Exploring the meaning of respect in medical student education: an analysis of student narratives.
BACKGROUND
Respect for others is recognized in the medical literature and society as an essential attribute of the good medical professional. However, the specific meaning of respect varies widely and is underexplored as a lived experience of physicians-in-training.


OBJECTIVE
To describe third-year medical students' narratives of respect and disrespect [(dis)respect] during their internal medicine clerkship.


METHODS
Qualitative thematic analysis of 152 third-year student narratives that 'taught them something about professionalism,' focusing on (dis)respect.


METHODS
Immersion/crystallization narrative analysis.


RESULTS
We reviewed 595 professionalism narratives and found that one in four narratives involved (dis)respect. We then found that 2/3 of these narratives were negative (describing instances of disrespect rather than respect). In the other coded categories, the proportion of negative narratives was significantly lower. In order to better understand these results, we analyzed the content of the (dis)respect narratives and identified six primary themes: (1) content and manner of communication (including, appreciating or belittling, being sensitive or blunt and respecting privacy); (2) conduct: behaviors expressing (dis)respect; (3) patient centeredness: honoring others' preferences, decisions and needs; (4) treating others as equals; (5) valuing the other and their experience and/or problem; and (6) nurturing students' learning.


CONCLUSIONS
Focusing on the lived experience of (dis)respect on wards broadens the concept of respect beyond any one type of act, behavior or attitude. Students perceive respect as a way of being that applies in all settings (private and public), with all participants (patients, family members, nurses, colleagues and students) and under all circumstances (valuing others' time, needs, preferences, choices, opinions and privacy). Respect seems to entail responding to a need, while disrespect involves ignoring the need or bluntly violating it.
Karnieli-Miller
Orit
O
Department of Community Mental Health, University of Haifa, Haifa, Israel. OritKM@gmail.com
Taylor
Amanda C
AC
Cottingham
Ann H
AH
Inui
Thomas S
TS
Vu
T Robert
TR
Frankel
Richard M
RM
D002983:Clinical Competence / Q000592:standards*; D003479:Curriculum / Q000592:standards*; D004501:Education, Medical / Q000592:standards*; D006801:Humans; D007400:Interprofessional Relations; D011369:Professional-Patient Relations; D013337:Students, Medical / Q000523:psychology*