title: Between two worlds: a multi-institutional qualitative analysis of students' reflections on joining the medical profession.
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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: University of Massachusetts Medical School, Worcester, MA, USA. fischerm@ummhc.org
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Fischer
authors.forename: Heather E
authors.initials: HE
authors.lastname: Harrell
authors.forename: Heather-Lyn
authors.initials: HL
authors.lastname: Haley
authors.forename: Adam S
authors.initials: AS
authors.lastname: Cifu
authors.forename: Eric
authors.initials: E
authors.lastname: Alper
authors.forename: Krista M
authors.initials: KM
authors.lastname: Johnson
authors.forename: David
authors.initials: D
authors.lastname: Hatem
mesh_terms: D002321:Career Choice; D002982:Clinical Clerkship; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D013337:Students, Medical / Q000523:psychology*; D014956:Writing