This research was conducted in one of the departments within a faculty of Health Sciences at a South African higher education institution (HEI). South Africa is a highly diverse nation, characterised by a multiracial, multicultural, and multilingual population. There are also increased migration patterns which add to the heterogeneity of a patient population in any region. The healthcare system in South Africa is divided into public and private healthcare sectors. The department where the research was conducted offers a four-year Bachelor of Science programme in diagnostic radiography through academic and clinical learning on a rotational basis from first year and throughout the four-year study period. Clinical learning takes place at various public and private clinical sites approved and accredited by the Health Professions Council of South Africa (HPCSA).

The current study population included students registered for 4^th year in diagnostic radiography at the research site. Qualified clinical diagnostic radiographers (i.e. radiographers in clinical practice who hold diagnostic radiography qualifications) working at the clinical sites where students conduct WPBL were also included. Purposive sampling was employed (Brink et al., 2012) to allow for only students partaking in clinical learning and qualified radiographers involved in the clinical education of diagnostic radiography students from the research site to participate.

A total of three focus groups were conducted to collect data from diagnostic radiography students, while data from qualified clinical radiographers was collected through seven one-on-one interviews. All focus groups and one-on-one interviews utilised the unstructured interview method with one central open-ended question. The unstructured interview method afforded participants opportunities to express themselves in their own words while also allowing the researcher to probe for more information when necessary, resulting in collection of information rich data (Holloway & Galvin, 2017).

Each focus group consisted of five to six participants, in line with the recommendations by Holloway and Galvin (2017). All focus group interviews were conducted online via Zoom, and the duration ranged between 47 and 57 minutes for each interview. The one-on-one interviews with qualified clinical radiographers were conducted outside participants’ working hours to avoid interfering with their work. Participants were given an option between in-person and online interviews, and all preferred in-person interviews. As a result, all interviews with qualified clinical radiographers were conducted in-person, at various locations according to participants’ preferences. Each interview lasted between 23 and 45 minutes.

Data collection continued until data saturation was considered to have been reached (Brink et al., 2012). The researcher captured field notes and audio recorded all interviews. The audio recordings were later verbatim transcribed by an independent transcriber.

Data was manually analysed using the framework approach of thematic analysis, also termed framework analysis (Gale et al., 2013; Braun & Clarke, 2022). This analysis method allowed for the identification, description, and interpretation of key themes and patterns of the phenomenon of interest within and across the two groups of data (Braun & Clarke, 2022). It also offered analytic transparency which added to the audit trail (Braun & Clarke, 2022). The seven steps of framework analysis described by Gale et al. (2013) were followed (Figure 1). All interview data was transcribed verbatim and familiarity with the data was achieved by repeatedly reading the transcripts and field notes and listening to the audio recordings. After familiarity was gained, the one-on-one interview data was coded, and themes were developed from the dataset. The developed codes and themes were then used to construct the analytical framework which was applied to the separately coded focus group data. The analytical framework was revised taking into consideration the new data (focus group data). The result was three themes being generated from the data.

Under this theme, participants described different aspects of learning in the clinical workplace, such as opportunities to progress from learning through observations to learning by doing, preparation for different clinical contexts, the time it takes to gain familiarity and learn, and the development of student’s confidence. In addition, this theme highlighted the important interpersonal skills that can foster professional socialisation and effective global engagements. These skills which are developed through participation in workplace include communication, adaptability and teamwork.

To be a global professional, radiographers require the ability to operate in various healthcare environments. Adaptability is an essential characteristic of a global professional, and this trait is evident in the experiences shared by the participants when learning in the clinical environment. Data demonstrated the process of professional growth through active involvement in authentic activities, where students build confidence over time and develop their interpersonal abilities for effective global engagements. Participants also emphasised the importance of preparing students for future employment in different clinical contexts. Students suggested rotating between private and public hospitals, which indicates that they realise the importance of exposure to different environments to gain a broad understanding of the profession which might better prepare them for future professional practice in diverse environments. At present, each student engages in workplace learning at either a public or private clinical site. Educators at the research site should be cognisant of this important suggestion and consider strategies to implement it.

Data under this theme revealed that role modelling and peer learning, i.e., students learning by observing and imitating qualified radiographers and other students, are influential methods of diagnostic radiography students’ learning in the clinical environment. Student participants indicated that they engage in reflective practice to determine suitable and unsuitable behaviour. This reflection and ethical awareness enable students to identify appropriate professional behaviour and role models they can relate to and adjust their behaviour accordingly.

Globalisation brings together diverse perspectives and values, which means it is possible for professionals to be exposed to unfamiliar behaviours. This necessitates reflection and ethical awareness to navigate complex moral situations and make ethically sound decisions appropriate for the profession. Through reflection, individuals critically evaluate their actions as well as those of others around them, fostering the development of appropriate professional behaviour. Students in this research indicated that they engage in reflective practice as they interact with peers and clinical radiographers to determine suitable behaviours to learn. This practice can guide their decision-making and professional conduct in future roles within a global healthcare environment.

