Clinical Learning Environment Research Articles

Linking nursing students' professional identity, clinical learning environment, financial incentives, and career opportunities with migration intent: Structural equation modeling.

To investigate how nursing students' professional identity, clinical learning environment, financial incentives, and career opportunities influence their intention to migrate. There is a preponderance of studies about nurse migration and its impact on the global nursing workforce. However, a critical gap remains about nursing students' intentions to migrate, particularly among developing countries like the Philippines. Using a cross-sectional design, third- and fourth-year nursing students (n=316) from the largest comprehensive university in Manila were conveniently recruited. Data were collected from November to December 2023 using five validated self-report scales. Descriptive (e.g., mean, standard deviation) and inferential statistics (e.g., Spearman rho, covariance-based structural equation modeling) were used to analyze data. The emerging model demonstrated acceptable model fit indices. Nursing students' professional identity (β=0.18, p=0.043) and financial incentives (β=0.10, p=0.046) significantly and positively influence the intention to migrate. The satisfaction with future career opportunities (β=-0.12, p=0.038) and clinical learning environment perception (β=-0.15, p=0.048) negatively influence the intention to migrate. These four predictors accounted for 4.60% of the total variance of intention to migrate. Nursing students' professional identity and financial incentives directly impact intent to migrate, whereas future career opportunities satisfaction and clinical learning environment inversely affect intent to migrate. This study underscores the imperative for nursing colleges and faculty to promote positive professional identity and provide a conducive clinical learning environment to develop sustainable nurses' migration policies.

Nurses, midwives and students' reports of effective dedicated education units in five European countries: A qualitative study.

To investigate nursing/midwifery students, Clinical Mentors, Link Teachers and Head Nurses experiences within "Dedicated Education Unit" model in 6 European clinical placements and analyse the necessary elements for a powerful clinical learning environment. A multi-country, phenomenological, qualitative study. Focus group interviews were performed to identify the personal and organizational factors of importance for students and nurses/midwives. Data analysis produced 4 main themes (1) Clinical placement organization, (2) students' clinical knowledge and skill acquisition, (3) students, and nurses/midwives' experiences within the DEU model and (4) factors for creating an effective learning environment. A close educational-service collaboration, a realistic clinical placement planning, a focus on student learning process and an investment in professionals' education and development among others, are elements to set up a powerful clinical learning environment. It is considered advisable and urgent to improve the working conditions of nurses/midwives and the learning environments of students as a strategy to alleviate the global shortage of nurses and respond to the increasingly demanding health needs of the population. Due to the close relationship between students' learning and features of the clinical environment nurse educators seek innovative models which allow students to manage patient care and their transition to professional practice. To implement new learning strategies, identifying students, nurses and midwives perceptions and suggestions is a powerful information to evaluate implementation process and outcomes. Our findings could help academic and clinical managers to meet the human and organizational requirements to create a successful learning environment in every student placement.

“This should be a compulsory placement for all nursing students”: An evaluation of pre-registration nursing students’ perceptions of learning on a mental health clinical placement

AimTo conduct a longitudinal exploration of pre-registration nursing students’ perceptions of their learning on an immersive mental health clinical placement grounded in learning from people with a lived experience of mental illness (otherwise known as consumers). BackgroundEnriching mental health clinical learning environments are crucial for positive mental health nursing outcomes. Though non-traditional clinical placement (i.e. non-hospital-based) models effectively increase student learning in a range of domains, little is known about the specific features of contemporary non-traditional placement settings that may be supporting student learning over time. DesignA survey design in the form of a standardised evaluation tool with additional qualitative response questions was used to examine nursing students’ perceptions of learning whilst on a non-traditional clinical placement over a 5-year period. Non-traditional placement settings are alternative placement options to traditional inpatient/community mental health settings. The TREND Statement Checklist was adhered to. MethodsSecond- and third-year students studying a Bachelor of Nursing (N = 753) from eight Australian Universities completed a Student Placement Feedback Survey between 2019 and 2023. Data were collected via an evaluation survey including 7-items (rated on a 5-point agreement scale) and three free-response questions. Quantitative and qualitative responses were analysed over all observations and compared between the five years of student evaluations. ResultsAcross five years, the immersive mental health placement was consistently rated by students as a highly valuable learning experience. Utilizing a Multivariate Analysis-of-variance (MANOVA) for the quantitative component revealed that student ‘learning from lived experience’ remained uniformly high and steady throughout 2020–2023. This was despite disrupted learning that ceased face-to-face tuition caused by the COVID-19 pandemic. An increase in ‘student enthusiasm for nursing’ was identified after the return to face-to-face learning. Qualitative analysis identified a greater need for preparedness prior to attending the placement and wellbeing support amongst students. ConclusionsOver the five years, pre-registration nursing students report clinical skill improvement and enhanced knowledge following the immersive mental health placement alongside an increased desire for further skill development. Learning from people’s lived experience of mental illness and specialised facilitators was valuable for student learning outcomes. Increased support is needed for student mental health vulnerabilities and wellbeing ahead of clinical placements. Further research is recommended on the aspects of non-traditional clinical placements that may be protective for student learning.

