How do medical students navigate learning opportunities during clinical placements? Exploring the inter-related processes underlying student engagement
Creators: name: Osborne, Fiona
name: Rothwell, Charlotte
name: Paes, Paul
name: Ellis, Janice
Publisher: name: F1000 Research Limited
Year: 2024

description: <b>Background</b><br>
Workplace learning theories such as ‘Experience-Based Learning’ have elaborated the complex interacting influences on student learning on clinical placement.  However, the literature reveals a gap in relating these determinants to the pervasive problem of variable student engagement on placement. Examining student involvement with activity (‘engagement’) and their agency in the process (‘navigation’), requires exploration of the moment-by-moment factors underpinning student participation, recognising these may be reactive and unconscious. <br>
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<b>Summary of work</b><br>
The study followed constructivist grounded theory methodology from an interpretivist perspective. The aim was to develop a conceptual model of the inter-related processes underlying UK medical students’ decisions to engage with learning opportunities during clinical placements. Semi-structured interviews were conducted with a sample of 18 final year medical students, utilising a pre-interview questionnaire. Four focus groups examined contextual influences. Two member-reflexive focus groups developed the emerging conceptual model.  Data was collected from 46 participants. Analysis followed a constant comparative method.<br>
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<b>Results</b><br>
Student engagement with clinical activity is underpinned by a complex interaction of individual, social and environmental influences. Students’ prior traits and beliefs influenced decision-making in conjunction with motivational drivers such as assessment and career goals. Complex relational dynamics both supported and inhibited learning, especially given students’ reliance on external mediation and susceptibility to the value judgements of others. Pertinent environmental influences included the physical space, clinical activity dynamics and students’ personal lives. These interacting factors translated to behavioural norms, evident in students’ highly selective and strategic interactions with patients, staff members and clinical tasks.<br>
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<b>Discussion and Conclusion</b><br>
Where the existing literature over-emphasises formal learning processes, this study suggests student engagement with workplace learning opportunities is determined by a complex interaction of explicit and implicit factors which are dynamic, reactive and contextually dependent. Educators’ aspirations for student behaviour on placement contrasts with the reality of variable engagement patterns. Suggested interventions include challenging staff-student behavioural norms such as staff directing students to a circumspect group of patients and asking students to leave placement early.<br>
<b>Take home message</b><br>
Uncovering the interacting network of influences underpinning medical student activity during clinical placement yields valuable insight into modifiable factors which may support student engagement including revising assessment strategies and investing in staff-student relationships.