Understanding medical students’ transition to clinical training: a qualitative study of transformative learning and professional identity formation

Abstract

Introduction

The transition from preclinical to clinical training represents a pivotal stage in medical education, offering opportunities for transformative learning and professional identity formation. This study aims to explore how medical students reflect on their initial clinical learning experiences during the first week of clinical training, and how these reflections reveal early shifts in their professional identity, using Mezirow’s transformational learning framework.

Method

A qualitative descriptive study was conducted at VinUniversity, Hanoi, Vietnam. 47 fourth-year medical students from a single cohort submitted reflective writings after their first week of clinical training. Thematic analysis was performed, with emergent themes mapped against the dominant phases of Mezirow’s transformational learning framework.

Results

Thematic analysis revealed four main themes: (1) disorientation and emotional adaptation, (2) bridging theory and practice, (3) learning from the clinical environment and (4) personal and professional growth. Reflections revealed both emotional and cognitive shifts, highlighting students’ early adaptation and growth. Findings emphasised the need for enhanced mentorship, emotional resilience training and tailored bilingual communication strategies to optimise the transition.

Conclusions

Reflective writing captured students’ first impressions of clinical training and highlighted the critical role of emotional adaptation, mentorship and experiential learning in supporting identity formation. These insights offer practical implications for enhancing student support strategies and curriculum design in medical education.

STRENGTHS AND LIMITATIONS OF THIS STUDY.

• This study explores students’ early reflections during their first week of clinical training, addressing a critical but under-researched transition phase in medical education.

• Reflective writing, combined with Mezirow’s transformational learning framework, provided a structured and theory-driven approach to analyse emerging shifts in professional identity.

• Thematic analysis was applied to reflections from a complete cohort of fourth-year medical students at a Vietnamese medical institution, allowing for in-depth exploration within a consistent educational and cultural context.

• Potential presentation bias may have influenced the reflections, as students might tailor responses to meet perceived faculty expectations.

• Findings are based on a single cohort at one institution, which may limit the transferability of the results to broader contexts.

Introduction

Professional identity formation in medicine is a complex, longitudinal process that emerges from the interplay of academic learning, clinical encounters, prior life experiences and societal expectations.¹ Rather than being acquired in isolation, professional identity is co-constructed through ongoing interactions with patients, peers, mentors and the healthcare environment. Holden et al describe this development as involving dimensions of professionalism, psychosocial maturation and the transformation from layperson to physician.² This development process progressively evolves into a professional self-concept through medical education.³

It is important to understand professional identity formation during the medical programme through formal and informal curricular approaches, and narrative reflections can be one of the tools.³ Simultaneously, medical students undergo multiple transitions throughout their educational journey, including the shift to university life, the process of learning to become a doctor and the progression from preclinical to clinical training, among others.

The transition from preclinical to clinical training is a critical phase in medical education, where students are required to shift from theoretical learning to direct patient care.⁴ This period is often marked by significant challenges, as students need to adapt to the complexities of clinical environments, apply theoretical knowledge to real-world scenarios and develop new skills, including communication, clinical decision-making and time management.⁵ The importance of a smooth transition cannot be overstated, as difficulties during this phase can impact not only students’ immediate performance but also their long-term development as healthcare professionals.⁵ Literature has highlighted several dimensions of these challenges. According to Atherley et al, students often report feeling unprepared for the demands of clinical practice. From a developmental view, they struggle to bridge the gap between preclinical training and the realities of patient care. Socially, students face difficulties in finding a sense of belonging in new clinical settings.⁵ The rich body of research in this field demonstrates that the transition is a complex and critical concern in the medical student’s journey⁵. Atherley et al, in their scoping review, explicitly call for further research into the opportunities for transformation during this critical transition phase, emphasising the need to understand how early clinical exposure can shape identity development and learning behaviours. Addressing this gap is essential for informing curricular strategies that better support students’ adaptation, emotional resilience and professional growth. While much research has focused on long-term professional identity formation, there is limited understanding of students’ first impressions during the earliest days of clinical training. This study responds to that call by examining how reflective writing captures students’ transformative experiences during the first week of clinical training, offering new insights into identity formation at the very beginning of clinical immersion.

