Medical Students' Socialization Tactics When Entering a New Clinical Clerkship: A Mixed Methods Study of Proactivity

Sense of Belonging Among Medical Students, Residents, and Fellows: Associations With Burnout, Recruitment Retention, and Learning Environment

PURPOSE

This study examines sense of belonging (belongingness) in a large population of medical students, residents, and fellows and associations with learner burnout, organizational recruitment retention indicators, and potentially modifiable learning environment factors.

METHOD

All medical students, residents, and fellows at Mayo Clinic sites were surveyed between October and November 2020 with items measuring sense of belonging in 3 contexts (school or program, organization, surrounding community), burnout (2 Maslach Burnout Inventory items), recruitment retention indicators (likelihood of recommending the organization and accepting a job offer), potentially modifiable learning environment factors, and demographics (age, gender, race and ethnicity, LGBTQ+ identification, disability, socioeconomic background).

RESULTS

Of 2,257 learners surveyed, 1,261 (56%) responded. The percentage of learners reporting a somewhat or very strong sense of belonging was highest in the school or program (994 of 1,227 [81%]) followed by the organization (957 of 1,222 [78%]) and surrounding community (728 of 1,203 [61%]). In adjusted analyses, learners with very strong organization belongingness had lower odds of burnout (odds ratio [OR], 0.05; 95% CI, 0.02-0.12) and higher odds of being likely to recommend the organization (OR, 505.23; 95% CI, 121.54-2,100.18) and accept a job offer (OR, 38.68; 95% CI, 15.72-95.15; all P < .001). School or program and community belongingness also correlated strongly with these outcomes. In multivariable analyses, social support remained associated with higher odds of belongingness in all 3 contexts; favorable ratings of faculty relationships and leadership representation remained associated with higher odds of belongingness in 2 contexts (school or program and organization); and favorable ratings of diversity, equity, and inclusion learning climate remained associated with belongingness in 1 context (community).

CONCLUSIONS

Sense of belonging among medical students, residents, and fellows varies across contexts, correlates strongly with burnout and organizational recruitment retention indicators, and is associated with multiple potentially modifiable learning environment factors.

Transitioning to residency: a qualitative study exploring residents' perspectives on strategies for adapting to residency

BACKGROUND

The transition to residency (TTR) goes along with new opportunities for learning and development, which can also be challenging, despite the availability of preparation courses designed to ease the transition process. Although the TTR highly depends on the organization, individual combined with organizational strategies that advance adaptation are rarely investigated. This study explores residents' strategies and experiences with organizational strategies to help them adapt to residency.

METHODS

We conducted a template analysis of interview transcripts with 16 second-year residents from different hospital-based specialties in the Netherlands. To identify residents' perceptions of their own and other healthcare professionals' strategies, our template consisted of the individual and organizational strategies originating from the Organizational Socialization theory.

RESULTS

Residents employed five individual strategies: observing, asking questions, establishing social relationships, and seeking information. These strategies helped them learn their tasks, appropriate behaviors, and integrate into their teams. On the organizational side, residents experienced six strategies, mapped through Organizational Socialization theory. Collective-individual: whether the residents felt they were treated as a group or as individuals. Formal-informal: whether the introduction period was formal, structured and explicit, or implicit and unstructured. Sequential-random: whether guidance was aligned with training levels or approached inconsistently. Fixed-variable: whether the residency program followed a fixed timeline or a flexible structure. Serial-disjunctive whether role models or experienced professionals were available for guidance or not. Investiture-divestiture: whether the healthcare team embraced residents' individuality or emphasized residents' conformity to norms. Factors influencing TTR included individual strategies, such as establishing social relationships, and organizational strategies, particularly interactional (relationships with healthcare professionals) and systemic strategies (training program structure). Residents' perceptions varied on whether these strategies facilitated or hindered their TTR.

CONCLUSION

TTR involves dynamic interactions between residents and healthcare professionals, bridging individual and organizational strategies. This largely unexplored interaction adds a new dimension to Organizational Socialization theory. Importantly, residents' perceptions of these strategies varied: some thrived with independence, while others needed structured guidance. This suggests that residency programs should customize support to individual needs, balancing support and autonomy to improve transitions and enhance training.

Challenges to Students' Learning and Wellbeing During Placement Abroad: A Qualitative Study Using Rich Pictures

Introduction

Undergraduate healthcare students on placement abroad can experience challenges that affect their wellbeing, personal and professional development. These challenges may result in students taking a more peripheral role in workplace activities, which negatively impacts learning. We studied how personal and professional challenges affect students' learning and wellbeing during a clinical placement abroad.

Methods

We used the rich pictures drawing method to elicit semi-structured student interviews and capture personal and professional challenges within different contexts. Language, culture, education, and belonging were used as sensitizing concepts, underlying thematic analysis. We conducted a parallel and iterative analysis of the transcripts and rich pictures. Team discussions focused on developing patterns and further conceptualization of results.

