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Between Two Worlds: A Multi-Institutional Qualitative Analysis of Students’ Reflections on Joining the Medical Profession

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Abstract

BACKGROUND

Recent changes in healthcare system and training mandates have altered the clinical learning environment. We incorporated reflective writing into Internal Medicine clerkships (IMcs) in multiple institutions so students could consider the impact of clerkship experiences on their personal and professional development. We analyzed student reflections to inform curricula and support learning.

METHODS

We qualitatively analyzed the reflections of students at 3 US medical schools during IMcs (N = 292) to identify themes, tone, and reflective quality using an iterative approach. Chi-square tests assessed differences between these factors and across institutions.

FINDINGS

Students openly described powerful experiences. Major themes focused on 4 categories: personal issues (PI), professional development (PD), relational issues (RI), and medical care (MC). Each major theme was represented at each institution, although with significant variability between institutions in many of the subcategories including student role (PI), development-as-a-physician (PD), professionalism (PD) (p < 0.001). Students used positive tones to describe student role, development-as-a-physician and physician–patient relationship (PD) (p < 0.01–0.001), and negative tones for quality and safety (MC) (p < 0.05). Only 4% of writings coded as professionalism had a positive tone. Students employed a “reporting” voice in writing about clinical problem-solving, healthcare systems, and quality/safety (MC).

DISCUSSION

Reflection is considered important to professional development. Our analysis suggests that students at 3 institutions reflect on similar experiences. Theme variability across institutions implies curricula should be tailored to local culture. Reflective quality analysis suggests students are better equipped to reflect on certain experiences over others, which may impact learning. Student reflections can function as a mirror for our organizations, offer institutional feedback for support and improvement, and inform curricula for learners and faculty.

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Acknowledgments

Funding: Dr. Fischer was funded by the Sarah L Stone Endowed Fellowship in Medical Education, University of Massachusetts Medical School.

Conflict of Interest

None disclosed.

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Authors and Affiliations

  1. University of Massachusetts Medical School, Worcester, MA, USA

    Melissa A. Fischer MD, MEd, Eric Alper MD & David Hatem MD

  2. Meyers Primary Care Institute, Worcester, MA, USA

    Melissa A. Fischer MD, MEd

  3. University of Florida College of Medicine, Gainesville, FL, USA

    Heather E. Harrell MD

  4. Clinical Faculty Development Center, University of Massachusetts Medical School, Worcester, MA, USA

    Heather-Lyn Haley PhD

  5. The University of Chicago, Chicago, IL, USA

    Adam S. Cifu MD & Krista M. Johnson MD

Authors
  1. Melissa A. Fischer MD, MEd
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  2. Heather E. Harrell MD
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  3. Heather-Lyn Haley PhD
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  4. Adam S. Cifu MD
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  5. Eric Alper MD
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  6. Krista M. Johnson MD
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  7. David Hatem MD
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Corresponding author

Correspondence to Melissa A. Fischer MD, MEd.

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Fischer, M.A., Harrell, H.E., Haley, HL. et al. Between Two Worlds: A Multi-Institutional Qualitative Analysis of Students’ Reflections on Joining the Medical Profession. J GEN INTERN MED 23, 958–963 (2008). https://doi.org/10.1007/s11606-008-0508-1

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  • DOI: https://doi.org/10.1007/s11606-008-0508-1

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