The information shared by participants revealed that students are self-motivated, driven and eager to learn. They value being recognised for their work, getting compliments, and being treated like they belong. Factors such as professional pride and passion, radiographers’ passion for student training, as well as students’ motivation and willingness to learn promote a sense of belonging for students and positively influence their professional socialisation.

This study also found that students are sometimes faced with difficult situations in the clinical environment including negative experiences such as unprofessional behaviour by clinical staff and unrealistic expectations towards students, which can have a negative influence on their sense of belonging and professional socialisation. The high patient volumes and staff shortages also make it difficult for clinical radiographers to provide students with adequate supervision and support, potentially leading to feelings of neglect and a diminished sense of belonging among students. Participants’ expressions were as follows:

A sense of belonging plays a crucial role in shaping professional identities and developing the competencies and attributes necessary for appropriate behaviour in diverse professional settings. The participants’ expressions of belonging reflect a meaningful connection within the local radiography community, with the potential to expand to other settings globally. However, the negative experiences they shared highlight areas that require attention in order to foster and sustain their sense of belonging.

The findings of the current study revealed the role of the clinical learning environment in the professional socialisation of diagnostic radiography students and the development of essential competencies for effective global engagements. Participants recognised that it takes time to adjust to the clinical environment and build confidence. These findings emphasise the need to create a supportive clinical learning environment. These findings are supported by Jeyandrabalan et al. (2022) assertion that clinical learning is an important component of diagnostic radiography education. Students develop confidence and a professional identity through the practical experiences they gain in the clinical environment (Arkana et al., 2018; Jeyandrabalan et al., 2022). The interactions between students, patients, clinical radiographers, and other students in the clinical environment facilitate the acquisition of patient care, critical thinking, decision-making skills, and professional socialisation (Cunningham et al., 2015; Arkana et al., 2018). In line with the findings of this study, Thompson et al. (2016), posit that it takes time for students to become familiar with the clinical environment, but once familiarity is gained, learning develops quicker. Spending adequate time in the same clinical environment can facilitate professional socialisation of diagnostic radiography students (Naylor et al., 2016).

Diagnostic radiography students in the current study indicated that they first learn by observing clinical radiographers in practice, and over time progress to hands-on experience. Correspondingly, a study conducted by Lundvall et al. (2021) on the learning of students during clinical placements in Sweden revealed that learning in the clinical environment starts with students listening to and observing qualified radiographers in practice. This includes listening to how radiographers speak to patients and other health care professionals and how they perform radiographic examinations (Lundvall et al., 2021). Students then progress to hands-on experience where they perform the examinations on their own, under supervision (Lundvall et al., 2021). Students in this study by Lundvall et al. (2021) explained that they learned more when they performed examinations independently, and they internalised the knowledge through repeated actions. Similarly, in a study conducted by Portanier Misfud et al. (2015) radiography students reported learning more when they are given opportunities to be actively involved in the task. A literature review conducted by Bwanga and Lidster (2019) also highlighted the significance of a conducive clinical learning environment where students are given opportunities and time for hands-on experience.

The current study findings further highlighted the interpersonal skills essential for diagnostic radiographers as global professionals. These skills including adaptability, teamwork and communication skills are developed during professional socialisation in the clinical learning environment. In agreement with these findings, a scoping review conducted by Ofori-Manteaw et al. (2025) reported that communication, empathy, teamwork and adaptability are some of the important interpersonal skills in radiography. These authors argue that the aforementioned skills are essential for delivering high quality, personalised patient care, collaborative practice and professional development. Specifically, adaptability facilitates continuous professional development and excellence in practice (Ofori-Manteaw et al., 2025). Teamwork between radiographers and other categories of medical professionals, such as nurses and doctors, is essential for ensuring that appropriate medical imaging is performed, and patients’ needs are met (Wallin et al., 2023). In a study conducted by Kasita et al. (2023) participants shared that teamwork among radiographers eased the work and increased work efficiency. This study further found that teamwork facilitates the development of professional identity in newly qualified radiographers because of the guidance they obtain from experienced radiographers (Kasita et al., 2023).