At College of Health Sciences, VinUniversity, Hanoi, Vietnam, the Medical Doctor curriculum training follows a 6-year structure, as prescribed by the Vietnam Ministry of Education and Training.⁶ The first 3 years are dedicated to preclinical training, focusing on foundational medical sciences, while the final 3 years are centred on clinical education. This programme is mainly taught in English during on-campus theoretical coursework but shifts to a bilingual format (English and Vietnamese) during clinical rotations in hospital settings.⁷ Early clinical exposures during the preclinical years include community visits, patient interviews, hospital observations and simulation-based learning. In preparation for the first official clinical training, VinUniversity implemented a 4-week intensive transition to clinical training (TCT) bootcamp.⁸ This bootcamp was designed to enhance students’ confidence and ensure that they are prepared for the demands of patient care. The programme emphasises developing practical skills, enhancing communications and hospital orientation, thereby facilitating a smoother transition into the responsibilities of clinical practice.⁸ Despite the comprehensive nature of this bootcamp, questions remain regarding how successfully students adapt during the early transition period.

Reflective writing was selected for this study as a method to explore students' experiences during their transition into clinical training. Compared with focus groups, questionnaires or interviews, reflective writing offers an individualised and introspective approach, capturing the personal aspect of students’ experiences.⁹ Students are provided training through workshops in their first year and have regular opportunities to submit reflections through VINMED Portfolio. This method not only encourages self-awareness and critical thinking but also aligns with Mezirow’s transformative learning framework, as it enables the identification of disorienting dilemmas, critical reflection and evolving perspectives. By analysing students’ written reflections, we can explore the presence of Mezirow’s transformational learning phases and gain insight into how these experiences contribute to early professional identity formation.¹⁰ Transformative learning theory, as proposed by Mezirow (2000), identifies a process where change requires a critical examination of one’s thoughts and feelings to revise assumptions and progress to new perspectives.¹¹ Mezirow’s framework identifies five levels:

• Disorienting dilemma: A significant event that challenges the learner’s prior understanding of roles, values and assumptions.

• Critical reflection: Analysing experience and questioning beliefs, emotions and actions.

• Rational discourse: Engaging in discussions to explore multiple perspectives.

• Revising assumptions: Integrating new professional values and skills.

• Action and integration: Applying the new perspective in future learning experiences

Research objectives

This study aims to explore how medical students reflect on their initial clinical learning experiences during the first week of clinical training, and how these reflections reveal early transformative shifts in their professional identity, using Mezirow’s transformational learning framework.

Method

Study design

This study employed a qualitative descriptive design within a constructivist paradigm to explore medical students’ reflections during their transition into clinical training. Under the constructivist worldview, learning is understood as a contextual and interpretive process shaped by individual experiences.¹² Reflective writing was chosen as the primary method for data collection, allowing students to express their thoughts and emotions.

Participants and setting

The study involved 48 fourth-year medical students (first cohort) enrolled in the undergraduate programme Academic Year 2023–2024 at the Medical Doctor programme, VinUniversity, Hanoi, Vietnam. These students had completed the 3-year preclinical curriculum and TCT bootcamp designed to enhance clinical readiness. Students were divided into eight groups of six, rotating across six clinical specialties: internal medicine (two groups), surgery (two groups), psychiatry, paediatrics, obstetrics and gynaecology, and neurology (one group each). Rotations included both inpatient and outpatient settings in public and private hospitals, with exposure from Monday to Thursday each week and occasional night shifts. Some clinical activities were supervised by residents under faculty oversight.

