title: A qualitative study of undergraduate clerkships in the intensive care unit: It's a brand new world.
abstract: BACKGROUND
  While ICU clerkships are commonplace in undergraduate medical education, little is known about how students learn there. This study aimed to explore students' perceptions of the ICU as a learning environment, the factors influencing their learning and any perceived differences between learning in the ICU and non-ICU settings.
  
  
  METHODS
  We used interpretivist methodology, a social cognitive theoretical framework and a qualitative descriptive strategy. Ten medical students and four graduate doctors participated in four semi-structured focus group discussions. Data were analyzed by six-step thematic data analysis. Peer debriefing, audit trail and a reflexive diary were used.
  
  
  RESULTS
  Social cognitive influences on learning were apparent in the discussions. Numerous differences emerged between ICU and non-ICU clinical clerkships, in particular an unfamiliarity with the environment and the complex illness, and difficulty preparing for the clerkship. A key emergent theme was the concept of three phases of student learning, termed pre-clerkship, early clerkship and learning throughout the clerkship. A social cognitive perspective identified changes in learner agency, self-regulatory activities and reciprocal determinism through these phases. The findings were used to construct a workplace model of undergraduate intensive care learning, providing a chronological perspective on the clerkship experience.
  
  
  CONCLUSIONS
  The ICU, a rich, social learning environment, is different in many respects to other hospital settings. Students navigate through three phases of an ICU clerkship, each with its own attendant emotional, educational and social challenges and with different dynamics between learner and environment. This chronological perspective may facilitate undergraduate educational design in the ICU.
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, St. James's Hospital and Trinity College, Dublin, Ireland. oconnoen@tcd.ie.
authors.forename: Enda
authors.initials: E
authors.lastname: O'Connor
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, St. James's Hospital, Dublin, Ireland.
authors.forename: Michael
authors.initials: M
authors.lastname: Moore
authors.affiliation: Department of Urban Primary Care, University College Dublin, Dublin, Ireland.
authors.forename: Walter
authors.initials: W
authors.lastname: Cullen
authors.affiliation: Department of Primary Care, National University of Ireland, Galway, Ireland.
authors.forename: Peter
authors.initials: P
authors.lastname: Cantillon
keywords: Clinical workplace learning; Intensive care medicine; Qualitative research; Social cognitive theory; Undergraduate education