Impact of Clinical Learning Environment and Incivility on Professional Self-Concept in Dental Hygiene Students

Impact of Clinical Learning Environment and Incivility on Professional Self-Concept in Dental Hygiene Students

Clinical learning experiences of healthcare professional students in a student-led clinical learning environment (SLCLE) – A mixed methods evaluation

AimTo evaluate healthcare professional (HCP) students clinical learning experiences’ whilst undertaking placements in a student-led clinical learning environment (SLCLE) and any changes in self-reported ratings of confidence. BackgroundThe English NHS Long Term Workforce Plan (2023) highlights the need to expand domestic education of HCPs to meet workforce shortages. The demand for quality clinical placements to support the preparation of HCP students remains a challenge globally. A creative solution has been the development of student-led learning clinical environments in healthcare settings. SLCLEs provide high-quality learning experience, increase clinical placement capacity whilst maintaining patient care standards. A multisite NHS Trust adopted this model as evidence suggests HCP students will be better prepared on qualification to adopt registered practitioner professional responsibilities. This model has been integrated across three hospital sites within a large teaching hospital, providing care for a diverse population and designed to accommodate students from a range of HCP disciplines and higher educational institutions. DesignA mixed methods convergent design. MethodsAn online survey was administered to SLCLE allocated nursing and allied health profession (AHP) undergraduate and graduate-entry first, second and third-year students (n=132). Face to face focus groups/individual interviews were undertaken with a purposive sample of student participants (n=80) to evaluate their experiences of clinical learning in SLCLEs. Survey data were analysed using descriptive statistics and paired t-tests, interviews using framework method. ResultsUndergraduate and graduate-entry students from four UK universities completed the survey (n=132), 103 students (78 %) responded. Most were year 2 students (n=43/42 %), pursuing nursing programmes (n=82/80 %). Most considered the SLCLE met their expectations (n=76/74 %), reported increased confidence post-placement (n=84/82 %), felt supported by staff (n=80/78 %), peers (n=93/90 %) and clinical educators (n=93/90 %). Self-reported confidence scores post-SLCLE were significantly higher than pre-SLCLE. On-line pre-placement information was infrequently accessed yet identified as an omission. Four themes were identified: (i) preconceptions and initial anxiety; (ii) empowerment, growth and a unique learning experience; (iii) collaborative inter-professional learning and support; and (iv) insights and anticipations. ConclusionsThe SLCLE allocation enhanced students’ confidence and knowledge. Support from clinical educators, ward staff and doctors was perceived as invaluable for creating a positive learning culture. Peer support and opportunities to lead care delivery contributed to students’ professional development. The format and method for providing pre-placement information needs review as do strategies for avoiding delays in completing assessment documentation. Overall, the SLCLE experience offers much potential as a nurturing and effective learning environment for HCP students.

Clinical learning evaluation among undergraduate physical therapy students during rotations in teaching hospitals of Sialkot and Lahore.

To evaluate the clinical learning environment among undergraduate physical therapy students. The descriptive, cross-sectional study was conducted from Januar y 23 to May 25, 2023, after approval from the ethics revie w committe e of Imran Id rees Ins titute of Rehabilitation Sciences, Sial kot, Pak istan, an d comprised undergraduate physical therapy students of either gender aged 19-26 years in their 3rd to 5th academic year studying in different institutions in Lahore and Sialkot. Data was collected using the clinical learning evaluation questionnaire. Data was analysed using SPSS 22. Of the 295 students, 269(91.2%) were females and 26(8.8%) were males. The overall mean age was 22.03±1.14 years. There were 210(71.2%) stude nts enrol led in the semester system , w hile 85(28.8%) we re part of the an nual system. The overall mean score was 71.05±10.20. Super vision (76.02±11.80) and motivation (80.21±11.71) were the most satisfying part of clinical learning identified by the students. The clinical learning environment demonstrated high satisfac tion levels in supervision and motivation domains, while im provements were nee ded in the areas of cas es, authenticity and organisation of doctor-patient encounters.