Data collection

Following their first week of clinical training in October 2023, students were invited to submit reflective writings via the university’s Learning Management System. Each reflection was guided by prompts designed to encourage detailed and introspective responses, with a word limit of 200–500 words. Prompts included the following:

1. In one word, describe your experience in the clinical setting this week.

2. Describe three learning moments in your first week of clinical training. For each learning moment, describe:

   • What you learnt from it.

   • How prepared you were to deal with the learning moment.

All students submitted reflections under identifiable accounts. These reflections were downloaded by a teaching assistant who anonymised the data by removing names and identifiers. This approach protected student confidentiality while preserving the depth and authenticity of their narratives.

Data analysis

A total of 47 reflections were received by the deadline (response rate: 97.9%). Data analysis was conducted in two sequential stages to balance data-driven insights with theoretical interpretation.

Stage 1: inductive thematic analysis

The first stage involved inductive thematic analysis to identify recurring patterns and concepts across students’ reflective writings. Two researchers independently coded a sample of 30 reflections, generating initial codes that captured emotional responses, learning challenges, adaptation strategies and evolving perceptions of professional identity. The coding framework was then refined through discussion and reviewed by a third faculty member with a PhD in medical education to enhance analytical consistency and validity.

Once agreement was reached on the code structure, the remaining reflections were divided between the two researchers and coded accordingly. Emerging codes were grouped into categories and themes, which were reviewed and finalised through multiple rounds of in-person and online discussion. Representative excerpts were selected to illustrate each theme, ensuring that student voices remained central to the analysis.

Stage 2: theoretical mapping to Mezirow’s transformational learning framework

In the second stage, each finalised theme was mapped to the dominant phase within Mezirow’s five-phase transformational learning framework:

1. Disorienting dilemma.

2. Critical reflection.

3. Rational discourse.

4. Revising assumptions.

5. Action and integration.

Reflexivity

The research team consisted of two educators with backgrounds in the medical education field. Both authors recognised their potential influence on interpretation and maintained reflexivity by engaging in regular discussions about preconceptions, ensuring that data interpretation remained grounded in the participants’ authentic voices rather than researcher bias.

Results

A total of 137 learning moments were reviewed. Although students were prompted to submit three learning moments, four students provided fewer than requested. Most reflections aligned with the five phases of Mezirow’s transformational learning framework. However, in 10 cases, the critical reflection phase was either partially addressed or missing, indicating varying levels of engagement with the reflective writing process.

Students’ reflective writings captured a diverse range of emotional and cognitive responses during their transition. These responses formed the foundation for transformational learning processes, as described in the themes below.

Thematic analysis linked to transformational learning phases

The analysis revealed four major themes, each corresponding to distinct phases in Mezirow’s transformational learning framework: (1) disorientation and emotional adaptation, (2) bridging theory and practice, (3) learning from the clinical environment and (4) personal and professional growth. These themes reflect a range of emotional, cognitive and behavioural shifts as students transitioned into clinical training. The themes are presented below with illustrative excerpts and interpreted in alignment with Mezirow’s phases of transformation.

Disorientation and emotional adaptation

Dominant phases: disorienting dilemma and critical reflection

Students’ initial exposure to clinical environments provoked a wide range of emotional reactions. While many entered with anticipation and motivation to apply theoretical knowledge, they were quickly met with the disorienting reality of patient care. Feelings of confusion, uncertainty and even helplessness emerged when confronting unfamiliar tasks, communication challenges and fast-paced workflows. This emotional discomfort, especially when encountering real patients with complex conditions, created disorienting dilemmas that challenged students’ existing beliefs about their preparedness. A considerable proportion expressed feeling ‘overwhelmed’ during their first week, often due to simultaneous demands on knowledge, clinical skills and emotional regulation. Many expressed positive emotions such as ‘excited’ or ‘motivated,’ reflecting a readiness to embrace the learning curve despite early difficulties.

