title: What Do Medical Students Perceive as Meaningful in the Psychiatry Clerkship Learning Environment? A Content Analysis of Critical Incident Narratives.
abstract: OBJECTIVE
  In order to better understand the professional development of medical students during their psychiatry clerkship, this study identifies common themes and characteristics of students' critical incident narratives which are designed to capture a recount of clerkship experiences they perceived as meaningful.
  
  
  METHODS
  A total of 205 narratives submitted by psychiatry clerkship students in 2010-2011 were subjected to a thematic analysis using a methodological approach and adaptation of categories derived from prior similar research. Descriptive content analysis was also carried out to assess the valence of the narrative content, characters involved, and whether there was evidence that the experience changed students' perspectives in some way.
  
  
  RESULTS
  Narratives contained a variety of positive (19%) and negative content (24%) and many contained a hybrid of both (57%). The most common theme (29%) concerned issues of respect and disrespect in patient, clinical, and coworker interactions. In general, the majority (68%) of students' meaningful experience narratives reflected a change in their perspective (e.g., I learned that...). Narratives containing positive and hybrid content were associated with a change in students' perspective (χ(2) = 10.61, df = 2, p < 0.005).
  
  
  CONCLUSIONS
  Medical students are keenly aware of the learning environment. Positive and hybrid critical incident narratives were associated with a stated change in their beliefs, attitudes, or behaviors due to the experience. Understanding the events that are meaningful to students can also provide rich feedback to medical educators regarding the ways in which students perceive clinical learning environments and how to best foster their professional development.
authors.affiliation: University of Arkansas for Medical Sciences, Little Rock, AR, USA. gathrightmollym@uams.edu.
authors.forename: Molly M
authors.initials: MM
authors.lastname: Gathright
authors.affiliation: University of Arkansas for Medical Sciences, Little Rock, AR, USA.
authors.forename: Carol
authors.initials: C
authors.lastname: Thrush
authors.affiliation: University of Arkansas for Medical Sciences, Little Rock, AR, USA.
authors.forename: J Benjamin
authors.initials: JB
authors.lastname: Guise
authors.affiliation: University of Arkansas for Medical Sciences, Little Rock, AR, USA.
authors.forename: Lewis
authors.initials: L
authors.lastname: Krain
authors.affiliation: University of Arkansas for Medical Sciences, Little Rock, AR, USA.
authors.forename: James
authors.initials: J
authors.lastname: Clardy
mesh_terms: D001290:Attitude; D002982:Clinical Clerkship / Q000379:methods; D003479:Curriculum; D004504:Education, Medical, Undergraduate; D005260:Female; D006801:Humans; D007858:Learning; D008297:Male; D033262:Narration; D011570:Psychiatry / Q000193:education*; D012189:Retrospective Studies; D013337:Students, Medical / Q000523:psychology*
keywords: Learning environment; Medical education; Professional development; Psychiatry clerkship