How do medical students navigate learning opportunities during clinical placements? : exploring the inter-related processes underlying medical students’ decisions to engage with learning opportunities in the workplace

Abstract

Workplace learning theories have elaborated the complex interacting influences on student learning on clinical placement. However, the literature insufficiently relates these determinants to the pervasive problem of variable student engagement. Examining student involvement with activity (‘engagement’) and their agency in the process (‘navigation’), requires exploration of the moment-bymoment factors underpinning participation. Methods The study followed constructivist grounded theory methodology from a social constructivist perspective. The aim was to develop a conceptual model of the inter-related processes underlying medical students’ decisions to engage with learning opportunities during clinical placements. Data was collected through six focus groups and 18 semi-structured interviews utilising a pre-interview questionnaire. The sample comprised 46 third and final year medical students. Analysis followed a constant comparative method. Results Student engagement with clinical activity is underpinned by a complex interaction of individual, social and environmental influences. Individual factors included affective state, motivational drivers, prior experience and existing traits, values and beliefs. Complex relational dynamics both supported and inhibited learning, with the students demonstrating reliance on external mediation. Pertinent environmental influences included the physical space, clinical activity dynamics and students’ personal lives. These interacting factors translated to behavioural norms, evident in students’ highly selective and strategic interactions. Discussion The novel conceptual model developed is the first of its kind and draws together known and previously unknown influences of medical student engagement with clinical placements. Where the existing literature over-emphasises formal learning processes, this study suggests student engagement with workplace 3 learning opportunities is determined by a complex interaction of explicit and implicit factors which are dynamic, reactive and contextually dependent. The model sits in accordance with Billet’s learning theory of workplace affordances which provides a useful theoretical framework for interpreting the findings. Conclusion This study is unique in establishing a model of the inter-related processes determining medical student engagement with learning on clinical placements. Understanding the interacting network of individual, social and environmental influences of student participation provides educators with valuable insight into modifiable factors which may support student learning.