These emotionally charged moments initiated critical reflection, in which students began to assess their limitations, internal expectations and evolving professional identities. Some reflected on their struggles to manage uncertainty and expectations, while others described personal growth through developing coping strategies or asking for guidance. Students also reflected on their emotional responses to patients, including discomfort when caring for individuals with psychiatric or neurological conditions, or guilt when feeling unprepared. These reflections marked the beginning of emotional awareness, prompting deeper insight into the emotional labour of clinical work.

I found it hard to interrupt patients while they are talking without making them feel uncomfortable or impolite

I then learned to follow a specific timeline and progression of symptoms accordingly, and not to miss important red-flag signs.

(Reflections from Neurology)

Bridging theory and practice

Dominant phases: critical reflection and revising assumptions

A significant challenge for students was the difficulty in translating theoretical knowledge into practical applications in real-life clinical settings. This gap in preparedness became evident as they encountered the complexities of patient care, which often deviated from the standardised cases presented in textbooks or where block teaching is used specific to a particular discipline. Many students expressed feeling underprepared for the technical and procedural demands of clinical practice, with tasks such as neonatal examinations, psychiatric history taking and procedural skills like cannulation exposing their need for additional firsthand training. These experiences triggered critical reflection, particularly as students began to question the adequacy of their prior learning and whether they were truly ready to perform in a clinical setting.

Expriencing a real-life encounter with a patient exhibiting symptoms of psychosis was eye-opening.

The intensity and nuances of the actual interaction highlighted the necessity for continued learning and hands-on .

(Reflections from Psychiatry)

Some students identified communication challenges, particularly in paediatrics and psychiatry. Engaging patients and fostering effective communication proved difficult, as students had to navigate both the emotional aspects of patient interaction and the technical challenges of gathering relevant information. Students struggle to use communication skills tailored to specific patient populations, such as using non-verbal cues or relying on family members. Language barriers further complicated these difficulties, particularly when documenting medical histories in Vietnamese and using interchangeable terms between English and Vietnamese, in addition to the fact that all record keeping in hospitals is in the Vietnamese language. Reflections confirm students’ evolving awareness of their limitations, including insufficient vocabulary, inefficient questioning techniques or biases during patient interactions.

The format and the content of the medical record were similar to that in English but wording is different. I am not prepared for this. This is easy to understand as most of the knowledge I have is in English and almost all the patients, doctors, nurses I met were Vietnamese. It seemed that I have to learn everything all over again.

(Reflection from OBGYN)

Reflection on failures, such as disorganised oral presentations or inability to elicit history from unresponsive patients, encourages learners to reassess and refine their approaches. Adaptability emerges as a crucial skill, as students learn to navigate unexpected patient behaviours and complex cases.

I thought I was good at history taking, but real patients didn’t follow the script. I had to think on my feet and simplify my words.

(Reflection from Paediatrics)

Learning from the clinical environment

Dominant phases: rational discourse and revising assumptions

The clinical environment provided an opportunity for students to gain firsthand clinical skills. Through direct observation and participation, they improved practical competencies, such as assisting in surgeries and conducting physical exams. Students frequently highlighted the importance of applying classroom knowledge to clinical scenarios, which deepened their understanding and reinforced learning from the preclinical phase, allowing them to recognise the relevance of their earlier studies. These experiences prompted both rational discourse through feedback, mentorship and modelling and revising assumptions as students began to question and reshape their prior beliefs about practice.

The clinical presentation of disease is variable, and might be slightly different from the textbook… I did not think about IgA vasculitis because the skin rash was not typical as in the textbook.

(Reflection from Internal Medicine)

Collaborative practice and recognising the role of other team members becomes clearer while the students can also see the differences in practice between public and private hospitals, especially in terms of caseloads and the clinical team’s responsibilities to patient care. Similarly, the striking differences between outpatient and inpatient settings emerge as students acknowledge the varied style of approaching patients.

