Becoming a doctor: using social constructivism and situated learning to understand the clinical clerkship experiences of undergraduate medical students

BACKGROUND

Despite the emphasis on the uniqueness and educational importance of clinical clerkships in medical education, there is a lack of deep understanding of their educational process and outcomes. Especially due to an inherent trait of clinical clerkships which requires participation in the workplace outside the classroom, it is difficult to fully comprehend their educational potential using traditional learning perspectives such as imbibing outside knowledge. Accordingly, this study aims to explore the experiences of a rotation-based clerkship of medical school students from the perspective of social constructivism of learning, which can empirically examine what and how medical students learn during clinical clerkship in South Korea. By providing an insight into the workings of the clerkship process, this study contributes to a better understanding of how a learning-friendly environment can be cultivated at clinical clerkships.

METHODS

The study utilized a basic qualitative study to understand what and how medical students learn during their clinical clerkships. Semi-structured, in-depth individual interviews were conducted with eight sixth-graders who had experienced a two-year clerkship at Ajou University Medical School. Data were analyzed based on Lave and Wenger's situated learning theory and Wenger's social theory in learning.

RESULTS

We found that the medical students had developed different aspects of their professional identities such as values, functionality, career decisions, sociality, and situating during their clinical clerkships. Further, professional identity was formed through a combination of participation and reification-the processes involved in the negotiation of meaning. This combination was facilitated by the students' first experience and relationships with professors, classmates, and patients. Finally, non-learning occurred in the context of over-participation (learning anxiety and alienation) or over-reification (evaluation and e-portfolio).

CONCLUSIONS

This study revealed five sub-professional identities and their formation process from the learners' perspective, thereby uncovering the unique learning characteristics and advantages of rotated-based clerkship and contributing to a further understanding of how gradual improvements can be made to the traditional clerkship education of medical students.

The Case for Smiling? Nonverbal Behavior and Oral Corrective Feedback

Oral Corrective Feedback is a widely used teaching strategy that has been found to help language acquisition. The factors that contribute to its effectiveness, however, remain elusive. In this study, the role of smiling during teachers' OCF provision is investigated in intact language classrooms by modifying the analytical framework developed by Lyster and Ranta (Stud Second Lang Acquis, 19(1):37-66, 1997), which determines OCF effectiveness by the success of the learner uptake. In addition to the feedback strategies used, this study examines teacher smiling during the feedback instances, and whether they were genuine or polite smiles. The Facial Action Coding System (Ekman & Friesen, Environ Psych Nonver, 1(1), 56-75, 1976; Ekman, Friesen, & Hager, Facial Action Coding System: The Manual on CD ROM. Salt Lake City, UT: Research Nexus division of Network Information Research Corporation, 2002) is utilized to operationalize smile genuineness. Significant findings indicate that when teacher smiling is genuine, learners are more likely to correct their errors, while polite smiles do not have the same effect.