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Generational differences in perceptions of medical student experiences of clinical attachments in surgery: an ethnographic study


Type

Thesis

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Authors

Aitken, Deborah 

Abstract

For a number of years, the medical student feedback on clinical attachments in General Surgery at the University of Edinburgh Medical School was poor. This phenomenon was a reflection of medical students’ experiences on their surgical attachments in medical schools across the UK to varying degrees. Furthermore, student dissatisfaction with experiences in surgery on an international level are widely reported in the medical education literature and a number of concerning outcomes have been reported.

This study sought to explore the student experiences that are resulting in poor feedback and dissatisfaction. It did not seek to evaluate the student experiences, but to gain a deeper understanding of what might be causing them to feel dissatisfied. An important factor in the meaningfulness of a student’s experience on clinical attachments is the clinical teacher, yet this relationship has rarely been considered and, as a result, it is poorly understood. This study therefore explored the clinical teachers’ (in this case surgeons’) experiences with a view to juxtaposing them against those of the student to explore if there were any similarities or differences.

An ethnographic approach was utilised, from mainly an interpretative and socio- cultural constructivist perspective; this approach has also been influenced by generational theory, teaching and learning regimes and workplace participatory practice theory. This study focused on listening to students’ and surgeons’ voices in the more intimate and contained clinical settings, rather than the experiences reported within large scale surveys. It was conducted in the colorectal surgery department of the Western General Hospital in Edinburgh. Over a period of three months, semi- structured interviews with 18 medical students and eight surgeons were conducted. All students and surgeons were also observed every day for three clinical attachment blocks.

The overall findings demonstrated that there were some generational differences and some similarities between the students’ and surgeons’ perspectives, interpretations and behaviours. Often the students and the surgeons were trying hard to relate to each other, however their lack of understanding of each other was often a barrier to the relational interdependence between the workplace affordances (the department as a whole) and the individual engagement (the students). Since generational difference is not something that can be changed, an increased understanding of generational differences between the generations may be the key to improving the relationship between workplace affordances and individual engagement and, conversely, a lack of understanding of generational differences may be a barrier to improving this relationship.

Description

Date

2021-05-01

Advisors

Morrison, Morag

Keywords

medical, medical education, generations, surgery, surgical education, medical student, surgeon, clinical attachment

Qualification

Doctor of Philosophy (PhD)

Awarding Institution

University of Cambridge