Peterson William J, House Joseph B, Sozener Cemal B, Santen Sally A
Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan.
J Emerg Med. 2018 Jan;54(1):102-108. doi: 10.1016/j.jemermed.2017.09.014. Epub 2017 Oct 31.
The clinical learning environment helps to shape the professional identity of medical students. This process begins from existing personal identity and is influenced by various factors, including clinical experiences and clinical learning environment.
The purpose of this study was to examine medical students' reflections as a way to identify and better characterize the modern struggles that medical students face, in order to inform the development of professional identity.
Students rotating in their emergency medicine clerkship wrote reflections on dilemmas that highlighted common struggles of becoming a doctor. Qualitative analysis was performed to determine common themes from the essays. The research team coded 173 reflections and identified themes and major domains.
The first domain was Patient-Provider Conflict, including challenging patient (34%), difficult communication (25%), competing priorities between patients' interest and trainees need to learn (19%), and bias (13%). The second domain was Provider-Specific Issues, such as the "gray zone," in which there is not a clear standard of practice (29%), end-of-life care (14%), emotional struggle (6%), and fear of litigation (5%). The final domain was Systems Issues, such as cost of care (12%) and role of the emergency department (6%).
The reflections point to a wide variety of challenges that students confront in practice that will contribute to how they develop into physicians.
临床学习环境有助于塑造医学生的职业身份。这一过程从现有的个人身份开始，并受到多种因素的影响，包括临床经验和临床学习环境。
本研究旨在考察医学生的反思，以此来识别并更好地描述医学生面临的现代困境，为职业身份的发展提供信息。
参与急诊医学实习轮转的学生就突出成为医生常见困境的难题撰写反思。进行定性分析以确定文章中的共同主题。研究团队对173篇反思进行编码，确定主题和主要领域。
第一个领域是医患冲突，包括具有挑战性的患者（34%）、沟通困难（25%）、患者利益与实习生学习需求之间的优先事项竞争（19%）以及偏见（13%）。第二个领域是特定于提供者的问题，例如存在不明确实践标准的“灰色地带”（29%）、临终关怀（14%）、情感挣扎（6%）以及对诉讼的恐惧（5%）。最后一个领域是系统问题，例如护理成本（12%）和急诊科的作用（6%）。
这些反思指出了学生在实践中面临的各种各样的挑战，这些挑战将影响他们成长为医生的方式。
