Constrained triadic reciprocal determinism: advancing social cognitive theory through an exploration of informal learning in paediatric communication among medical students

<ns7:p>Purpose This study explores the role of informal learning in the development of competent communication skills among medical students interacting with paediatric patients. By investigating the interplay between personal, environmental, and behavioural factors, the study aims to identify how clinical placements facilitate or hinder communication proficiency. Ultimately, the research seeks to advance Bandura’s Social Cognitive Theory by contextualising its constructs within the high-stakes, opportunistic learning environment of undergraduate medical education. Methods Adopting a relativist ontology and an interpretivist epistemology, the study utilised a qualitative phenomenological methodology. Semi-structured interviews were conducted with eight senior medical students (Years 4 and 5) from the University of Leicester. Data were analysed using Braun and Clarke’s reflexive thematic analysis. This approach allowed for a deep exploration of the lived experience of informal learning, ensuring that the findings were grounded in the subjective realities of the participants. Results The findings suggest that personal factors, such as prior non-clinical experience and exam-centric motivation, act as primary filters for clinical engagement. The clinical environment offered unique child-centred affordances that facilitated rapport, yet systemic variability in placement locations created a lottery of learning opportunities. Behaviourally, students progressed through observation and subsequent triadic inclusion strategies, though many defaulted to adult-centric models under high cognitive load. Conclusion This study concludes that informal learning in paediatrics is a process of ‘constrained triadic reciprocal determinism.’ While students demonstrate significant agency, their learning is bounded by an assessment-driven hidden curriculum. To innovate, medical schools must shift from passive shadowing to active, interprofessional collaborative models. Using the Schumpeterian Innovation model, this study identifies five key dimensions of educational reform required to ensure that future doctors can meet the complex communication needs of children and their families.</ns7:p>