title: The emotions of graduating medical students about prior patient care experiences.
abstract: OBJECTIVE
  To determine the emotional responses to patient care activities described by fourth year medical students.
  
  
  METHODS
  Qualitative content analysis for emerging themes in letters written by graduating medical students to patients during a Capstone Course. The patient need not be alive and the letter would never be sent.
  
  
  RESULTS
  Six themes emerged from student letters: (1) Sorrow for the depths of patient suffering; (2) Gratitude towards patients and their families; (3) Personal responsibility for care provided to patients; (4) Regret for poor care provided by the student or student's team; (5) Shattered expectations about medicine and training; and (6) Anger towards patients. Students expressed sensitivity to vulnerable patients, including those who were alone, unable to communicate, or for whom care was biased. Students' expressed powerlessness (inability to cure, managing a work-life balance, and challenges with hierarchy) in some essays.
  
  
  CONCLUSIONS
  At graduation, medical students describe strong emotions about previous patient care experiences, including difficulty witnessing suffering, disappointment with medicine, and gratitude to patients and their families
  
  
  CONCLUSIONS
  Providing regular opportunities for writing throughout medical education would allow students to recognize their emotions, reflect upon them and promote wellness that would benefit students and their patients.
authors.affiliation: Department of Surgery, Duke University, Durham, USA. Electronic address: alison.clay@duke.edu.
authors.forename: Alison S
authors.initials: AS
authors.lastname: Clay
authors.affiliation: Department of Orthopedics, Duke University, Durham, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Ross
authors.affiliation: Department of Medicine, Duke University, Durham, USA.
authors.forename: Saumil M
authors.initials: SM
authors.lastname: Chudgar
authors.affiliation: Duke University School of Medicine, Durham, USA.
authors.forename: Colleen O'Connor
authors.initials: CO
authors.lastname: Grochowski
authors.affiliation: Department of Medicine, Duke University, Durham, USA.
authors.forename: James A
authors.initials: JA
authors.lastname: Tulsky
authors.affiliation: Department of Humanities, Penn State College of Medicine, Hershey, USA.
authors.forename: Dan
authors.initials: D
authors.lastname: Shapiro
mesh_terms: D000328:Adult; D003479:Curriculum; D004504:Education, Medical, Undergraduate / Q000379:methods*; D004644:Emotions; D005260:Female; D006801:Humans; D008297:Male; D005791:Patient Care; D036301:Qualitative Research; D013337:Students, Medical / Q000523:psychology*; D013727:Terminal Care / Q000523:psychology*
keywords: Doctor-patient relationship; Medical culture; Medical education; Medical education-attitude and psychosocial; Medical education-undergraduate