Abstract
IntroductionWhile ICU clerkships are commonplace in undergraduate medical education, little is known about how students learn there. This study aimed to explore students’ perceptions of the ICU as a learning environment, the factors influencing their learning and any perceived differences between learning in the ICU and non-ICU settings.MethodsWe used interpretivist methodology, a social cognitive theoretical framework and a qualitative descriptive strategy. Ten medical students and four graduate doctors participated in four semi-structured focus group discussions. Data were analyzed by six-step thematic data analysis. Peer debriefing, audit trail and a reflexive diary were used.ResultsSocial cognitive influences on learning were apparent in the discussions. Numerous differences emerged between ICU and non-ICU clinical clerkships, in particular an unfamiliarity with the environment and the complex illness, and difficulty preparing for the clerkship. A key emergent theme was the concept of three phases of student learning, termed pre-clerkship, early clerkship and learning throughout the clerkship. A social cognitive perspective identified changes in learner agency, self-regulatory activities and reciprocal determinism through these phases. The findings were used to construct a workplace model of undergraduate intensive care learning, providing a chronological perspective on the clerkship experience.ConclusionsThe ICU, a rich, social learning environment, is different in many respects to other hospital settings. Students navigate through three phases of an ICU clerkship, each with its own attendant emotional, educational and social challenges and with different dynamics between learner and environment. This chronological perspective may facilitate undergraduate educational design in the ICU.
Highlights
Introduction Whileintensive care unit (ICU) clerkships are commonplace in undergraduate medical education, little is known about how students learn there
A key emergent theme was how the students’ physical, emotional and social engagement with the clerkship underwent a process of change, much of which could be explained in terms of Social cognitive theory (SCT), characterized by negative emotions, apprehension and uncertainty prior to the clerkship, moving through a period of orientation and increasing familiarization, before reaching a state where positive learning experiences could occur
A majority of these subthemes related to the differences between ICU and non-ICU clerkships
Summary
Introduction WhileICU clerkships are commonplace in undergraduate medical education, little is known about how students learn there. Its ‘horizontal’ structure enables simultaneous exposure to numerous subspecialties [2]. It facilitates vertical integration between basic and clinical sciences and exposes students to the clinical and procedural aspects of acute and critical illness, infrequently found elsewhere [3, 4]. The intensive care unit (ICU), with its unique customs and norms, may be a challenging learning environment for students. They may feel intimidated by the unfamiliarity of the surroundings and the complexity of pathology and treatments [5], promoting uncertainty and disengagement, thereby hindering learning [6, 7]. Active student participation, important for effective learning [8,9,10,11], may be harder to achieve in the complex, high-stakes ICU setting
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