title: Medical students' opportunities to participate and learn from activities at an internal medicine ward: an ethnographic study.
abstract: To optimise medical students' early clerkship is a complex task since it is conducted in a context primarily organised to take care of patients. Previous studies have explored medical students' perceptions of facilitation and hindrance of learning. However, the opportunities for medical student to learn within the culture of acute medicine care have not been fully investigated. This study aimed to explore how medical students approach, interact and socialise in an acute internal medicine ward context, and how spaces for learning are created and used in such a culture.
  
  
  
  Ethnographic observations were performed of medical students' interactions and learning during early clerkship at an acute internal medicine care ward. Field notes were taken, transcribed and analysed qualitatively. Data analysis was guided by Wenger's theory of communities of practice.
  
  
  
  21 medical students and 30 supervisors participated.
  
  
  
  Two themes were identified:Nervousness and curiosity-students acted nervously and stressed, especially when they could not answer questions. Over time curiosity could evolve. Unexplored opportunities to support students in developing competence to judge and approach more complex patient-related problems were identified.Invited and involved-students were exposed to a huge variation of opportunities to learn, and to interact and to be involved. Short placements seemed to disrupt the learning process. If and how students became involved also depended on supervisors' activities and students' initiatives.
  
  
  
  This study shed light on how an acute internal medicine ward culture can facilitate medical students' possibilities to participate and learn. Medical students' learning situations were characterised by questions and answers rather than challenging dialogues related to the complexity of presented patient cases. Further, students experienced continuous transfers between learning situations where the potential to be involved differed in a wide variety of ways.
authors.affiliation: Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Hägg-Martinell
authors.affiliation: Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: H
authors.initials: H
authors.lastname: Hult
authors.affiliation: Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Henriksson
authors.affiliation: Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Kiessling
mesh_terms: D000884:Anthropology, Cultural; D001007:Anxiety / Q000523:psychology; D002982:Clinical Clerkship; D005106:Exploratory Behavior; D005260:Female; D006757:Hospital Units; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007398:Interpersonal Relations; D007858:Learning; D008297:Male; D036301:Qualitative Research; D013337:Students, Medical / Q000523:psychology; D013548:Sweden
keywords: ethnography; internal medical ward; learning; medical students; undergraduate