Creating a third space during clerkships: a qualitative study of a well-being intervention in the clinical learning environment

BACKGROUND: Medical students often experience significant stress during the transition to the clinical learning environment (CLE), yet evidence-based interventions to support well-being during this period remain limited. This study explored medical students' experiences with a pilot Wellness Debrief Program (WDP) during the clerkship year and examined its role in supporting well-being and professional identity formation. METHODS: We conducted a qualitative study using a social constructivist approach at a regional campus of a U.S. medical school. Students who attended four or more of the six WDP sessions were invited to participate in semi-structured interviews. Data were analyzed using constant comparative methods, guided by Gruppen's CLE model. Analysis was informed by third-space theory and professional identity formation frameworks. Trustworthiness was established through reflexivity, member checking, and iterative codebook development. RESULTS: Four of five eligible students participated in interviews. Analysis yielded five themes: (1) the CLE as a liminal space that impacts professional identity formation; (2) validation of experiences and perspectives facilitates belonging; (3) the structure of the environment impacts outcomes; (4) tension exists between the feeling self and the thinking brain; and (5) the WDP served as a transformative third space supporting professional identity formation. CONCLUSION: Our results suggest that voluntary well-being programs can be integrated into clerkships to complement teaching and learning in the CLE. Such programs can be designed to promote psychological safety, normalize emotional experiences, and foster belonging. Designing clerkship interventions as transformative spaces may enhance student well-being during the transition to the CLE and support professional identity formation.