Exploring Medical Students’ Challenging Experiences in Clinical Environments
The Problem
Previous studies suggest that students experience challenging situations in clinical environments. Despite attempts to address issues such as bullying and denigration, concerns exist that challenging experiences are impacting negatively on learning. This study sought to gain an up-to-date qualitative understanding of the challenging experiences that medical students are encountering in clinical environments; their perceived impact and the nature of support and education that would enable students to cope more effectively.
Our Approach
This study used a qualitative approach in keeping with the interpretivist research paradigm. 3rd and 4th year medical students were invited by e-mail to participate. Individual interviews of nine students were conducted using a semi-structured guide. Students were asked about experiences relating to both primary and secondary care placements. Data were thematically analysed using the Braun and Clarke model.
The Learning
Participants reported challenging experiences, centred around three themes: hierarchy, challenging patient situations and not feeling part of a team. Whilst these occurred in all clinical settings, they were found to be more common in hospitals. Being reprimanded and humiliated were felt to reflect an ongoing underlying hierarchical structure. These experiences impacted student learning, career intentions and confidence. Students made suggestions for support and education, including provision of specialised support services, better teaching organisation and improved preparation for clinical learning.
Why it Matters
This study highlighted the nature of challenging experiences that students encounter. Our results suggest that hierarchical structures within healthcare settings, alongside students not feeling part of the clinical team, may have a significant, detrimental impact on students’ learning and speciality choice. Our study further emphasises the importance of optimising the learning environment and active student participation to enable students to learn effectively. We also recommend the provision of more specialised student support services and a zero-tolerance approach to bullying and mistreatment of students.
Presenting author: Charlotte Ford- Newcastle University. (School of Medical Education, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK NE2 4HH.)
Co-authors:
Michael Harrison- Newcastle University (School of Medical Education, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK NE24HH.) michael.harrison@doctors.org.uk.
Hugh Alberti - Newcastle University (School of Medical Education, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK NE24HH.) hugh.alberti@newcastle.ac.uk