Coordinating with nurses, doctors, and other staff members, I realized the importance of clear communication and timely updates.

(Reflection from Pediatrics)

Feedback from mentors played a pivotal role in the learning process. Constructive feedback from mentors was frequently cited as instrumental in helping students refine their clinical skills and build confidence. For example, detailed critiques of case presentations provided students with actionable insights that improved their ability to structure and communicate their findings effectively. Observing experienced clinicians navigate complex interactions with patients and families highlighted the importance of empathy, professionalism and effective communication. Additionally, the emotional support provided by mentors emerged as a key factor in helping students manage stress and maintain resilience during challenging moments. The assessment of the learning, both formative and summative, in the clinical context by the clinicians adds more stress, as do the expectations. These moments of mentorship represent rational discourse, structured interactions where students reconsidered their approach, adjusted behaviours and deepened their learning through dialogic processes.

Under the instruction of Dr. X, I have received feedback on how to ask the logical questions… not just following the checklist questions.

(Reflection from Surgery)

These challenges prompted students to revise their assumptions about learning as a passive process and instead take initiative to seek learning moments more strategically.

Personal and professional growth

Dominant phase: action and integration

Many students highlighted struggles with time management, as they found it challenging to balance clinical duties with studying and personal life. Despite these difficulties, significant growth in confidence and professional identity was observed, as students became more comfortable in the clinical setting and began to view themselves as future doctors, reinforcing their professional development as indicators of Mezirow’s ‘Action and Integration’ phase. Small acts, such as assisting with procedures, contributing to patient care or receiving acknowledgement from staff, served as affirmation of their evolving role.

Even when I could only do small things, like holding the baby while the doctor examined, I felt part of the team. It made me want to learn more and be more helpful.

(Reflection from Paediatrics)

Engaging directly with patients deepened their appreciation for empathy and patient-centred care, particularly in specialties such as psychiatry and paediatrics. Students reported learning to adapt their communication and care strategies to meet the unique needs of each patient. Resilience and adaptability emerged as key outcomes of this phase.

Additionally, students increasingly recognised the role of self-care in maintaining professional effectiveness. Several reflected on the physical and emotional toll of clinical exposure and acknowledged the need to balance their own well-being in order to provide optimal patient care.

It was really stressful in the first two days, but I learned to prepare better the night before and to stay calm even if I didn’t understand everything right away.

I realized that being tired or stressed can affect how I talk to patients. So, I made sure to eat well and take short breaks when I could.

(Reflection from Internal Medicine)

A shift towards lifelong learning was also evident. Many students described identifying knowledge gaps during patient interactions, which sparked internal motivation to study further. Rather than viewing these gaps as failures, they interpreted them as opportunities for growth.

Every time I couldn’t answer a question or forgot a step, I felt frustrated. But then I would go back, read more, and the next time, I was better.

(Reflection from Surgery)

In one reflection, a student went beyond individual learning and connected with the broader social role of the physician, identifying the doctor as an advocate for patients.

I saw how the doctor stood up for a patient’s right to treatment even when the family disagreed. I realized that part of being a doctor is not just knowing medicine but speaking up for your patients.

(Reflection from OBGYN)

Discussion

This study explored how medical students experience the transition from preclinical to clinical training, with a focus on the processes of transformation and professional identity formation. Through the lens of Mezirow’s transformative learning theory, we analysed students’ reflective writings to understand how emotional, cognitive and experiential challenges shaped their learning and identity. The findings revealed four interconnected themes, each aligning with one or more phases of transformative learning and contributing to students’ evolving professional identity. This approach provides insight into how critical moments during early clinical exposure act as catalysts for transformative learning and identity development.

