Intra- and interprofessional practices through fresh eyes: a qualitative analysis of medical students’ early workplace experiences

Abstract

Background Professional identities are influenced by experiences in the clinical workplace including socialisation processes that may be hidden from academic faculty and potentially divergent from formal curricula. With the current educational emphasis on complexity, preparedness for practice, patient safety and team-working it is necessary to evaluate and respond to what students are learning about collaborative practices during their clinical placements. Methods 394 second year medical students at a London medical school were invited to submit a short formative essay as part of their coursework describing, evaluating and reflecting on their experiences of how healthcare professionals work together. Their experiences were derived from having spent two days each week for 25 weeks in clinical contexts across primary and secondary care. We consented 311 participants and used a Consensual Qualitative Research approach to analyse these essays, creating a ‘students-eye view’ of intra- and interprofessional practices in the workplace. Results We identified four overarching themes in students’ essays: - Theme 1: analyses of contextual factors driving team tensions including staff shortages, shifting teams, and infrastructural issues; - Theme 2: observations of hierarchical and paternalistic attitudes and behaviours; - Theme 3: respect for team members’ ability to manage and mitigate tensions and attitudes; and - Theme 4: take-forward learning including enthusiasm for quality improvement and system change. Conclusions Students are being socialised into a complex, hierarchical, pressurised clinical workplace and experience wide variations in professional behaviours and practices. They articulate a need to find constructive ways forward in the interests of staff wellbeing and patient care. We present educational recommendations including providing safe reflective spaces, using students’ lived experience as raw material for systems thinking and quality improvement, and closing the feedback loop with placement sites on behalf of students.

Medical identity; perspectives of students from two countries

“…This is likely to reflect cultural differences in the modelling of medical practice in both society as a whole, and in medical education approaches between the two countries. Increasing exposure to hidden curricula factors such as the professional behaviour observed in clinical role-models, organisational pressure such as work hours and pressure to meet key performance indicators may influence students’ perceptions of the real doctor [ 21 ].…”

‘It benefits patient care’: the value of practice-based IPE in healthcare curriculums

“…There are challenges specific to integrating practice-base IPE that differ from those relating to classroom IPE. Beyond the well documented logistical complexities [ 10 ], practice-based IPE involves tackling sensitive issues such as professional stereotypes and role boundaries in often demanding clinical settings [ 11 ] where patient safety and wellbeing are the primary focus [ 7 ]. Educators at clinical sites are primarily practicing clinicians [ 12 ] and can sometimes lack educator specific training even uniprofesionally [ 13 , 14 ].…”

Introduction of a new teaching method to support Professional Identify Formation in medical students 

“…Professional Identify Formation (PIF) is regarded to be a fundamental aspect of medical education (Cooke et al, 2010;Cruess et al, 2015;Jarvis-Selinger et al, 2012) . Where identity formation is a continuous process that happens in medical school, during residency and beyond (Hafferty & Franks, 1994;Leedham-Green et al, 2019;Witman, 2014), for medical students to develop a Professional Identity, support in this process is desired and education is one of the important tools in this process (Cruess et al, 2015;Goldie, 2012).…”