Studies by Hyde (2015), Lundvall et al. (2021) and Jeyandrabalan et al. (2022) found that good relationships and positive interactions between radiographers and students are crucial for students’ learning in the clinical environment. Effective communication is an essential aspect of such relationships and for effective engagements with patients, other healthcare professionals and the public (Arkana et al., 2018; Migliorini & Portelli, 2019; Hyde & Hardy, 2021). Language is central to effective, respectful communication (Lee et al., 2025). Therefore, it is important for radiographers, like other healthcare professionals, to be able to speak in a language that is understood by patients (Sharkiya, 2023). While English is the most spoken language in South Africa, not all patients can speak the language (Soudien & McKinney, 2016). Also, in a multicultural nation or globalised healthcare, health professionals need to be mindful of the culture differences and be able to communicate in a culturally sensitive manner (Lee et al., 2025). This challenges radiographers to develop intercultural, multilingual and/ or non-verbal communication skills to ensure effective communication (Sharkiya, 2023). These skills, which are also essential for effective global engagements (Lai et al., 2019; Di Michelle et al., 2024) can be developed during undergraduate radiography education as part of professional socialisation (Gunn et al., 2020) or through continuous professional development (Lee et al., 2025).

Rotation of diagnostic radiography students between private and public hospitals was suggested by current study participants as a possible approach for effective professional socialisation and preparing students for diverse clinical contexts. Currently, each student from the research site undertakes clinical learning at either public or private hospital. Staffing levels, variety and types of available imaging equipment and imaging examinations performed at these clinical sites differ. Accordingly, this study revealed that students' learning experiences varied across facilities. The public hospitals were regarded as having an advantage of exposure to a broader range of imaging examinations. On the contrary, certain imaging examinations are rarely performed at private practices, limiting students’ competency levels for such examinations. But private hospitals were perceived as offering a more supportive learning environment with more focused student supervision. This finding corresponds to those of a study by O’Connor and McNulty (2024) where private clinical learning environments were associated with more opportunities for hands-on learning, better quality of supervision and safe learning. These authors attributed this finding to the smaller number of students at private clinical sites (O’Connor & McNulty, 2024). In a study by Gunn et al. (2020) to investigate the experiences of international exchange students, initial challenges related to the unfamiliar clinical environment, imaging equipment and different imaging protocols were identified. However, participants reported gaining rich learning experiences in the end, characterised by a deeper understanding of their profession (Gunn et al., 2020). While the context of the finding in the current study is different to that of the study by Gunn et al., it is envisaged that exposing diagnostic radiography students to both private and public clinical learning environments would have similar results where students get to view and experience the profession from different contexts, enhancing their professional socialisation and readiness for global engagements.

The current study found that diagnostic radiography students learn through role modelling and peer learning in the clinical environment. However, this exposes students to a range of behaviours necessitating their incorporation of ethical awareness and critical reflection to ensure that they adopt appropriate behaviours and actions. The crucial role of positive role modelling in the effective professional socialisation of diagnostic radiography students is emphasised in the literature (Cunningham et al., 2015; Bwanga & Lidster, 2019; Hyde & Hardy, 2021; Lundvall et al., 2021). Diagnostic radiography students engage in reflective practice to identify a particular clinical radiographer to be their role model; sometimes they create an ideal role model by choosing and combining certain characteristics from different radiographers (Cunningham et al., 2015). Anderson et al. (2022) reported the potential ethical dilemmas that students may encounter during clinical placements, particularly in interactions involving patients, peers, and qualified staff. These challenges are often compounded by the diverse backgrounds and perspectives of the different individuals. Dealing with these issues requires theoretical knowledge, ability to reflect on what is right or wrong and decide on what needs to be done in a specific situation (Anderson et al., 2022). According to these authors, professional knowledge, cultural competence and an understanding of diverse patient perspectives are essential for making ethically sound decisions. These are especially important in a globalised or diverse healthcare system.

Another approach to learning in the clinical environment is peer learning, where senior students teach junior students with the purpose of improving understanding, knowledge, and skills (Boyd et al., 2019). In this approach, senior students gain confidence and enhanced communication skills from teaching junior students (Cunningham et al., 2015; Meertens, 2016). Peer teachers in a study by Meertens (2016) further expressed that participating in peer learning prepared them for their future role as qualified radiographers in student training. For peer learners, the benefits include improved academic performance and clinical skills as their peer teachers often can explain concepts in an easy-to-understand manner based on their experiences with the content (Boyd et al., 2019). International mobility students in a study by Di Michele (2024) highlighted the role of peer support in their successful learning during the exchange programme. Likewise, international peer-assisted learning was reported as a useful tool to boost radiography students’ learning experience on internationalisation (Lai et al., 2019). Therefore, role modelling and peer learning are instrumental in the professional socialisation and internalisation of diagnostic radiography students. Reflective practice and ethical awareness remain critical in ensuring that students learn and internalise only the appropriate behaviours and values.

