The effects of contributing to patient care on medical students' workplace learning

Abstract

Context Previous research has suggested that as medical students become more senior, they should increasingly take on the roles they will enact as newly qualified doctors by contributing to patient care. However, student contribution to patient care carries inherent risks to patient safety. This study aimed to provide students with a new opportunity to contribute to patient care and to use this as a platform from which to explore the influence of contributing to patient care on medical student learning. Methods This study took place in the context of final‐year medical student prescribing education at the University of Edinburgh, Edinburgh, UK. Students on attachment at a district general hospital were afforded a unique opportunity to learn prescribing by completing in‐patient drug charts in a process termed ‘pre‐prescribing’. All students were invited to participate in focus groups conducted by the principal researcher. Focus group discussions were audio‐recorded, transcribed verbatim and thematically analysed. Results Six focus groups, each lasting 20–50 minutes, were conducted with four to seven participants (33 students in total). The emerging themes took the form of developmental outcomes and learning processes. Developmental outcomes included ability to perform the task, modification of attitudes towards the task, formation of a professional identity, and development of relationships within the team. The central feature of the experience which influenced all developmental outcomes, was making mistakes. The themes interact in complex ways and all contribute towards development as a professional. Conclusions This study has demonstrated that contributing to patient care enhances students' development as professionals. Some of these developmental outcomes, such as improvements in knowledge and skills, may be achievable to some extent within the classroom. Other changes, such as developing relationships, forming a sense of professional identity and modifying attitudes, might arguably be achievable only within the context of contributing to patient care.

Experience, trajectories, and reifications: an emerging framework of practice-based learning in healthcare workplaces

“…Late 2013 and early 2014 three different research groups published three papers from different geographical contexts, all looking at medical students' workplace learning in undergraduate training programs (Smith et al 2013;Steven et al 2014;Karani et al 2014). In their focus group study on a new way for students to participate in real patient care through 'pre-prescribing', Smith and colleagues stressed the importance of professional identity formation through participation in practice.…”

“…From the perspective of the ETR framework, they explained how opportunities for active participation contributed to students' trajectories. While students' learning trajectories were the main level of analysis in this paper, they also explained how, at the level of personal experiences, making mistakes ''affected all developmental outcomes in this study'' and how, at the reifications level, hierarchies and limitations traditionally attached to the role of students affected students' development (Smith et al 2013). Steven and colleagues longitudinal and multi-method qualitative research on ''how undergraduate medical students learn from real patients in practice settings'' confirmed the basic assumption underlying the ETR framework; learning and acting are part of the same process (Steven et al 2014).…”

What’s in a name? A discussion of what medical students and junior doctors call their senior colleagues, and why it matters

“…Conversely however, there is evidence that reducing social distance within teams improves team-working, and that the perception of hierarchy prevents medical students asking for help. (Smith, Tallentire, Cameron, & Wood, 2013) Each of the authors has a different code of practice when it comes to what we allow or prefer students to call us. JL suggests they call her 'Janet' because that is what her non-medical colleagues do with student groups from year 1, believing this to emphasise adult learner and collegiate status.…”

Capsule commentary on Vijn et al., Involving medical students in providing patient education for real patients: a scoping review

“…Contributing to patient care enhances the student's development of social relationships among the team whereby they assume the values of their profession and transition between acting as a physician and becoming a physician. 4 In addition to the above outcomes, it would be interesting to see future research in this area address how undergraduate students' involvement in patient education contributes not only to their patients' health and their own clinical competency but also to their individual maturation and capacity for empathy, which are critical to the goals of patient-centered care.…”