At the precipice: a prospective exploration of medical students’ expectations of the pre-clerkship to clerkship transition

Abstract

Medical learners face many challenging transitions. We prospectively explored students' perceptions of their upcoming transition to clerkship and their future professional selves. In 2013, 160/165 end-of-second-year medical students wrote narrative reflections and 79/165 completed a questionnaire on their perceptions of their upcoming transition to clerkship. Narratives were separately analyzed by four authors and then discussed to identify a final thematic framework using parsimonious category construction. We identified two overarching themes: (1) "Looking back": experiences which had helped students feel prepared for clerkship with subthemes focused on of patient care, shadowing, classroom teaching and the pre-clerkship years as foundational knowledge, (2) "Looking forward": anticipating the clerkship experience and the journey of becoming a physician with subthemes focused on death and dying, hierarchy, work-life balance, interactions with patients, concerns about competency and career choice. Questionnaire data revealed incongruities around expectations of minimal exposure to death and dying, little need for independent study and limited direct patient responsibility. We confirmed that internal transformations are happening in contemplative time even before clerkship. By prospectively exploring pre-clerkship students' perceptions of the transition to clerkship training we identified expectations and misconceptions that could be addressed with future curricular interventions. While students are aware of and anticipating their learning needs it is not as clear that they realise how much their future learning will depend on their own inner resources. We suggest that more attention be paid to professional identity formation and the development of the physician as a person during these critical transitions.

Beyond the struggles: a scoping review on the transition to undergraduate clinical training

“…By contrast with researchers’ focus on problems from educational and social perspectives, when taking a developmental perspective, researchers mentioned the desire ‘to empower third‐year undergraduate medical students to recognize learning opportunities in their clinical placements and to proactively use them to develop their understanding and practice’ . Empowering students promotes personal and professional development by optimising learning strategies and encouraging reflection …”

“…Unique to this perspective, researchers reported the transition to clinical training as challenging . This terminology differs to that of the other two perspectives and could be considered a positive cognitive appraisal by researchers highlighting the potential for students’ growth .…”

“…Included studies were from the USA (n = 21), Europe (n = 11), UK (n = 8), Canada (n = 3) and Australia (n = 2). There were 12 qualitative studies, 10,11,14,[19][20][21][22][23][24][25][26][27] 11 cross-sectional surveys, [6][7][8]13,[28][29][30][31][32][33][34] eight descriptive case studies 5,[35][36][37][38][39][40][41] (two of which were related, using the same participants and intervention), 36,37 seven longitudinal studies, [42][43][44][45][46][47][48] three descriptive comparative studies, 12,49,50 three review papers 1,3,9 and one concept paper. 51…”

“…Unique to this perspective, researchers reported the transition to clinical training as challenging. 1,5,7,9,[36][37][38]43,44,50 This terminology differs to that of the other two perspectives and could be considered a positive cognitive appraisal by researchers highlighting the potential for students' growth. 52,53 Research within this perspective allows the discussion to shift away from a stance of minimising particular struggles that students experience during the transition to clinical training and towards recognising the need for students to be able to cope with change.…”

Interprofessional learning through shadowing: Insights and lessons learned

“…This interprofessional shadowing activity took place in the second year of medical school with students who would start clerkships in the coming two to three months. One benefit to this timing is that students are at a critical learning period, a time of transition during which they are developing their professional identities (Soo et al 2016). Goals and resolutions developed before starting clerkships may persist through students’ clinical training and may mitigate any negative role models students encounter.…”