Navigating without a map: how medical students interact with clinical learning environments

ABSTRACT

Through an exploration of the interdependence between workplace affordances and individual engagement, this study addressed how medical students interact with clinical learning environments (CLEs). Building on the workplace participatory practices approach outlined by Billett, CLEs can be viewed as constructed through a negotiation of meaning between the workplace and the student. Inspired by ethnography, an observational study using field observations and follow-up interviews was performed. Workplace affordances included being given a marginal status in the healthcare team which students adapted to through striving to fit into the workplace. Further, there were many potential activities available to students; however, students seemed selective in terms of what activities they elected to engage in. As such, interacting with CLEs entailed students navigating complexity without the immediate access to any explicit ‘map’ of workplace learning. This study indicates that workplaces increasingly need to invite and include students in the practice of workplaces.

KEYWORDS:

• Learning environment
• observational study
• undergraduate medical education
• workplace learning
• workplace participatory practices

Acknowledgements

The authors would first like to thank all the students and staff who participated in this study. Our sincere gratitude also goes to Nienke Renting, Peter Cantillon and our institutional colleagues for insightful comments on early drafts of the manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the Stockholm County Council (ALF project) [grant number SLL20110191].