Medical and nurse students' perspective on learning in acute care

Abstract: Background: Medical and nurse students’ professional training takes place in a complex and rapidly changing health care setting. Workplace learning in this context have a considerable potential to contribute to the development of professional competence. However, the complexity of the acute care context can also hinder such an advancement. Aim: To explore medical and nurse students’ perspective on how and what they learn during acute care placements, and how aspects of such a milieu could influence learning. Method: A qualitative design was chosen. In study I free text answers and interview data from medical and nurse students were collected and a content analysis was conducted. In study II & III ethnographic observations and informal conversations were collected in an acute medical ward. Medical and nurse students, staff and supervisors were observed and an inductive analysis was performed. In study IV interview data was collected from graduated nurses on their learning experiences as students in acute care. An inductive comparative analysis was performed on these interview data together with data from ethnographic observations of nurse students’ interactions and learning in the acute health care ward. Results: In study I we identified three themes that influenced students’ progress towards professional competence: Management, planning and organisation for learning; Workplace culture and Learning a profession. In study II we identified four characteristics that formed how students adapted and interacted in the community of practice: Complex and stressful situations; Variable composition and roles of community members; Transitions through community boundaries and Levels of importance and priority. In study III we identified two themes that influenced medical students’ opportunities to participate and learn in an acute internal medicine ward: Nervousness and curiosity and Invited and involved. Finally, in study IV three themes described long-term outcomes of workplace learning for nurse students: To handle shifting situations; To build relationships and To act independently. Conclusion: The workplace culture in an acute care ward formed the conditions in which students learn and interact. Students have at arrival to enter a community of practice, adapt to its culture and to be accepted. If students were given opportunities to participate actively in the real patient care, they successively developed a professional identity. Medical and nurse students achieved differing competences and interacted in dissimilar ways during workplace learning. Medical students’ interactions and learning were dominated by queries and responses. However, the potential to develop competence to judge and approach complex patient cases was underutilised. Learning at the ward provided nurse students with understanding of their future profession as nurses, and they learnt how to handle stress and variable situations. We found that the stressful, ever-changing, demanding, but also considerably structured and organised acute care ward offered abundant learning opportunities that could be used. Therefore, it is maybe not necessary to create and structure new learning situations. But rather to use real care situations and patient cases, and to form conditions and attitudes that make learning in this real world situation inspiring and valuable. However, the full potential of this is as yet not fully utilized.