Ackerman Alexandra, Graham Mark, Schmidt Hilary, Stern David T, Miller Steven Z
Department of Pediatrics, Columbia University Medical Center, New York, NY 10032, USA.
J Gen Intern Med. 2009 Jan;24(1):27-32. doi: 10.1007/s11606-008-0769-8. Epub 2008 Oct 30.
Early residency is a crucial time in the professional development of physicians. As interns assume primary care for their patients, they take on new responsibilities. The events they find memorable during this time could provide us with insight into their developing professional identities.
To evaluate the most critical events in the lives of interns.
Forty-one internal medicine residents at one program participated in a two-day retreat in the fall of their first year. Each resident provided a written description of a recent high point, low point, and patient conflict.
We used a variant of grounded theory to analyze these critical incidents and determine the underlying themes of early internship. Independent inter-rater agreement of >90% was achieved for the coding of excerpts.
The 123 critical incidents were clustered into 23 categories. The categories were further organized into six themes: confidence, life balance, connections, emotional responses, managing expectations, and facilitating teamwork. High points were primarily in the themes of confidence and connections. Low points were dispersed more generally throughout the conceptual framework. Conflicts with patients were about negotiating the expectations inherent in the physician-patient relationship.
The high points, low points, and conflicts reported by early residents provide us with a glimpse into the lives of interns. The themes we have identified reflect critical challenges interns face the development of their professional identity. Program directors could use this process and conceptual framework to guide the development and promotion of residents' emerging professional identities.
住院医师早期阶段是医生职业发展的关键时期。实习生开始对患者进行主要护理时，会承担新的责任。他们在此期间认为难忘的事件能让我们深入了解他们正在形成的职业身份。
评估实习生生活中最关键的事件。
某项目的41名内科住院医师在第一年秋季参加了为期两天的务虚会。每位住院医师都提供了一份关于近期高峰、低谷和医患冲突的书面描述。
我们使用扎根理论的一个变体来分析这些关键事件，并确定早期实习的潜在主题。对摘录进行编码时，评分者间的独立一致性达到了90%以上。
123个关键事件被归为23类。这些类别进一步被组织成六个主题：自信、生活平衡、人际关系、情绪反应、管理期望和促进团队合作。高峰事件主要集中在自信和人际关系主题中。低谷事件则更广泛地分散在整个概念框架中。与患者的冲突涉及协商医患关系中固有的期望。
早期住院医师报告的高峰、低谷和冲突事件让我们得以一窥实习生的生活。我们确定的这些主题反映了实习生在职业身份发展过程中面临的关键挑战。项目主任可以利用这个过程和概念框架来指导住院医师新兴职业身份的发展和提升。
