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Cultivating Belongingness in Clerkship and Beyond

By Eve Purdy (@purdy_eve)

Anthropologists are fascinated by the concept of belonging – social membership in a particular group. How do individuals become a part of a group? How does one maintain membership? What happens to those who are excluded?

The need for belonging is universal. The desire for social inclusion likely roots itself in evolution. (1) Historically, belonging to a group could mean the difference between satiation and starvation, between hypothermia and warmth, between death and survival. Now, as our lives become more complex – with multiple work, home, and recreational circles – we find ourselves negotiating belonging in many different contexts. Though membership in these groups may not be as physically necessary as it once was, personal fulfillment and psychological well-being are dependent on inclusion.

Belonging in Clerkship 

A sense of belonging is often threatened in medical, particularly clerkship, education. In the first two years of medical school, most students develop an intense sense of belonging. They spend countless hours learning with their classmates in lecture, working on small group projects, and often their time together extends beyond the classroom to social events such as parties and intramural teams. For many, myself included, this might be strongest sense of membership to a group ever experienced. It feels lovely. Then, come clerkship, this sense of belonging changes dramatically. Here, students are transient members on clinical teams, often rotating to a new service every two weeks. With each new rotation comes a new set of norms, expectations, idiosyncrasies, rules of engagement, and social currency. In addition to learning the new type of medicine, clerks are trying to understand how to belong. Rarely are social expectations explicit. Sometimes the student sits in the wrong chair, or speaks at the wrong time. These seemingly minor transgressions can result in rejection from the group. By the time a student sorts out just how things work, it’s time to rotate to a new service and start the process all over again. In addition to scrambling, and sometimes failing, to belong in their work environments, erratic schedules and away rotations mean that clerks’ memberships in other circles important to them might also be at risk. All this to say, clerkship is a particularly vulnerable time. There is no shortage of data about high rates of depression and suicide in medical students. I find myself reflecting often on how belongingness might play into this tragedy we find ourselves in as a community.

Cultivating Belonging 

Recognizing belonging as a fundamental human necessity is an important step in clerkship education and discussions around medical student wellness. Simply stated, when students feel as though they belong, they will learn more and be happier. When I reflect on my richest learning experiences, they were times when I was in the inner circle. I was part of the team. In one circumstance I remember a surgical resident specifically finding me from another part of the hospital before going down to the emergency department because there was an interesting consult that she knew I would like to see. She went out of her way to include me. For the next two weeks on the service, with her as my senior resident, I was engaged and excited about the work. That experience, and sense of belonging, almost convinced me to be a general surgeon! Both educators, I will focus on residents as teachers, and medical students can cultivate belonging.

Tips for Residents

While trying to navigate their own belonging – which can certainly be a challenge on its own – residents also play an absolutely integral role in facilitating belonging for medical students. They are often the closest point of contact and, as a near peer, they are usually the least threatening potential ally on the team. Here are some ways that residents might cultivate belongingness for medical students.

At the end of the day, be the person who finds a way to bring others into your inner circle, not the person who finds a reason to keep others out.

In residency learners again belong to a set group of peers with whom they
spend a great deal of time. This is our ER group bonding at a residency retreat. This sense of
belonging can sometimes be threatened on off-service rotations or away rotations but that
serves as a home-base that is lacking in clerkship.

Tips for Medical Students

As a learner there are also ways that you can also cultivate belongingness. The onus doesn’t just rest on the teams that work on to bring you in to the inner circle. Muscle your way in.

How do you cultivate belongingness?

I hope that this article will spark a reflection and discussion about belongingness at all levels of our system. Belongingness can be cultivated and threatened at any educational and professional stage. Please comment below with suggestions about how you cultivate belongingness in your teams? What suggestions do you have for educators, residents, and medical students?


  1. Wever-Rabehl G. 2006. The anthropology of belonging: the need for social inclusion. Suite 101.
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