Department of Medicine, Brigham and Women's Hospital, Boston, MA, and Harvard Medical School, Boston, MA.
Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA.
Fam Med. 2021 Mar;53(3):200-206. doi: 10.22454/FamMed.2021.128713.
Professionalism is essential in medical education, yet how it is embodied through medical students' lived experiences remains elusive. Little research exists on how students perceive professionalism and the barriers they encounter. This study examines attitudes toward professionalism through students' written reflections.
Family medicine clerkship students at Stanford University School of Medicine answered the following prompt: "Log a patient encounter in which you experienced a professionalism challenge or improvement opportunity." We collected and analyzed free-text responses for content and themes using a grounded theory approach.
One hundred responses from 106 students generated a total of 168 codes; 13 themes emerged across four domains: challenging patients, interpersonal interactions, self-awareness, and health care team dynamics. The three most frequently occurring themes were interacting with emotional patients, managing expectations in the encounter, and navigating the trainee role.
Medical students view professionalism as a balance of forces. While many students conceived of professionalism in relation to patient encounters, they also described how professionalism manifests in inner qualities as well as in health systems. Interpersonal challenges related to communication and agenda-setting are predominant. Systems challenges include not being seen as the "real doctor" and being shaped by team behaviors through the hidden curriculum. Our findings highlight salient professionalism challenges and identity conflicts for medical students and suggest potential educational strategies such as intentional coaching and role-modeling by faculty. Overall, students' reflections broaden our understanding of professional identity formation in medical training.
医学教育中专业精神至关重要，但医学生的实际体验如何体现专业精神仍难以捉摸。关于学生如何看待专业精神以及他们遇到的障碍，相关研究甚少。本研究通过学生的书面反思来考察他们对专业精神的态度。
斯坦福大学医学院家庭医学实习学生回答了以下提示：“记录一次您遇到专业精神挑战或改进机会的患者就诊经历。”我们使用扎根理论方法对自由文本回复进行了内容和主题的收集和分析。
来自 106 名学生的 100 份回复共产生了 168 个代码；在四个领域中出现了 13 个主题：与情绪激动的患者互动、在就诊中管理期望、自我意识和医疗团队动态。出现频率最高的三个主题是与情绪患者互动、管理就诊中的期望、以及在学员角色中导航。
医学生将专业精神视为一种力量的平衡。虽然许多学生将专业精神与患者就诊联系起来，但他们也描述了专业精神如何体现在内在品质以及医疗系统中。与沟通和议程设置相关的人际挑战是主要问题。系统挑战包括不被视为“真正的医生”以及通过隐性课程被团队行为塑造。我们的研究结果突出了医学生面临的明显专业精神挑战和身份冲突，并提出了潜在的教育策略，如教师的有针对性的指导和榜样作用。总的来说，学生的反思拓宽了我们对医学培训中专业身份形成的理解。