Some is not everything? Designing an instrument that measures the clinical learning environment holistically

This article describes the development as well as face and content validation of an instrument for measuring the clinical learning environment of professional healthcare students. A methodological research design was used to develop the instrument and a Delphi technique was used to determine face and content validity. The research was conducted systematically in two phases to construct the instrument, and to establish face and content validity. Phase 1 comprised a general literature overview to identify existing instruments. The retrieved instruments were thematically analysed into the four themes of atmosphere, teamwork, workload and learning opportunities, and then the first version instrument was drafted. In Phase 2, the first version instrument was evaluated for face and content validity. Thirty-six healthcare professional experts responded in the consensus Delphi study, and consensus was reached after three rounds. A consensus Delphi study confirmed the face and content validity of 62 items. The second version of the new instrument was determined. A new holistic clinical learning environment measuring instrument, based on existing instruments, was developed to promote quality student placements.

Do Resident Unions Improve Graduate Medical Education Training? Benefits and Potential Pitfalls.

The last 10 years have seen an increase in union representation for residents and fellows across the United States. It is estimated that 15% of residents and fellows are represented by unions. With increasing numbers of U.S. residents and fellows in graduate medical education (GME) programs being represented by unions, the authors contend that it is worthwhile to consider the benefits and potential drawbacks of resident unions and how GME and health system leaders can best work to ensure that the educational needs of residents continue to be emphasized in an era of resident unionization. Union bargaining can be a method to secure salary increases and other benefits for residents. Unionization can also provide a mechanism for more rapidly addressing worker protection issues and allows residents to advocate on behalf of patients. Residents participating as union leaders may develop important leadership and negotiation skills as well as gain beneficial knowledge about health system structure, financing, and priorities. However, with all the possible benefits that may come with resident unionization, there are also potential pitfalls. The collective bargaining process may create an adversarial relationship between program and institution leaders and trainees. Additionally, while residents are considered employees and able to collectively bargain, the National Labor Relations Board has also acknowledged that residents are "students learning their chosen medical craft." Program and institution leaders have an obligation to prioritize resident education and adhere to accreditation requirements even when these requirements conflict with union demands. Furthermore, because of the obligation to protect the public, program leaders should maintain control of resident academic due process issues. Program and institutional leaders must continue to prioritize resident education. Furthermore, GME leaders have a joint responsibility to create clinical learning environments that are conducive to quality patient care and promote resident learning and well-being.

The second victim phenomenon: A qualitative study among bachelor’s degree nursing students within the clinical learning environment

AimThis study explores and describes the second victim phenomenon in nursing students in association with the characteristics of the clinical learning environment and the clinical supervision process. DesignQualitative design using conventional content analysis and summative content analysis approaches. MethodsFrom September 2022 to July 2023, in-depth semi-structured individual interviews were conducted with a purposive sample of 10 undergraduate nursing students. ResultsSix main themes were developed: ‘defining the physical and psychological responses after the most significant patient safety incident’, ‘analyzing the characteristics of patient safety incidents’, ‘creating a safe learning environment to provide the best care for patients’, ‘developing mentorship capabilities and qualities for an ideal follow up of students as a second victim’, ‘providing resources and integrating support structures to second victim nursing students during their clinical learning’, and ‘considering the cooperation and coordination between the health institution and the higher education institutions.’ ConclusionNursing students become second victims during their clinical placement. The clinical learning environment and mentoring characteristics influence the second victim experience.

The role of competency based medical education in addressing health inequities and cultivating inclusive learning environments

Pediatric health inequities are pervasive and reflect the confluence of social and structural determinants of health including racism in all its forms. Current approaches in graduate medical education that prepare trainees to address health inequities and improve population health are inadequate. Competency based medical education (CBME) can advance equity-oriented efforts to improve patient outcomes, optimize the learning environment and encourage lifelong learning. We briefly describe the impact of racism and discrimination on the clinical learning environment. We then highlight how to apply the 5 core principles of CBME to equip learners across the continuum to address health inequities. We provide specific examples including 1) how CBME can inform teaching, assessment and professional development activities to promote equitable pediatric health outcomes via enturstable professional activities, 2) competency-focused instruction that address racism and inequities, 3) multimodal learning approaches to facilitate the acquisition of the desired competencies to address health inequities, 4) sequenced learning approaches across the continuum of practicing pediatricians, and 5) tools and resources for programmatic assessment of trainee and program performance in addressing pediatric health inequities.

