Medical Education Research Unit, Imperial College London, Sir Alexander Fleming Building, London, SW7 2BB, UK.
Department of Population Health Sciences, King's College London, London, UK.
BMC Med Educ. 2019 Jul 29;19(1):287. doi: 10.1186/s12909-019-1722-8.
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.
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.
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; andTheme 4: take-forward learning including enthusiasm for quality improvement and system change.
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.
职业认同受到临床工作场所经验的影响，包括可能不为学术教师所知的社会化过程，并且可能与正式课程存在差异。鉴于当前教育强调复杂性、实践准备、患者安全和团队合作，有必要评估和应对学生在临床实习期间对协作实践的学习情况。
伦敦一所医学院的 394 名二年级医学生被邀请提交一份简短的形成性论文，作为他们课程作业的一部分，描述、评估和反思他们在医疗保健专业人员如何共同工作方面的经验。他们的经验来自于在初级和二级保健的临床环境中每周花两天时间，共 25 周。我们同意了 311 名参与者，并使用共识定性研究方法分析这些论文，从学生的角度看待工作场所中的专业内和专业间实践。
我们在学生论文中确定了四个总体主题：主题 1：分析团队紧张的驱动因素，包括人员短缺、团队变动和基础设施问题；主题 2：观察到等级制度和家长式作风的态度和行为；主题 3：尊重团队成员管理和缓解紧张局势和态度的能力；主题 4：前瞻性学习，包括对质量改进和系统变革的热情。
学生正在被社会化到一个复杂、等级分明、压力大的临床工作场所，并且经历了专业行为和实践的广泛变化。他们表达了在员工福利和患者护理利益的基础上寻找建设性前进道路的需求。我们提出了教育建议，包括提供安全的反思空间、将学生的生活经验作为系统思考和质量改进的原始材料、并代表学生向实习场所反馈。
