"If We Participate in Research, it’s Because We Want to Give Back" - Medical Student Perspectives on Engaging in Sensitive Research about Emotionally Laden Events within Clinical Learning Environments

Context: The clinical learning environment (CLE) is a complex learning space with

social interactions at the heart. Medical students experience emotionally laden events within

CLEs. Prior research has shown that these experiences can have profound effects, necessitating

further research. However, medical student participation rates in research have been reported

as problematic. Perspectives on engaging in sensitive research about emotionally laden events

within CLEs was explored using qualitative research.

Methods: Interpretive description, within a pragmatic epistemology, was used to scaffold

the research. Ten participants who were or had recently been medical students were interviewed

using semi-structured interviews. Data collection and analysis were undertaken iteratively. The

interviews were transcribed and analysed using reflexive thematic analysis. Researcher

reflexivity was integral to the research process.

Results: Three themes were generated. ‘Learned powerlessness’ describes the futility

students felt operating within an unyielding hierarchy where their feedback was perceived as

unheard. ‘Feeling unsafe in the learning environment’ reflects the impact engendered by their

mistreatment within the CLE and concerns of retaliation. The third theme, ‘conditional

postures’, describes the contingent consideration of aspects of the research process within their

CLE experiences. Social exchange theory was used to interpret the findings, understanding that

research participation can be viewed as an organisational citizenship behaviour (OCB) and is

impacted by exchange ideology.

Conclusion: OCB antecedents within the CLE, such as work satisfaction, fairness,

organisational culture and commitment, and perceived organisation support, were intricately

linked with psychological safety. By understanding research participation as an OCB, relevant

antecedents of OCB within CLEs can scaffold a framework to support researchers and

educational institutions in increasing the OCB of medical students to improve research

participation.