Disorientation and emotional adaptation

One of the key findings in this study was the overwhelming emotional response students experienced during their first week in the clinical environment. The feeling of being ‘overwhelmed’ was the most frequently reported sentiment, expressing the immediate pressures students face when transitioning from a controlled academic environment to the unpredictable nature of patient care. This aligns with the literature on medical education transitions, where students often describe clinical practice as a ‘sink or swim’ experience.¹³ Such transitions often present a disequilibrium, a misalignment between expectations and reality, which, as Mezirow’s theory suggests, is a necessary catalyst for transformative learning. Medical educators need to consider these emotional challenges, as they can have a lasting impact on students’ performance and mental well-being during their clinical years.

Importantly, students did not solely report negative emotions. Alongside confusion and stress, many also expressed excitement and motivation, particularly during their first patient encounters. These emotionally complex experiences prompted students to reflect critically on their reactions, begin regulating their responses and seek strategies to manage uncertainty. These reflections marked the beginning of a shift from emotional reaction to emotional insight, an essential step in both transformative learning and professional identity formation. Recognising the value of disequilibrium may be particularly helpful for students themselves. Making this process explicit during transition programmes could normalise emotional discomfort and empower students to use such moments as learning opportunities rather than signs of inadequacy. Structured reflection and supportive environments at this vulnerable stage have the potential to enhance motivation, build resilience, and contribute meaningfully to students’ long-term professional development.¹⁴

Bridging theory and practice

Many students felt unprepared to apply their classroom learning to real-world scenarios, echoing findings from literature that highlight the challenge of bridging the gap between preclinical training and the realities of patient care.⁴ The complexity of patient presentations, which often deviates from textbook examples, requires students to engage in higher-order critical thinking and decision-making, skills that are not always emphasised in preclinical education.¹⁵

Another significant challenge identified was communication, particularly in specialised areas such as paediatrics and psychiatry. These fields require an elevated level of sensitivity and precision in communication, and students often struggled with both literal language barriers and the complexity of medical jargon. In paediatric settings, engaging with young patients can be particularly challenging as it requires not only effective verbal communication but also an understanding of non-verbal cues and simplified explanations suitable for children.¹⁶ Similarly, in psychiatry, students faced difficulties in navigating delicate conversations with patients who may have impaired cognitive or emotional abilities to communicate clearly.¹⁷ Students found themselves needing to re-learn familiar content in a different linguistic and cultural context, an experience that prompted revised assumptions about their preparedness.

Moreover, the use of bilingual instruction in the MD programme at VinUniversity adds an additional layer of complexity. The curriculum’s dual language medium, with both Vietnamese and English used as languages of instruction, can be a double-edged sword.¹⁸ Bilingual education equips students with the necessary English proficiency to engage with medical literature and prepare for international opportunities. On the other hand, the constant switching between languages can create cognitive overload, complicating both patient interactions and intrateam communications in clinical settings.¹⁹ Research has shown that students learning through a bilingual medium may experience challenges processing information, which can lead to miscommunication, especially in high-pressure environments, where precise communication is crucial. Addressing these barriers will require tailored communication training that not only focuses on improving language proficiency but also provides strategies for managing bilingual communication in medical contexts. This may include specific modules that emphasise medical language acquisition in both Vietnamese and English and provide practical simulations to bridge the gap between classroom learning and real-world patient communication.

Learning from the clinical experience

Engagement with real patients and healthcare teams allowed students to observe, question and re-evaluate their roles within the clinical hierarchy. These interactions, especially when supported by constructive mentorship and feedback, represent the phase of rational discourse in Mezirow’s model. Students described a steep learning curve in developing clinical judgement and decision-making under pressure, which mirrors findings in similar studies where students emphasised the importance of experiential learning.²⁰ Practical experiences, such as assisting in surgeries and conducting physical exams, were highlighted as invaluable, as they provided students with the opportunity to observe and practice patient care.

