title: Critical events in the lives of interns.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  To evaluate the most critical events in the lives of interns.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pediatrics, Columbia University Medical Center, New York, NY 10032, USA. alack97@yahoo.com
authors.forename: Alexandra
authors.initials: A
authors.lastname: Ackerman
authors.forename: Mark
authors.initials: M
authors.lastname: Graham
authors.forename: Hilary
authors.initials: H
authors.lastname: Schmidt
authors.forename: David T
authors.initials: DT
authors.lastname: Stern
authors.forename: Steven Z
authors.initials: SZ
authors.lastname: Miller
mesh_terms: D001291:Attitude of Health Personnel; D004644:Emotions; D006801:Humans; D007388:Internal Medicine / Q000639:trends; D007396:Internship and Residency / Q000639:trends; D008016:Life Change Events