Participation in practice: how medical students learn and form their professional identity during clinical placements through the lens of community of practice theory

The importance of effective medical education cannot be overstated considering a planned doubling of medical students by 2031-32, increasingly complex health issues and an NHS facing unprecedented change. This thesis explores the dynamic, relational nature of medical students’ participation, learning and professional identity formation during clinical placements. The current literature emphasises the central importance of active participation for student learning and professional identity formation, and the usefulness of Etienne Wenger’s (1998) social theory of learning (also referred to as community of practice theory) for understanding this phenomena. Studies using this theory often provide a helpful yet partial theoretical perspective. Hence, this research utilises the panoply of Wenger’s theoretical constructs in a single study and seeks to answer a pressing question: How do medical students learn and develop their professional identity during clinical placements through the lens of community of practice theory?

The qualitative methodology involves an analysis of weekly audio diaries and interview data from six medical students. Findings uncover fundamental influencing factors and demonstrate the centrality of active participation, the social and cultural clinical environments, the sustained development of relationships, students’ access to the shared repertoire and practice for the development of their learning and professional identity. The implications of this study extend beyond clinical placements because understanding the relationship between participation, learning and professional identity formation is essential for key stakeholders, including the NHS, the General Medical Council, medical schools and students themselves.

This thesis contributes to our evolving comprehension of the dynamic interplay between participation, learning and identity. It underscores the importance of active participation strategies and improves our understanding of community of practice theory in the context of medical education. Moving forwards, this research serves as a foundation for future research and real-world enhancements to student learning and professional identity formation in clinical environments.