Trainee negotiation of professional socialization in medical education.

Abstract

The character of the professional socialization experience is a subject of debate in the literature; one of the primary issues being the relative contributions of trainees to the nature of their socializing experience. As crucial as the clinical education experience is to the educational and professional development of medical students, it has received relatively little attention in the literature on professional socialization of physicians. The goals of this research were to understand, from the students' perspective, the character of the first clinical learning experience in the medical school career of a group of medical students and, given the character of that context, the role of student negotiations in their own education and professional socialization. This study employed a symbolic interactionist framework and the data collection methods of participant observation and unstructured interview. The data collection was conducted over a six-week period during which time the researcher experienced along with a group of six medical students their first clinical learning experience. These students perceived the clinical learning environment to be challenging, complex and frequently too busy to easily accommodate their learning needs. They recognized the enormity of their learning task and of their own incompetence. These were the basic perceptions that prompted the students to negotiate their clinical learning experience. Student negotiations took three basic forms: the creation of new learning opportunities, the manipulation of existing learning resources, and interpretation of events and behaviors. Students' negotiations were constrained by the structure of the education program and the students' own assertiveness. The study's findings indicate that the students were active negotiators of the content and the conduct of their own professional education and professional socialization. Even in the face of overwhelming demands on their intellectual and emotional resources, the students expressed their individual and collective intent for their educational experience. The study findings were similar to those of earlier studies of professional socialization, although new behaviors and behaviors inconsistent with those found in previous research were uncovered. Contributions to the literature on professional socialization and to an understanding of this phenomenon were made through the explanation of these inconsistencies.