Table 1 Codes, themes and example quotes from student and clinical teacher interviews

Permission to participate

Being present and involved

‘And he [the consultant] was like fine, go and integrate yourself into the team’ (Pete, student)

‘I think a lot of the time as a medical student you do stand there feeling like a lemon’ (Anita, student)

Attention

Permission to ask a question/for advice

Being given a role

Feeling included

Wasted time

Preparing themselves

Contact with role models

Continuity of and exposure to role models

‘You find people that you work with well and then you have to start again every three or four weeks’ (Anita, student)

‘I also try and highlight anything I thought might have been particularly helpful about the consultation, a particular sign or something or a particular… you know something that the patient asked me that was difficult to answer.’ (Melanie, teacher)

Role models being approachable

Role models being observable

Valued knowledge

Aligned values

‘When you find a good role model it tends to be someone you can relate to.’ (Liam, student)

‘when I see patients react that way [positively] that gets me more that ‘oh, I’ve published 70 things’ (Emily, student)

Getting along

Attitude to patients

Attitude to colleagues

Value to patients

Value to colleagues

Making meaning

Learning the language

‘Because you hear people present….and in the first year you’re like’ I don’t know what they are talking about’ but the more you listen to it and the more you look things up… you just absorb it’ (Anita, student)

‘You need to use the right words…a good role model will teach you how to make yourself just sound better’ (Liam, student)

Retention

Looking up terminology

Discussing meaning with peers

Using the right words

Sounding professional

Role models thinking/reasoning out loud

Understanding thought processes

‘So if they can talk through their thought process then it’s easy for you to kind of understand it better that way’ (Liam, student)

‘They might say, for example, ‘I saw a patient with such and such a presentation… ‘what would your thought process have been?’ (Melanie, teacher)

Modelling clinical thinking

Similar thought processes

Formal reflection requirement

Meaningful reflection

‘Hearing a good question and going ‘that’s a really effective what of asking that. Mine’s not as good. I’ll try and see if it works for me’ (Jason, student)

‘If you enforce people to reflect on a price of paper…. They’re not going to do it.’ (Stefan, teacher)

Student led reflection

Value of reflection

Impact of reflection

Curricula alignment

Student-led note taking

Writing it down

‘I’ll write done the date and ‘ok, this is what I’ve taken out of it’ (Liam, student) ‘get them to write down a few things that they may have noticed me doing a lot or questions that they noticed me… asking a lot and then try and get them to reflect on why’ (Melanie, teacher)

Teacher-directed note taking

Sharing notes

Priority of exams

Barriers to retention

“They’re saying you can get a lot more out if you go on Pastest (online revision resource), there’s 3000 questions and you spend a day doing that, that’s much more useful then writing notes on a ward round.” (Mark, student).

Practice with peers

Opportunity to practice

‘I think you have to be proactive…either asking for teaching or….if there are any spare patients that it would be good for me to examine’ (Anita, student)

‘We don’t necessarily want the knowledge now, we want to practise being baby doctors’ (Pete, student)

Reproduction

Competition for practice opportunity

Proactivity

Practice with patients

Practice being in setting

Role model’s feedback

Feedback

‘So she [role model] got me to be the person doing the questions, taking the history etc.… and then she’d either top up or said’ well done… [because] that…[gives] a very good indicator of where you are at…’ (Jason, student)

Peers’ feedback

Lack of continuity of feedback giver

Wanting to please

Feedback

‘So I…didn’t want to disappoint him [role model] and I did actually care what he thought’ (Mark, student)

‘When the patients come in I’ll leave you alone to do that because I know having spent the past half day that you are competent in this…’ (Liam, student)

Motivation

Being considered more independent

Response or reaction of students

Observing others’ responses - Vicarious reinforcement

Vicarious punishment

‘I think perhaps the negative behaviours have a greater impact… when they [students] have observed something they don’t want to emulate or that sits uncomfortably with them, they do…tell each other’ (Iris, teacher)

I’d always thought that if you want kids’ attention you want to be loud but to him [role model] is was the opposite. If he kept quiet they’d do the same to him’ (Liam, student)

Reaction of colleagues

Reaction of patients

Lack of opportunity to see reaction

Clinical outcomes

Being considered more independent

Value to them

Reciprocity

‘If you have a good role model it encourages you to be a role model for other people if you can…it’s like paying it forward’ (Liam, student)

‘They’re [students] are in a good position to see what I’m doing and if I would have done anything better…’ (Shivani, teacher)

Two way

Feedback to role models