title: Medical student professionalism narratives: a thematic analysis and interdisciplinary comparative investigation.
abstract: BACKGROUND
  Professionalism development is influenced by the informal and hidden curriculum. The primary objective of this study was to better understand this experiential learning in the setting of the Emergency Department (ED). Secondarily, the study aimed to explore differences in the informal curriculum between Emergency Medicine (EM) and Internal Medicine (IM) clerkships.
  
  
  METHODS
  A thematic analysis was conducted on 377 professionalism narratives from medical students completing a required EM clerkship from July 2008 through May 2010. The narratives were analyzed using established thematic categories from prior research as well as basic descriptive characteristics. Chi-square analysis was used to compare the frequency of thematic categories to prior research in IM. Finally, emerging themes not fully appreciated in the established thematic categories were created using grounded theory.
  
  
  RESULTS
  Observations involving interactions between attending physician and patient were most abundant. The narratives were coded as positive 198 times, negative 128 times, and hybrid 37 times. The two most abundant narrative themes involved manifesting respect (36.9%) and spending time (23.7%). Both of these themes were statistically more likely to be noted by students on EM clerkships compared to IM clerkships. Finally, one new theme regarding cynicism emerged during analysis.
  
  
  CONCLUSIONS
  This analysis describes an informal curriculum that is diverse in themes. Student narratives suggest their clinical experiences to be influential on professionalism development. Medical students focus on different aspects of professionalism depending on clerkship specialty.
authors.affiliation: The Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus OH, USA. aaron.bernard@osumc.edu
authors.forename: Aaron W
authors.initials: AW
authors.lastname: Bernard
authors.forename: Matthew
authors.initials: M
authors.lastname: Malone
authors.forename: Nicholas E
authors.initials: NE
authors.lastname: Kman
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Caterino
authors.forename: Sorabh
authors.initials: S
authors.lastname: Khandelwal
mesh_terms: D002982:Clinical Clerkship; D002983:Clinical Competence; D003479:Curriculum; D006801:Humans; D007398:Interpersonal Relations; D009820:Ohio; D011369:Professional-Patient Relations; D012189:Retrospective Studies; D013337:Students, Medical / Q000523:psychology*