Dear Editor, With great interest we read the article by Tremayne and Hunt (2019) drawing attention to the impact of ensuring a welcoming environment on nursing students in a clinical setting. The authors alluded to how a sense of ‘lack of belonging’ can create hesitancy to engage with the team, which is particularly fascinating and also resonates among medical students. As medical students ourselves, we would like to offer our perspective on how different environments in clinical placements shape our experience. In particular, we would like to shed light on how discrepancies between clinical placements can significantly shape views on which future field of practice to enter.
We would first like to thank Tremayne and Hunt for identifying and exploring the impact of challenging clinical environments on students—a topic that resonates throughout medical school. Among medical students, opinions about the satisfaction of a clinical experience are largely based on two factors: the quality of the teaching provided and the attitudes of the staff towards students' presence. Although the importance of the former is acknowledged by medical schools and somewhat standardised across clinical attachments, the latter is often overlooked.
Before commencing clinical attachments, it is emphasised to us how valuable these experiences are and how we must be as involved as possible in order to maximise benefits. This alone presents a challenge as students endeavour to balance maximising participation with not becoming an inconvenience for staff. However, an unreceptive environment poses a greater internal challenge. In particular, when staff are dismissive of students in a department, it can perpetuate pre-existing feelings of anxiety about starting clinical placements as well as create resistance towards attending them. This can result in students disliking a department and, ultimately, not wanting to pursue a future career within that field. Among nurses, a similar impact is made, where the environment influences opinions on whether the department is suitable as a place of work for the future. In both situations, the outcome could have been different had the experience been more positive.
From this article, several parallels can be drawn between nursing and medical students. After all, we are all future members of the multidisciplinary team, aiming to learn from similar clinical experiences. Therefore, we propose that the methods of improving clinical experiences outlined by Tremayne and Hunt such as ‘actively give feedback when a student has done a good job to increase feelings of ownership’, should be considered and implemented within medical clinical attachments as well.
From personal experience, environments where students have been encouraged to be involved in the management of patient have been the most rewarding.
A report by London Medicine and Healthcare (2017) found that placements where staff expected medical students, offered dedicated teaching time and treated them as part of a team, made placements more successful and fostered more interest in the specialty.
Currently, the medical school curriculum does not consider the impact of these clinical experiences on the career decisions made by medical students. By considering the engagement of the team when deciding which departments students are allocated to, more medical students would be made to feel like part of the team across a variety of specialties. This would facilitate both informed decision-making and positive learning experiences throughout medical school.