Adapting to clinical responsibility: Challenges and learning environment in early practice-a longitudinal study

Area of Science:

• Medical Education
• Healthcare Professional Development
• Clinical Transition Research

Background:

• The transition from medical student to doctor is a critical but challenging period.
• Existing research often lacks longitudinal insights into learner adaptation and environmental influences.
• Understanding how educational environments support learners during this transition is vital.

Purpose of the Study:

• To explore medical students' experiences and adaptation to increasing clinical responsibility during the transition from clerkship to the first postgraduate year (PGY1).
• To interpret these experiences through the lens of Gruppen's Learning Environment Framework.
• To identify how learning environments shape challenges and learner adaptation.

Main Methods:

• A longitudinal study using audio diaries from medical students (August 2017 - July 2020).
• Inductive analysis of diaries to identify challenges and coping strategies.
• Application of Gruppen's Learning Environment Framework to organize findings across personal, social, and organizational domains.

Main Results:

• During clerkship, students struggled with knowledge application, team integration, and role clarity.
• Transition to PGY1 involved adaptive strategies like proactive engagement, relationship building, and self-reflection.
• Learners' responses evolved with increased responsibility, though some challenges persisted longitudinally.

Conclusions:

• Challenges in the student-to-doctor transition are influenced by learning environment factors.
• Learners adapt over time through evolving responses and coping mechanisms.
• Findings provide insights for designing educational strategies to better support medical learners.