Learning conversations, where medical trainees present patient assessments and engage supervisors to plan ongoing care, are essential to both clinical decision-making and trainee learning. While several frameworks for handover and case-based teaching (e.g., ISBAR, SNAPPS, PQRST, One-Minute Preceptor, WWW-DOC) are described to frame learning conversations, their application in rural generalist practice remains unclear. This study explored the use of these frameworks during learning conversations in two rural hospitals in Queensland, Australia. Using qualitative methods, 106 audio-recorded learning conversations involving 10 medical students, 18 junior doctors, and 18 supervisors were analysed via abductive thematic analysis. Conversations commonly included elements from multiple frameworks but did not consistently follow any single one. Common elements and key differences were observed between both the frameworks and observed clinical practice. Findings suggest that despite multiple proposed frameworks in clinical training, in-practice use is fragmented, context-dependent, and flexibly applied. The lack of shared understanding between trainees and supervisors may limit the educational potential of these interactions. This study highlights the need for an adaptable framework for learning conversations in rural generalist settings that aligns with actual clinical and educational practices.