-solve together.' Avoid punitive interpretation.
Can CLES+T be used to compare my clinical placement to others?
Cautiously. If multiple students from your cohort complete CLES+T on different wards, aggregate scores reveal relative strengths and gaps. However, specialty differences matter (e.g., intensive care units may score lower on Empowerment due to critical patient conditions); compare like with like. Use comparison to initiate improvement, not blame.
How often should CLES+T be administered?
Once per clinical placement (typically 4–12 weeks) is standard. If the placement is very brief (2–3 weeks), administer in the final week to allow sufficient acclimation. For longitudinal evaluation of ward quality, aggregate data from multiple cohorts (e.g., all students in the past 12 months) to identify trends.
Sources
- Saarikoski, M., Isoaho, H., Warne, T., & Leino-Kilpi, H. (2008). The nurse teacher in clinical practice: Developing the new sub-dimension for the Clinical Learning Environment Supervision and Nurse Teacher (CLES+T) evaluation scale. Int J Nurs Stud 45(8): 1233–1237. DOI: 10.1016/j.ijnurstu.2007.07.009 ↗
- Saarikoski, M., Leino-Kilpi, H., & Warne, T. (2007). Clinical learning environments as perceived by nursing students: Factor structure and relationships to learning outcomes. Nurse Educ Today 27(2): 122–128. link ↗
How to cite this page
ScholarGate. (2026, June 3). Clinical Learning Environment Scale with Teacher Feedback Subscale. ScholarGate. https://scholargate.app/en/health-education/clinical-learning-environment-scale
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