title: Medical students' creative projects on a third year pediatrics clerkship: a qualitative analysis of patient-centeredness and emotional connection.
abstract: BACKGROUND
  Increasingly, medical educators are incorporating reflective writing and original creative work into educational practices with the goals of stimulating student self-awareness, appreciation of multiple perspectives, and comfort with ambiguity and uncertainty. This study investigated students' creative projects to assess the extent to which they adopted a patient/relationship-centered, emotionally connected position toward patients and families.
  
  
  METHODS
  Over a 10 year period, students on a required third year pediatrics clerkship individually or in groups completed either a reflection or an education project using a creative medium. 520 projects (representing 595 students, 74.7 % of total eligible students) were qualitatively analyzed according to various thematic and emotion-based dimensions.
  
  
  RESULTS
  The majority of projects were personal narrative essays and poetry. The largest number of project themes related to the importance of patient/relationship-centered medicine with patients. The next largest number of projects focused on health education of parents, patients, or classmates. In telling their stories, students were more likely to use a personal voice representing either their or the patient's perspective than an objective, impersonal one. In terms of emotional tone, projects were more likely to be serious than humorous. The largest number of students' emotions expressed an empathic tone. Students identified a large number and wide range of both negative and positive feelings in themselves and their patients. The majority of student emotions were positive, while the majority of patient and family emotions were negative.
  
  
  CONCLUSIONS
  Students' preference for patient-centered, relational themes, as well as their tendency to favor the first voice, empathic tone, and willingness to express a range of positive and negative emotions in presenting their projects, suggests that they valued emotional connection with patients and families during the pediatrics clerkship experience.
authors.affiliation: Department of Family Medicine, University of California Irvine School of Medicine, 101 City Dr. South, Bldg 200, Rte 81, Ste 835, Orange, CA, 92868, USA. jfshapir@uci.edu.
authors.forename: Johanna
authors.initials: J
authors.lastname: Shapiro
authors.affiliation: University of California Irvine, Irvine, USA.
authors.forename: Diane
authors.initials: D
authors.lastname: Ortiz
authors.affiliation: Touro University School of Osteopathic Medicine, Henderson, NV, USA.
authors.forename: You Ye
authors.initials: YY
authors.lastname: Ree
authors.affiliation: University of California Irvine, Irvine, USA.
authors.forename: Minha
authors.initials: M
authors.lastname: Sarwar
mesh_terms: D001154:Art; D001291:Attitude of Health Personnel; D002648:Child; D002982:Clinical Clerkship / Q000379:methods*; D003405:Creativity; D004644:Emotions; D005190:Family / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D018802:Patient-Centered Care; D010361:Patients / Q000523:psychology; D010372:Pediatrics / Q000193:education*; D010817:Physician-Patient Relations; D036301:Qualitative Research; D012737:Sex Factors; D013337:Students, Medical / Q000523:psychology*; D014956:Writing
keywords: Medical humanities; Pediatrics clerkship; Reflection; Student-patient relationship