Feelings related to first patient experiences in medical school: A qualitative study on students’ personal portfolios

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Abstract

Feelings and thoughts of medical students related to first patient experiences during the first clinical year were examined. Twenty-two volunteer third and fourth year medical students (15 women and 7 men) of the University of Helsinki participated in a portfolio course for 1 year. Their reflective learning diaries and writings on specific themes were analyzed by qualitative content analysis. First patient encounters were strong emotional experiences for medical students. The first patient examination was often described as an anxiety-provoking and confusing incident. Other emotionally significant encounters included helplessness when faced with serious illness and death, and role confusion when examining patients of one’s own age but opposite sex. Students felt guilty for using patients for their own learning purposes. Portfolios as learning tools may help in recognizing key experiences and support professional development of medical students.

Introduction

What is the emotional journey like on the road to becoming a doctor? What kind of feelings do students have related to first patient experiences? Profound changes are known to take place in medical students as they progress through medical school [1], [2], [3], [4], [5], [6]. Medical education is a stressful and anxiety-provoking experience [1], [3], [4], [7], [8], [9]. Depressive and somatic symptoms are common among medical students [9], [10]. To adjust to the medical culture, students must suppress the inner feelings [4], [11] and objectify patients [3], [4]. While still quite young students are faced with cadavers, human suffering and death [4], [5]. Medical school focuses on teaching facts but does not support students’ reflective thinking in the developmental process [4], [5], [12].

Discussions about a “hidden curriculum” have been active for the past decades [3], [4], [6]. The introductory clinical year is considered to be especially important in the process of becoming a doctor [4], [7], [13]. Performing the first physical examination and finding one’s role in the clinical culture are key experiences in this process [1], [3], [4], [6]. Several well-known studies on medical school have observed that first patient contacts, particularly first physical examinations, produce anxiety in medical students [1], [3]. In addition, young patients of the opposite sex and dealing with issues of sexuality provoke role confusion and embarrassment [1], [3].

To our knowledge, besides these incidental findings, few studies have dealt with inner experiences of ordinary medical students and how students reflect on them. Rather, it has been suggested that students are unable to introspect about their feelings of insecurity and anxiety [6]. In addition, previous studies have mainly been participant observation studies by sociologists [1], [2], [3], [4], [6], and findings on medical students’ experiences have been drawn from the behavior of students. These studies have also been criticized for the researchers being outsiders of medical culture [4]. Thus, very few documents exist of “first-hand” experiences and personal feelings of medical students on their emotional journey through medical school [4].

Thus, the aim of our study was to investigate (1) the kind of feelings first patient experiences evoke in medical students and (2) how students reflect on their feelings.

Section snippets

Methods

An optional 1-year portfolio course was arranged for medical students during their first clinical year. At Helsinki university students start their first clinical year on spring term during their third year in the medical school and finish their first clinical year in fall term during their fourth year in the medical school. Two different student cohorts took part in the course: (1) those attending their first clinical year in 1997 and (2) those attending their first clinical year in 1998. The

Results

Students described their feelings abundantly and openly. The first year was full of important experiences with various emotions. We have classified these findings from diaries into feelings related to own competence with medical knowledge and skills, emotions emerging from patient interaction and feelings related to own role as “student–physician” (Table 3).

Discussion

First patient encounters proved to be strong emotional experiences for the medical students. According to our findings, there are three main areas the emotional experiences and development take place. Feelings related to own competence, like anxiety and insufficiency were well-known from previous studies that could be confirmed in our study [1], [3], [4], [6]. Through patient interaction, students continuously and profoundly reflect on their role as future doctors [16]. Our study also produced

Acknowledgements

This study was supported by the Finnish Medical Society Duodecim.

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