Results

Based on thirteen student accounts, we identified four main themes: 'Learning to work in the international context'; 'Cultural differences shape professional identity'; 'Deliberate social connections'; and 'Personal growth through international experiences'. Active participation in local practices was crucial to overcome barriers in language, culture or education, and increase belonging. Local healthcare teams and peers supported students' wellbeing, personal and professional development by helping them establish their role as a learner, whilst exploring the scope and boundaries of their future profession.

Conclusions

Language, cultural and educational challenges can be considered an inevitable part of student placement abroad. Local peers and staff may support this transition and help recognize learning opportunities and challenges in the workplace. Clinical educators can facilitate learning and wellbeing by providing social support and guidance on professional behavior, including communication.

"Discovering shine through feedback seeking"---feedback seeking among new graduate nurses: a qualitative study

BACKGROUND

Feedback is critical to improving practitioners' clinical practice and professional growth. Although they are still considered junior practitioners, their feedback-seeking experiences have yet to be investigated. This study aimed to understand the fundamental thoughts and experiences of new graduate nurses regarding feedback-seeking and to identify the main factors that influence their feedback-seeking behaviors.

METHODS

Conducting a descriptive phenomenological study, semi-structured in-depth interviews with newly graduated nurses from four hospitals in Zhejiang Province, China, face-to-face or via video call in the hospital conference room through purposive and snowball sampling. Interview data were evaluated using Colaizzi's 7-step phenomenological data analysis. The COREQ checklist was followed.

RESULTS

A total of 15 new graduate nurses were interviewed as a sample, and 13 categories emerged from our data. They were categorized into four central elements: (1) perceptions and attitudes, (2) drivers, (3) dilemmas and needs, and (4) transformation and growth.

CONCLUSIONS

This study found that new graduate nurses have various needs but face dilemmas in the feedback-seeking process. Nursing managers should be proficient at providing positive leadership, collaborating with clinical mentors to foster an atmosphere where new graduate nurses may obtain honest, transparent, and fair feedback, and exercising caution when providing negative feedback.

How to coach student professional development during times of challenges and uncertainties

BACKGROUND

What we teach our (bio)medical students today may differ from the future context under which they will operate as health professionals. This shifting and highly demanding profession requires that we equip these students with adaptive competencies for their future careers. We aimed to develop a framework to promote and facilitate professional development from day one, guided by self-awareness and self-directed learning.

APPROACH

Based on self-directed, transformative and experiential learning, patient involvement and teamwork, we developed a 3-year longitudinal personal-professional development (LPPD) program in the (bio)medical sciences undergraduate curriculum to stimulate self-driven professional development in a variable context. Through group meetings and individual coach consultations, students address topics such as self-awareness, self-directed and lifelong learning, collaboration, well-being and resilience. To drive learning students receive extensive narrative feedback on an essay assignment.

EVALUATION

Experiences and outcomes were evaluated with questionnaires and in-depth interviews. Students and coaches value personal and professional development in a safe learning environment that encourages self-exploration, diversity and connection. Over time, students show more self-awareness and self-directedness and increasingly apply trained skills, resulting in professional identity formation. Students need more clarification to understand the concept of assessment as learning.

IMPLICATIONS

With the generic content of a longitudinal program embedded in a meaningful environment, the personal and professional development of students can be facilitated and stimulated to face future challenges. When translating to other curricula, we suggest considering the complexity of professional development and the time expenditure needed for students to explore, experiment and practice. An early start and thorough integration are recommended.

Psychological safety in European medical students' last supervised patient encounter: A cross-sectional survey

OBJECTIVE

To investigate the association between European medical students' psychological safety in and experiences from their last supervised patient encounter.

MATERIALS AND METHODS

A cross-sectional online survey among European medical students. Bivariable and multivariable linear regression was used to explore the associations between the dependent variable psychological safety and independent variables concerning students' experiences from their last supervised patient encounter.

RESULTS

A total of 886 students from more than 25 countries participated. The variables most strongly associated with psychological safety were supervisor coaching and modelling behaviour, adjusted beta 0.4 (95%CI 0.3 to 0.5) and 0.1 (95%CI 0.1 to 0.2) per unit respectively on a one-to-five-point scale, and studying in Northern Europe, adjusted beta 0.4-0.5 compared to other regions. There was a weak negative association (reduced score on psychological safety) for being supervised by a medical doctor with <5 years' experience and a positive association for student confidence. Student gender, student seniority, speciality, whether peers were present, number of previous encounters with the supervisor and supervisor articulation and exploration behaviour were not associated in multivariable analysis.

CONCLUSION

Coaching might be a good primary focus to improve supervision practices, as participation with feedback is known to be beneficial for learning and coaching was strongly associated with psychological safety. Supervisors in western, eastern, and southern Europe might have to work harder to create psychological safety than their northern colleagues.