“It’s Like Starting All Over”: 5th-Year Medical Students Approach Psychiatry Clerkships as Absolute Beginners

Abstract

Objective : Student skills acquisition behavior during medical clerkships is rarely described. Based on the university learning objectives, the students should advance from the novice stage to the competence stage, making them ready for work as medical residents. We aimed to understand how the students’ skills acquisition progresses during the psychiatric clerkship, preparing them for resident work in psychiatry. Methods : This qualitative study is primarily based on ethnographic observations of key informants during a three-week clerkship in psychiatry, supplemented with semi-structured interviews. Field notes and the transcribed interviews were merged in a thematic analysis. Batalden’s model of skills acquisition was applied in the analysis of the observations and statements. Results : The students felt deeply unfamiliar with the field of psychiatry. They spent considerable time observing, imitating, and strictly following instructions. Gradually familiarizing themselves with the specialty, their work continued to exhibit crucial shortcomings. Applying different skills’ acquisition models to the discussion, the authors observed the students’ progress from the absolute beginner stage to the advanced beginner stage, with some moving towards the competent stage. Conclusions : The study shows that students are at risk of advancing no further than the advanced beginner stage during the brief psychiatric clerkship. The results indicate a need for better preparation of medical students before they begin psychiatry clerkships.