It Takes a Village: an ethnographic study on how undergraduate medical students use each other to learn clinical reasoning at the workplace

Abstract BACKGROUND When students learn with – and from – other students, it is called peer-assisted learning (PAL). How undergraduate students use their peers for their clinical-reasoning learning process remains unclear. This research therefore explores the question: ‘How is PAL manifested in the clinical learning environment of undergraduate medical students with regard to developing clinical-reasoning skills?’ Two sub-questions are formulated: (1) Which categories of PAL are identifiable within the clinical learning context of undergraduate students developing clinical-reasoning skills? And (2) How do different factors in this context influence PAL at the workplace for the development of clinical-reasoning skills by students? METHODS Focused ethnography and a combination of template and open coding was used to gather and analyze qualitative data. RESULTS Twenty semi-structured interviews were conducted with nine students, four residents and seven clinical supervisors. A total number of 31.5 hours were used for five clinical observations. Three categories were used to elaborate on the data: (1) The role of PAL in the clinical-reasoning learning practice, (2) The role of different actors during PAL and (3) The PAL environment. CONCLUSION Students utilize each other to enhance various clinical-reasoning skills. The complexity of the clinical context is represented in this research. Three topics of discussion are identified that need to be acknowledged: (1) the design of the PAL environment, (2) the shifting roles of peers when they enter clinical practice, and (3) the individualistic tendencies of students. Future research could focus on stimulating and facilitating PAL among the next generation of students and integrating PAL into the clinical practice workflow.