JMIR Publications

ABSTRACT

Background:

Transitioning from preclinical-to-clinical training is a critical milestone of ‘becoming and being’ in a medical student's journey. Despite simulation-based learning, real-world clinical exposure remains indispensable in shaping professional identity. The clinical learning environment (CLE) is a complex interplay of social, cultural, and organizational factors that influence students' development as future healthcare professionals.

Objective:

This study explores medical students' reflections on their first clinical placement in General Practice (GP), aiming to understand their experiences, challenges, and the CLE role in their learning and developing professional identity formation (PIF).

Methods:

We analysed reflections from fourth year medical students following their initial GP placement. A qualitative descriptive (QD) approach grounded in naturalism was employed to explain our participants' transitioning encounters in clear, everyday language to ensure their experiences were presented in their own words, without bias. Content thematic analysis was conducted to identify key themes related to their experiences.

Results:

Students’ reflections revealed a startled cohort unprepared for the epistemological, emotional, and practical realities of clinical work. Many assumed that classroom ‘knowing’ would seamlessly translate into clinical ‘doing’, but were met instead with uncertainty, failure, and emotional overwhelm, often manifesting as shame, guilt, and withdrawal. These experiences exposed a fracture between knowledge and knowing, underscored by students’ pre-reflective epistemological beliefs and varying degrees of supervisory preparedness. While emotional and cognitive struggles were widespread, rare instances of supportive mentorship and feedback significantly bolstered students’ confidence and participation.

Conclusions:

Reflection offered a valuable window into how students think, feel, and act during this critical transition, but it is not a cure-all. Reflection should be positioned as a developmental and communal tool within a broader scaffolding that includes early skills preparation, role clarity, psychological safety, and trained supervisors. Structured shared reflective circles and narrative listening sessions can help normalise uncertainty, support identity formation, and nurture resilience during students’ entry into clinical practice, and can ease the journey of ‘becoming and being’.