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Medical Education 2012: 46: 1074–1087
CONTEXT During early clinical exposure, medical students have many emotive experiences. Through participation in social practice, they learn to give personal meaning to their emotional states. This meaningful social act of participation may lead to a sense of belonging and identity construction.
OBJECTIVES The aim of this study was to broaden and deepen our understanding of the interplay between those experiences and students’ identity development. Our research questions asked how medical students give meaning to early clinical experiences and how that affects their professional identity development.
METHODS Our method was phenomenology. Within that framework we used a narrative interviewing technique. Interviews with 17 medical students on Year 1 attachments to nurses in hospitals and nursing homes were analysed by listening to audio-recordings and reading transcripts. Nine transcripts, which best exemplified the students’ range of experiences, were purposively sampled for deeper analysis. Two researchers carried out a systematic analysis using qualitative research software. Finally, cases representing four paradigms were chosen to exemplify the study findings.
RESULTS Students experienced their relationships with the people they met during early clinical experiences in very different ways, particularly in terms of feeling and displaying emotions, adjusting, role finding and participation. The interplay among emotions, meaning and identity was complex and four different ‘paradigms’ of lived experience were apparent: feeling insecure; complying; developing, and participating.
CONCLUSIONS We found large differences in the way students related to other people and gave meaning to their first experiences as doctors-to-be. They differed in their ability to engage in ward practices, the way they experienced their roles as medical students and future doctors, and how they experienced and expressed their emotions. Medical educators should help students to be sensitive to their emotions, offer space to explore different meanings, and be ready to suggest alternative interpretations that foster the development of desired professional identities.
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During early clinical exposure, medical students have many new, potentially emotional experiences, such as when they are confronted with death and dying, when they access the intimate, corporeal areas of life, when they build relationships with patients, and as they deal with uncertainty and role confusion.1,2 These experiences have been found to result in a broad variety of learning outcomes, such as greater motivation and the development of a positive state of mind, knowledge and clinical skills, which together constitute a professional identity.1,3,4 Although we know that entering medical practice for the first time can be confusing, daunting and overwhelming for young students,5 our previous research suggests that the emotional dimension of learning in workplaces tends to be ignored.6
Emotions and the meanings attributed to them may help people make sense of themselves and their relationships with others.7 Through participation in social practice, and by constructing a narrative of their experiences, students learn to give personal meaning to their emotional states. This meaningful social act of participation may then lead to a sense of belonging and identity construction.8 Emotional experiences and identity development are involved in a two-way relationship: emotionally salient incidents in medical workplaces represent powerful stimuli for the development of professional values and identity,9,10 and identity development can itself give rise to strong emotional disruptions.11
Identity development is an emotional, cognitive and social process that can be considered at individual or social levels.11 Students give meaning to their emotional experiences during early clinical placements within their particular personal and socio-cultural contexts. Through participation in work activities such as caring for patients and collaborating with colleagues, they begin to identify with their future roles as health care professionals. By telling stories about their experiences and trying to make sense of them, students shape and reshape their developing identities. An inquiry into medical students’ narratives of workplace experiences, then, may enhance our understanding of how identities are constructed and co-constructed within medical education.11,12
In this study, we focused on medical students’ meaning making and their developing awareness of the socio-cultural contexts they are entering. We explored the individual experiences of students who were in the throes of becoming health care professionals in the context of social practice. We chose phenomenology as a methodology through which to interpret these processes in depth. Previous phenomenological studies directed at professional identity development are scarce, particularly within medical education. A phenomenological study aimed at understanding how nursing students made meaning of being with patients revealed the strong inter-relatedness of emotions and meaning making, and identified fear of interacting with patients, developing confidence and becoming self-aware as main themes in students’ experiences.13 A recent study within medical education showed how Year 3 students gave meaning to their experiences of being with patients by learning to be receptive and responsible.14
The aim of the present study was to broaden and deepen our understanding of the identity development that occurs when medical students enter practice for the first time. This directed us towards the ‘lived experiences’ of these young people and towards exploring the ‘essence’ of being at once a Year 1 medical student and a future professional, and the emotional turmoil that might result from entering a clinical community of practice as a doctor-to-be. We sought to establish how medical students narrate and give meaning to their emotions in a Year 1 attachment to nurses, and how that affects their professional identity development.