Student participants shared experiences that reflected their sense of belonging to the workplace team. This sense of belonging was associated with feeling valued and included as part of the collective. Participants’ narratives also demonstrated a strong sense of professional pride, a commitment to learning, and high levels of motivation, factors that are linked to an enhanced sense of belonging within the clinical learning environment (Frangieh et al., 2024). Belonging is defined as the experience of feeling valued and connected to others within a group or community (Coleman et al., 2024) which is associated with authenticity, good interpersonal connections, and contribution to meaningful work (Boland et al., 2025). In healthcare contexts, a sense of belonging is essential for promoting compassionate care (Boland et al., 2025). Further to this, Murphy (2024) notes that for healthcare professionals working in international contexts, a sense of belonging enhances morale and motivation, thereby contributing to overall commitment to their profession and success at work.

Corresponding to the findings of the current study, radiography students in a study by Coleman et al. (2024) expressed feelings of belonging to their clinical placements. Similarly, Thompson et al. (2016) reported students’ feelings of belongingness characterised by feeling safe and comfortable, which increased their self-efficacy and motivation to engage in learning activities. A literature review conducted by Salisu et al. (2019) also found that students’ recognition by qualified staff motivated them, resulting in the development of a sense of belonging and professional identity. Furthermore, radiography students reported high levels of motivation to learn when they were surrounded by supportive professionals (Thompson et al., 2016). Involvement of students in clinical activities and interactions with patients has been reported to motivate student learning (Arkana et al., 2018; Portainer Mifsud et al., 2015; Hadwen et al., 2020). Radiographers’ passion and commitment to student learning also plays a significant role in student motivation (Cunningham et al., 2015; Bwanga et al., 2022). In turn, student motivation and eagerness to learn promotes their professional socialisation (Thompson et al., 2016).

Participants of this current study also shared challenging experiences, such as unrealistic expectations and negative role modelling which have a potential to negatively impact the sense of belonging and professional socialisation of students within the clinical workplace. According to Frangieh et al. (2024) a stressful clinical environment diminishes students’ sense of belonging. Examples of stressful or challenging clinical situations include work overload, staff shortages and limited resources (de Swart et al., 2017; Girn et al., 2022). These challenges can make it difficult for the clinical radiographers to balance the clinical workload with the supervision of students, often to the detriment of student supervision (Cunningham et al., 2015; Kasita et al., 2023). Negative consequences of workload pressures and time constraints on student learning were also reported by Hyde and Hardy (2021). Additionally, different radiographers have varying expectations and requirements from students, and different radiographic technique preferences which can be stressful for students (Cunningham et al., 2015; Girn et al., 2022). In a study by Girn et al. (2022) diagnostic radiography students reported experiencing challenges related to the expectations to be knowledgeable about certain radiographic examinations despite limited experience. All these challenges can hinder students’ ability to develop professional competencies and negatively affect their sense of belonging and professional socialisation.

The qualitative exploratory approach utilised for this research provided a deeper understanding of professional socialisation of diagnostic radiography students in the clinical learning environment from the participants’ perspectives. Data was collected through one-on-one and focus group interviews from qualified radiographers and diagnostic radiography students respectively. Focus groups were chosen as a data collection method for student participants because they are ideal for collecting data from research participants who have common experiences and characteristics (Brink et al. (2012). Also, since all student participants in this current study were fourth year diagnostic radiography students from the same higher education institution, the utilisation of focus groups made logistical sense. Furthermore, focus groups yield more data in the same amount of time when compared to one-on-one interviews (Holloway & Galvin, 2017). The downside of focus groups is the potential for some participants to dominate the discussions (Holloway & Galvin, 2017). Careful moderation was employed throughout the focus group discussions to avoid dominance by any individuals and afford everyone equal opportunities to share their opinions and experiences. One-on-one interviews were conducted to collect data from clinical radiographers because participants worked at different hospitals and possessed varying levels of clinical experience, therefore their perspectives could be diverse. This made the use of individual interviews more appropriate. One-on-one interviews also mitigated challenges associated with coordinating a convenient time and venue for different participants due to the shiftwork nature of diagnostic radiography.

Validity and reliability of data in qualitative research can be achieved by applying the principles of trustworthiness (Lincoln & Guba, 1985). These principles are credibility, dependability, transferability, and confirmability (Holloway & Galvin, 2017; McGregor, 2018). In this study, credibility was ensured by collecting data until saturation was reached and there was the opportunity for triangulation between the two participant groups as well as the field notes and interview transcriptions. Peer review or expert consultation (where the collected data, the data analysis method and the developed themes were discussed in the research team) also enhanced credibility (McGregor, 2018). Dependability was achieved by keeping an audit trail which involved a thick description of the research process, including direct quotations from the participants when reporting results (Holloway & Galvin, 2017). The transparent nature of the framework analysis method that was employed to analyse data added to the audit trail (Braun & Clarke, 2022). To allow for transferability to similar contexts, a detailed description of the research setting, and research participants are provided (McGregor, 2018). Lastly, audit trail, peer review and reflexivity were employed to ensure confirmability of results (Holloway & Galvin, 2017; McGregor, 2018).