Translation, cultural adaptation and linguistic validation of the postgraduate hospital educational environment measure into Arabic

BackgroundAssessment of the clinical learning environment (CLE) is an essential step that teaching hospitals routinely undertake to ensure the environment is conducive, learning-oriented and supportive of junior doctors’ education. The Postgraduate Hospital Educational Environment Measure (PHEEM) is an internationally recognized tool for assessing the CLE with evidence of high reliability and validity. Translation of PHEEM into other languages such as Spanish, Japanese and Persian enabled wider adoption of the instrument in the world. However, in Syria and other Arabic countries, a validated Arabic translation of PHEEM is still not available, making it difficult to adopt it and use it in Arabic contexts. This study aims to translate and culturally adapt the PHEEM from English into Arabic.MethodsThis study followed the structured translation and validation process guideline proposed by Sousa & Rojjanasrirat 2010. First, the PHEEM went through forward translation by three translators, then reconciled with the aid of a fourth translator. Afterwards, two professional bicultural and bilingual translators conducted back translation into English and compared it with the original version. This formed the Pre-final Version (PFV) which was then pretested for clarity on a sample of medical residents in Damascus, Syria. Following appropriate modifications, the PFV was sent to a panel of experts for a comprehensive review of language clarity and to assess content validity.ResultsA total of thirty-five medical residents were recruited. Ten items with language clarity issues were identified and modified according to the elicited suggestions. Thereafter, the modified PFV was presented to ten subject experts who identified three items in need of revision. The item-content Validity Index (CVI) was over 0.78 for all of the 40 items; the calculated scale-CVI was 0.945.DiscussionThis study provided the first linguistically valid Arabic translation of the widely used PHEEM inventory. The next step is to conduct a full psychometric analysis of the Arabic PHEEM to provide further evidence of validity and reliability.

Recommendations for Faculty Development in Addressing Implicit Bias in Clinical Encounters and Clinical Learning Environments.

Recommendations for Faculty Development in Addressing Implicit Bias in Clinical Encounters and Clinical Learning Environments.

Sociotechnical imaginaries in academic medicine strategic planning: a document analysis

Purpose Along with other industries, healthcare is becoming increasingly digitized. Our study explores how the field of academic medicine is preparing for this digital future. Method Active strategic plans available in English were collected from faculties of medicine in Canada (n = 14), departments in medical schools (n = 17), academic health science centres (n = 23) and associated research institutes (n = 5). In total, 59 strategic plans were subjected to a practice-oriented form of document analysis, informed by the concept of sociotechnical imaginaries. Results On the one hand, digital health is discursively treated as a continuation of the academic medicine vision, with expansions of physician competencies and of research institutes contributions. These imaginaries do not necessarily disrupt the field of academic medicine as currently configured. On the other hand, there is a vision of digital health pursuing a robust sociotechnical future with transformative implications for how care is conducted, what forms of knowledge are prioritized, how patients and patienthood will be understood, and how data work will be distributed. This imaginary may destabilize existing distributions of knowledge and power. Conclusions Looking through the lens of sociotechnical imaginaries, this study illuminates strategic plans as framing desirable futures, directing attention towards specific ways of understanding problems of healthcare, and mobilizing the resources to knit together social and technical systems in ways that bring these visions to fruition. There are bound to be tensions as these sociotechnical imaginaries are translated into material realities. Many of those tensions and their attempted resolutions will have direct implications for the expectations of health professional graduates, the nature of clinical learning environments, and future relationships with patients. Sociology of digital health and science and technology studies can provide useful insights to guide leaders in academic medicine shaping these digital futures.

Healthcare Students' Perceptions of the Quality of the Clinical Learning Environment in Morocco: A Cross-Sectional Study.

