Preprint: Please note that this article has not completed peer review.
Research article

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

Kathleen Leedham-Green, Alec Knight, Rick Iedema
DOI: 10.21203/rs.2.9766/v2

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.

Keywords
Education, medical, undergraduate, Hidden curriculum, Interprofessional education, Attitudes, Socialization, Secondary Care, Primary Health Care, Students, Medical

Figures

Background

Methods

Results

Discussion

Conclusions

Declarations

References

Table 1

STATUS: Accepted

Comments: 0
PDF Downloads: 3
HTML Views: 61

Integrity Check:

Peer Review Timeline

Version 2

Posted 13 Aug, 2019

  • No community comments so far
  • Editorial decision: Accept

    On 22 Jul, 2019

  • Editor assigned

    On 15 Jul, 2019

  • Submission checks complete

    On 15 Jul, 2019

  • Editor invited

    On 15 Jul, 2019

Version 1

Posted 23 May, 2019

View this version

Subject Areas

Internal Medicine

More from BMC Medical Education

Comments (0)

Comments can take the form of short reviews, notes or questions to the author. Comments will be posted immediately, but removed and moderated if flagged.

Learn more about our company.

Preprint: Please note that this article has not completed peer review.
Research article

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

Kathleen Leedham-Green, Alec Knight, Rick Iedema

STATUS: Accepted

Comments: 0
PDF Downloads: 3
HTML Views: 61

Integrity Check:

  • Article

  • Peer Review Timeline

  • Related Articles

  • Comments

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.

Figures

Background

Methods

Results

Discussion

Conclusions

Declarations

References

Table 1

Learn more about our company.