“A Taste of Real Medicine”: Third Year Medical Students’ Report Experiences of Early Workplace Encounters

INTRODUCTION: Medical students extend their preparatory learning on entering the clinical work environment, by joining their clinical team as peripheral participants and start to care for “real” patients. This learning is situated, experiential, varied, mainly unstructured, highly dependent on clinical opportunities (affordances), and students’ motivation to learn (learner agency). Students ideally contribute to workplace activities, which allow their practical skills, confidence and professional identity to evolve. This study sought to investigate senior students’ perspectives in their early stages of workplace learning, by using social learning theory as a framework. The focus is on team integration, practical skills performance, professional development and their evolving professional identity. METHODS: Between 2015 and 2018, we conducted five focus groups, with a total of 36 volunteers, out of a possible 200 (18% Stage 3 (Year 3)) medical students. Each focus group session was audio recorded and transcribed verbatim. Participants were de-identified, and framework analysis used the theoretical frameworks of communities of practice, and workplace affordances to gain insight into their work-place learning experience during the first two months of their clinical rotation. RESULTS: Thirty-six students out of 200 (18%) attended focus groups over a four-year period. The results are presented using the theoretical frameworks of community of practice and workplace affordances and presented as themes of: meaning, “learning as experience”, practice, “learning as doing” community, “learning as belonging”, and identity, “learning as becoming”. DISCUSSION: Participants reported many positive examples of workplace learning while dealing directly with patients. Students were also exposed to ethical dilemmas and unexpected risks in the workplace. These included lack of site orientation, unsupportive teams, lack of supervision, and students’ inability to initiate agency, all of which contributed to their workplace uncertainty. Performing manageable tasks for their team provided a role in their community of practice, strengthening their identity as evolving doctors. Exposure to both positive and negative role models allowed students to reflect on ethical issues, further extending their own professional identities. SUMMARY: Participants were quick to observe and report workplace dynamics as they were exposed to the positive and negative aspects of the hidden curriculum. This allowed them to reflect on patient safety, and ethical concerns promoting the development of their professional identity.