Summary Background The number of learners in clinical settings is increasing as health professions schools increase enrollment in order to develop the future workforce. Too many learners in clinics and hospital wards could create overcrowded conditions and diminish patient and learner experiences. Based on data gathered from a literature review, we identified challenges and solutions to address the increasing numbers of learners in clinical settings. Results Health care provider workload, physical environment and clinical culture were challenges identified from the literature review. These identified constraints were corroborated by learner and expert reflections on their experiences. Conclusion As the need for more health care providers increases, the number of learners in clinical settings poses a challenge. Innovative models to deliver care, an increasing role for learners, strategic patient scheduling and redesigning workspaces may mitigate problems. The recommendations suggested from this review may offer solutions that individual preceptors and organisations can implement.