The clinical learning environment (CLE) is critical for developing the practical skills needed in healthcare professions. This study aimed to evaluate healthcare students' perceptions of the quality of the CLE using the Arabic version of the Clinical Learning Environment, Supervision and Nurse Teacher (ar. CLES + T) scale. The study also aimed to evaluate the tool's measurement invariance and compare perceptions among student groups. This cross-sectional study was carried out at two health education institutes in Morocco throughout the academic year 2018-2019 among 1550 undergraduate students who had just finished a clinical practicum in a hospital or primary healthcare facility. Data were gathered using the ar. CLES + T scale. Confirmatory factor analysis (CFA) and multigroup CFA were performed. The measurement invariance of the ar. CLES + T scale was assessed across gender, study year, and clinical practicum duration, using configural invariance, metric invariance, scalar invariance, and strict invariance. The t-test and analysis of variance were used to compare the mean scores of the student groups. Students expressed positive perceptions toward the CLE. The "Pedagogical atmosphere on the ward" dimension scored the highest, while the "Role of the nurse teacher" dimension received the lowest scores. The measurement invariance of the ar. CLES + T scale by gender, study year, and clinical practicum duration was established. First-year students and those with an extended practicum period were the most satisfied. To promote effective learning in the clinical environment, nurse teachers might use innovative teaching approaches tailored to their evolving role in these settings. Moreover, extending the duration of clinical practicum can further enhance student learning outcomes.

Learning to teach at a norm-critical clinical learning centre: A Phenomenographic study

BackgroundCampus-based clinical learning centres are used for practice and learning in nursing students' education and can be arenas in which to enhance students' awareness and competence in social justice issues. Norm-critical approaches can be used as pedagogical tools in these centres to prepare students for hands-on caring situations in which social norms can bias the outcome. ObjectivesTo describe nursing teachers' conceptions of learning norm-critical approaches and implementing them in a clinical training centre. Setting and participantsThe study is based on interviews with 10 teachers at a Swedish university college. MethodsThe data was analysed using a phenomenographic approach. ResultsFive categories of description emerged in the analysis that described conceptions related to norm-critical approaches. These categories were: personally developing and meaningful; easily integrated with established nursing concepts; highlighting surrounding power; something to lean on when letting students take the first steps in norm-critical initiatives; and helping implementation in teaching and education. ConclusionsTeachers who are facing the task of providing norm-critical, practical education to nursing students in campus-based clinical learning environments are ambivalent towards the core principles of norm criticism, which they conceive as natural and provoking, at the same time. We therefore need to un-dramatise norm criticism and better prepare teachers in how to use it. Teachers would benefit from follow-up activities and formal collaborations regarding norm-critical teaching, so that they are given context to discuss, reflect, and learn from each other.

Exploring perceptions of pre-clerkship students about workplace learning in the clinical learning environment at Gulf Medical University, UAE

BackgroundMedical students view clinical workplace placements as an inspiring and motivating learning environment where active student participation is pivotal to development of students’ identity. The progress from pre-clerkship to clerkship education harbors many challenges which consist of experiential learning, adjusting to the clinical environment, and understanding roles & responsibilities. Workplace learning is underpinned by various adult learning theories including social theories,constructivism, supported participation and legitimate peripheral participation. Workplace learning course was recently initiated for pre-clerkship students at a medical university in UAE, which will enable their smooth entry into the clerkship phase of the curriculum.ObjectivesThe research aims to explore students’ perceptions of various domains of their clinical learning environment (CLE), highlight the challenges they face, and extract valuable feedback to improve their environment.MethodsThis study was conducted qualitatively by using focus groups method in order to explore students’ perceptions of the clinical learning environment. Two focus group discussions were conducted (n = 8 +/-10) to determine the common challenges of workplace learning and its potential solutions. Data were analyzed using thematic analysis. The approach used to carry out this study was phenomenology, as it helps to understand the learning and behavior of these students who are undergoing this pre-clerkship training in order to transition smoothly to the clerkship phase.ResultThe focus groups helped to deeply explore the perceptions of students about their clinical learning environment. It helped to reveal the challenges encountered by the students including the significance of proper orientation of staff and students, language barrier, availability of learning opportunities, and supervision quality. The focus groups provided worthwhile suggestions to improve the learning opportunities in the clinical learning environment which include orientation of the staff and students what to expect, improved supervision, mentoring and providing learning opportunities to encourage participation.ConclusionThis study attempted to identify the pre-clerkship students’ perception of their clinical learning environment and the challenges they face over there. Possible suggestions by the students included a formal orientation for the staff and students to be carried out at the beginning. Efforts should be made by clerkship directors to provide students with learning opportunities by increasing patient exposure, encouraging participation, and providing high-quality supervision.

