How Medical Students Learn Adolescent Medicine: An Explanatory Theory of Competency Development and Professional Identity Formation Running head : Learning Adolescent Medicine

<title>Abstract</title> <p>Introduction : Adolescent medicine remains largely peripheral to undergraduate medical education despite adolescents facing increasingly complex health challenges. Although educational needs are traditionally defined by institutions and experts, little is known about the learning needs perceived by medical students themselves. This study explored undergraduate medical students’ learning needs in adolescent medicine and generated an explanatory theory grounded in their experiences. Methods We conducted a qualitative study inspired by constructivist Grounded Theory. Semi-structured interviews were conducted with 10 undergraduate medical students from a French medical school. Participants were recruited through theoretical sampling. Interviews were audio-recorded, transcribed verbatim, and analysed iteratively using the constant comparative method and successive cycles of initial, focused, and theoretical coding. Results Eight themes emerged and were organised into three interrelated categories: competency, learning through supervised clinical participation, and professional identity development. Students perceived adolescent medicine as occupying a marginal place within the undergraduate curriculum and described training focused predominantly on declarative knowledge. Competency emerged from the mobilisation of internal and external resources, including prior experiences, representations, role models, peers, and the clinical environment. However, opportunities to mobilise these resources through supervised participation in authentic clinical situations were limited. Students reported insufficient observation, feedback, and assessment, as well as uncertainty regarding their role in adolescent care. Adolescent medicine emerged as a particularly challenging context for professional identity development. The resulting theory suggests that competency acquires meaning through learning achieved via supervised clinical participation, which in turn contributes to professional identity development. Conclusions Medical students’ learning needs in adolescent medicine extend beyond knowledge acquisition. The proposed theory highlights the dynamic interaction between competency, learning through supervised clinical participation, and professional identity development. It may inform the organisation of undergraduate medical education, particularly the educational role of clinical placements in competency development.</p>