"You’re like on an island if you’re the only medical student on the whole ward“ – Legitimate peripheral participation, medical students’ attendance and sense-making of learning opportunities on their initial clinical placements

Abstract

Introduction: Situated learning theory was developed by Lave & Wenger in the 1990s and has gained increasing relevance among medical education scholars who are concerned with workplace learning. It posits that learning is fundamentally a social process that is facilitated by interpersonal relationships. The notion of legitimate peripheral participation refers to the starting point from which novices move on towards other roles and identities within the community (of practice). The project reported here explored medical students" perspectives of their first full-time placements, which they entered during year three.

Objectives: To quantify the time students spend on different types of placements (surgery/medicine/primary care)To explore what motivates students to spend time on the wards and what barriers they might face.

Methods: Three exploratory focus groups were conducted with undergraduate medical students in year 3 (n=13). Data was collected after students had completed their second placement, which allowed for comparisons between placements in different specialties.

Results: Participants' approaches ranged between conscious immersion to reluctant attendance. Time spent on placement also differed markedly between specialties, ranging between – on average – 17 hours in surgery to 26 hours in primary care. Participants' motivations were influenced by a wide range of factors, including how they were received on the different wards, the encouragement (or lack thereof) by their clinical teachers, the presence of peers and their travel arrangements.

Conclusions: This small exploratory study indicates that despite early-patient-contact provisions and a structured healthcare support work placement in years one and two, some students are struggling to find a place for themselves in the workplace context that is primarily geared towards service delivery. Our data suggests that legitimacy – to be there and to participate – is not a given, but hard won.

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