Exploring Dental Students’ Perceptions of their Clinical Learning Environment: A Qualitative Study to Evaluate the Curriculum

Exploring Dental Students’ Perceptions of their Clinical Learning Environment: A Qualitative Study to Evaluate the Curriculum

Assessing Interprofessional Collaboration at Clinical Learning Sites: Methodology on Developing the IP-CLEAR Tool.

Interprofessional Clinical Learning Environment Assessment and Reflection (IP-CLEAR) tool was developed by a team of faculty from the schools of nursing, pharmacy, and medicine at University of North Carolina at Chapel Hill (UNC-CH), with the support of the North Carolina Area Health Education Consortium (NC AHEC) and the UNC-CH Office of Interprofessional Education and Practice (IPEP). The IP-CLEAR tool is intended for use by clinical sites that have or want to have clinical learners engaged and integrated into an excellent interprofessional CLE. The development of the IP-CLEAR and projections for future work are described here.

Applying simulation learning theory to identify instructional strategies for Generation Z emergency medicine residency education

AbstractIntroductionGeneration Z learners are entering emergency medicine (EM) residency training, bringing unique learning preferences that influence their engagement with residency education. To optimally teach and motivate this incoming generation of learners, EM educators must understand and adapt to the changing instructional landscape.MethodologyThe Simulation Leaders Advancing the Next Generation in Emergency Medicine (SLANG‐EM) Workgroup was created to identify effective educational strategies for Generation Z learners entering EM. Members were faculty in the Society for Academic Emergency Medicine (SAEM) Simulation Academy, well versed in learning theory supporting simulation‐based education (SBE) and actively involved in EM residency education.Unique treatment/analysisThrough primary and secondary literature searches, the SLANG‐EM Workgroup identified four distinctive learning preferences of Generation Z learners: (1) individualized and self‐paced learning, (2) engaging and visual learning environments, (3) immediate and actionable feedback, and (4) combined personal and academic support. Workgroup members evaluated these learning preferences using a novel conceptual framework informed by the theoretical principles underpinning SBE, recommending instructional strategies for Generation Z EM residency learners across multiple educational environments.Implications for educatorsInstructional strategies were described for the didactic, simulation, and clinical learning environments. In the didactic environment, identified instructional strategies included meaningful asynchronous education, interactive small‐group learning, and improved multimedia design. In the simulation environment, educational innovations particularly suitable for Generation Z learners included learner‐centered debriefing, rapid‐cycle deliberate practice, and virtual simulation. In the clinical environment, described instructional strategies involved setting learner‐centered goals and delivering facilitative feedback in the context of an educational alliance. Overall, these instructional strategies were clustered around themes of student‐centered education and the educator as facilitator, which align well with Generation Z learning preferences. These findings were synthesized and presented as an advanced workshop, “Delivering Effective Education to the Next Generation,” at the 2023 SAEM Annual Meeting.

From corners to community: exploring medical students’ sense of belonging through co-creation in clinical learning

BackgroundBelonging is critical for the development and wellbeing of medical students. Belonging, particularly within a ‘relational being’ paradigm, presents a significant challenge for students, especially within clinical learning environments. Co-creation is a learning relationship in which students are actively involved in the education process. It is inherently relational and promotes belonging within higher education environments. Little is known about utilising co-creation in the curriculum, within medical education. The aim of this study was to explore medical students’ experience of co-creation of learning resources within the clinical learning environment.MethodsFollowing ethical approval, medical students were invited to become co-creators of a learning bulletin resource, within the paediatric acute receiving unit, at a paediatric teaching hospital. Interpretative phenomenological analysis (IPA) was used to enable an in-depth exploration of how medical students experienced co-creation within the clinical learning environment. Medical students participated in semi-structured interviews about their experience, which were transcribed verbatim and analysed using IPA. The analysis integrated individual lived experiences into an analytic summary.ResultsNine medical students participated. Three group experiential themes were identified: identity maturation; learning community and workplace integration. The support found within this co-created learning community, along with maturation of their identity, allowed the participants to experience a challenge to their existing worldview. This shift in perspective resulted in them responding and behaving in the workplace in new ways, which enabled them to belong as themselves in the clinical learning environment. These findings were situated within the developmental concept of self-authorship, as well as contributing to a new understanding of how co-creation promoted social integration.ConclusionsCo-creation enabled students to learn in a meaningful way. The relational power of co-creation, can be harnessed to deliver participatory learning experiences, within our increasingly complex healthcare environment, to support the learning, development and integration of doctors of the future.