Adapting to context: supervisor's views on professionalism and professional identity development in regional, rural and remote settings

Early Abstract:

Introduction: During clinical placements (clerkships), supervisors support medical students’ developing professional identities, attitudes, skills and behaviours. While much has been written about medical students’ professionalism and professional identity, less is reported about the impact of specific clinical contexts on these crucial elements of the curriculum. Key to understanding this gap in the literature, and the multitude of factors that impact student learning about professionalism and professional identity formation is understanding supervisors’ beliefs and values about these concepts. 
Methods: This qualitative Informed Grounded Theory study captures the perspective of experienced clinical supervisors supporting third- and fourth-year students in regional, rural and remote clinics in the Northern Territory, Australia. Semi-structured phone interviews were conducted with seven supervisors living in the Northern Territory. 
Results: Analysis revealed challenges and benefits experienced during these unique placements. Three main themes emerged, relating to 1) beliefs and values, and what students and supervisors bring to the clinical experience; 2) adapting to the rural, remote and regional context; and 3) the supports supervisors give and require in context. The data revealed that: (a) supervisors’ definitions of professionalism, their professional beliefs and relationships, reflect a commitment to culturally aware and compassionate healthcare, integrating knowledge of traditional Western medicine and First Nations concepts of wellness; (b) experiences leading to professional growth differ and are unique for each student and supervisor; (c) working in challenging regional, rural and remote environments can be enjoyable as well as confronting; (d) reflection initiated by supervisors remains an important tool for navigating and managing conflicts of interest, while at the same time it is an invaluable model for culturally respectful and appropriate communication styles and relationships; and (e) while the goal of educators is to design transparent and overt medical curricula, lessons learned about professionalism and professional identity development may nonetheless emerge from the hidden curriculum during clinical placement. Supervisors have an important role in bridging the gap between overt and hidden curricula.
Discussion: This study is significant as it illuminates the complexity of growing and managing a sense of professionalism and professional identity – one that is based in relationships between supervisors and their students, patients and communities. Through personal supervisors’ accounts the findings elucidate the pressures of professional learning and identity growth in context. The study documents some of the ‘destabilising dilemmas’ encountered during clinical placements in these regions, and the benefits of critically examining one’s own values, behaviours and worldviews when confronted with medical and cultural conflicts of interest. 
Conclusion: By developing greater insight into the roles and perspectives of clinical supervisors in rural, regional and remote contexts, and the relationships that connect or disconnect them from the communities and cultures in which they work, we can learn more about the influences on students’ professional and personal development. Supervisors’ first-hand accounts provide important insights for curriculum design, and those supporting clinical supervisors and their students. These clinical experiences, positive or negative, may affect students’ willingness to work as healthcare providers in these contexts in the future, and their approaches to diversity, equity and inclusion within healthcare systems.
Keywords: clinical placement, clerkship, culture, curriculum, hidden curriculum, medical student supervision, professional identity, professionalism, regional, remote, rural.