JMIR Publications

ABSTRACT

Background:

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 professional growth.

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:

Reflective writing offered a rich window into how students thought, felt, and acted during their GP rotations, revealing a fractured epistemological landscape. Students thought that 'knowing' from classroom would translate to 'doing' in clinic. But reality resulted in emotional overwhelm, a sense of failure and shame, and ultimately led to self-doubt, avoidance, and withdrawal. Students recounted transformative experiences that were shaped by patient interactions, moments of uncertainty, and the shift in professional roles. While emotional and cognitive challenges were common, rare encounters of supportive mentorship played a crucial role in the students’ development.

Conclusions:

Identity dissonance reveals why reflection is pivotal in bridging the transition from preclinical-to-clinical practice – not to be merely used as an assessment. We propose treating reflection not only as a personal insight but also as a communal insight, a developmental artifact. Shared reflection circles, narrative listening reflective sessions, and post-reflection dialogues can ease the journey of ‘becoming and being’.