Negotiating the dual role of performer and learner: Medical students' impression management in the clinical learning environment.

Abstract

Background: Existing literature suggests that learning during clinical placements is predominantly informal and unstructured, requiring medical students to be proactive in maximising learning opportunities. Students learn to emulate the characteristics of a doctor and navigate social structures of the clinical learning environment (CLE) through legitimate peripheral participation. The study aim was to explore how students present themselves and manage impressions in the CLE to optimise learning.

Method: An ethnographic approach included 120 h of observations conducted in two hospital wards hosting placements for medical students. Additionally, n = 13 students and n = 23 healthcare staff populating these clinical sites were interviewed to capture the lived experiences and perspectives around self-presentation (students), and impact of these performances (staff). Sensitising concepts from Goffman's theory related to impression management served as priori guides in data analysis to identify prominent patterns.

Results: We identified five themes: (1) Students display a veneer of interest and engagement aligned to their understanding of the social norms, (2) Creating a positive first impression on healthcare staff is a preventive practice adopted by students to avoid interprofessional conflicts, (3) Atypical personal front of overseas doctors and students impacts their impression management, (4) Participatory learning with near-peers involves less impression management burden and consequent stress, and (5) Understanding social rules of the CLE takes time and slows learning.

Conclusion: The research reveals diverse ways in which medical students present themselves and their activities to others. Engineering convincing and desired impressions is an affective and cognitive task for students, in their dual position of actor-performers and learners. Our findings indicate that certain personal fronts punctuate learning, and we advocate for clinical workplaces to incorporate participatory learning opportunities, given their empowering benefits. Robust induction and allowing students to be authentically contributory in the CLE should ensure that diverse learners thrive in unfamiliar cultural spaces.