Mentorship emerged as a crucial factor in students’ learning experiences, both in terms of constructive feedback and emotional support. Previous research supports the idea that mentorship significantly enhances the learning process, particularly in clinical education where students often rely on the guidance of more experienced professionals to navigate new challenges.²¹ Emotional support from mentors was especially important in helping students manage the stress and uncertainty of clinical practice. This is consistent with existing literature that highlights the dual role of mentors as both educators and emotional support systems for students.²¹

Personal and professional growth

In the final theme, students described acting on new perspectives: adapting communication, managing time more effectively and internalising the values of patient-centred care. These are clear markers of Mezirow’s phase of action and integration as students’ personal and professional growth, particularly in developing time management skills and building confidence as future doctors.

The difficulty in balancing clinical duties, personal life and studying was a common challenge among students. This reflects broader concerns in medical education about the impact of clinical training on student well-being, as time management becomes an increasingly critical skill during this period.²² Despite these difficulties, many students reported significant growth in confidence and professional identity, viewing themselves increasingly as future healthcare professionals.²³

Implications for practice

The findings from this study have further implications for medical education. First, the emotional challenges faced by students during their transition suggest the need for more structured emotional support systems. Incorporating emotional resilience training into the curriculum could help students better cope with the stress and anxiety of clinical practice. Expanding mentorship programmes to include both technical guidance and emotional support would further enhance the student experience, recognising the dual role of mentors as educators and emotional anchors.

Second, the gaps in preparedness identified in this study, particularly in patient communication, point to a need for more targeted preclinical training in specialties such as paediatrics and psychiatry. Simulated patient interactions, early clinical exposure and focused communication workshops could help better prepare students for the realities of patient care in these challenging fields. But these will come at a price to remove some other content in the curriculum. It may, therefore, be worth revisiting the clinical placements plan and considering if really paediatrics and psychiatry should be included in the first full year of clinical rotation.

Third, students faced challenges navigating clinical training in a dual-language environment, particularly with documenting medical histories and communicating effectively in both English and Vietnamese. These challenges highlight the need for targeted strategies to support learning in bilingual contexts, ensuring students are better prepared to overcome language barriers and develop into linguistically competent and culturally sensitive healthcare professionals.

Reflective writing, as demonstrated by this study, is a valuable tool for capturing the depth of students’ experiences. Medical schools could consider integrating reflective writing as a regular practice throughout clinical training, allowing students to continuously reflect on their growth and challenges.²⁴ This method offers educators a window into both the cognitive and emotional dimensions of student learning, providing further insights than traditional evaluation methods.

Limitations and strengths of the study

This study has several limitations. It was conducted at a single institution, which may limit the transferability of findings to other contexts. Additionally, although reflections offered rich insight into students’ experiences, they may have been influenced by the structure of the writing prompt or students’ willingness to disclose vulnerability. Despite these limitations, the study also has important strengths. It applied a theoretical framework, Mezirow’s transformative learning theory, to explore transformation at the earliest stage of the clinical transition, offering a structured lens to interpret how students adapt emotionally, cognitively and professionally. Furthermore, the near-complete participation rate enhances the credibility of the findings and provides a robust representation of the cohort’s experience.

Further research suggestions

Future research could expand on this study through longitudinal examination of student reflections and how it shapes their professional identity. Additionally, exploring the long-term impact of emotional resilience training and mentorship on student performance and well-being would provide valuable insights. Further research into how targeted interventions in specialties like paediatrics and psychiatry can improve student preparedness would also be beneficial.

Conclusions

The transition from preclinical to clinical learning represents a significant phase in medical education, marked by opportunities for transformative learning and professional identity formation. Through reflective writing analysed within Mezirow’s transformational learning framework, this study illuminated how medical students navigated emotional adaptation, bridged the gap between theory and practice, learnt from the clinical environment, and initiated personal and professional growth during their first week of clinical training. While students experienced stress and feelings of being overwhelmed, they also found motivation and growth through direct patient care. These findings offer practical implications for enhancing student support and curriculum design, fostering professional identity formation and resilience.

Data availability statement

Data are available on reasonable request.