General Practice Research Unit, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway.
Saksvik Medical Center, Hundhammeren, Norway.
Scand J Prim Health Care. 2023 Dec;41(4):417-426. doi: 10.1080/02813432.2023.2263486. Epub 2023 Nov 29.
The aim of the study was to identify final-year medical students' experiences with thought-provoking and challenging situations in general practice.
We conducted a qualitative analysis of 90 reflective essays written by one cohort of Norwegian final-year medical students during their internship in general practice in 2017. The students were asked to reflect upon a clinical encounter in general practice that had made a strong impression on them. A primary thematic content analysis was performed, followed by a secondary analysis of encounters that stood out as particularly challenging.
Clinical scenarios in general practice that make students feel professionally 'caught off guard'.
The analysis identified several themes of challenging student experiences. One of these was 'disorienting encounters' for which the students felt totally unprepared in the sense that they did not know how to think and act. Five different scenarios were identified: (1) patients with highly distracting appearances, (2) 'ordinary consultations' that suddenly took a dramatic turn, (3) patients who appeared unexpectedly confrontational or devaluating, (4) scornful rejection of the young doctor's advice, and finally, (5) confusion related to massive contextual complexity.
Disorienting encounters stood out as particularly challenging clinical experiences for medical students in general practice. These scenarios evoked an acute feeling of incapacitation: not knowing what to think and do. Further curriculum development will focus on preparing the students to 'know what to do when they don't know what to do'.
本研究旨在确定医学专业应届毕业生在普通科实习期间经历的发人深省和具有挑战性的情况。
设计、设置和研究对象：我们对 2017 年挪威应届医学毕业生在普通科实习期间撰写的 90 篇反思性文章进行了定性分析。要求学生反思在普通科实践中遇到的给他们留下深刻印象的临床情况。首先进行了主要主题内容分析，然后对特别具有挑战性的情况进行了二次分析。
普通科中让学生感到专业上“措手不及”的临床情况。
分析确定了一些具有挑战性的学生体验主题。其中之一是“令人困惑的遭遇”，学生感到完全没有准备，不知道如何思考和行动。确定了五种不同的情况：（1）外表高度分散注意力的患者，（2）“普通会诊”突然出现戏剧性转折，（3）患者突然表现出对抗性或贬低性，（4）对年轻医生的建议不屑一顾，最后，（5）与大量背景复杂性相关的困惑。
令人困惑的遭遇是普通科医学生特别具有挑战性的临床经历。这些情况引起了他们无能为力的强烈感觉：不知道该想什么该做什么。进一步的课程发展将侧重于让学生为“在不知道该做什么时知道该做什么”做好准备。
