Abstract
Medical learners face many challenging transitions. We prospectively explored students’ perceptions of their upcoming transition to clerkship and their future professional selves. In 2013, 160/165 end-of-second-year medical students wrote narrative reflections and 79/165 completed a questionnaire on their perceptions of their upcoming transition to clerkship. Narratives were separately analyzed by four authors and then discussed to identify a final thematic framework using parsimonious category construction. We identified two overarching themes: (1) “Looking back”: experiences which had helped students feel prepared for clerkship with subthemes focused on of patient care, shadowing, classroom teaching and the pre-clerkship years as foundational knowledge, (2) “Looking forward”: anticipating the clerkship experience and the journey of becoming a physician with subthemes focused on death and dying, hierarchy, work-life balance, interactions with patients, concerns about competency and career choice. Questionnaire data revealed incongruities around expectations of minimal exposure to death and dying, little need for independent study and limited direct patient responsibility. We confirmed that internal transformations are happening in contemplative time even before clerkship. By prospectively exploring pre-clerkship students’ perceptions of the transition to clerkship training we identified expectations and misconceptions that could be addressed with future curricular interventions. While students are aware of and anticipating their learning needs it is not as clear that they realise how much their future learning will depend on their own inner resources. We suggest that more attention be paid to professional identity formation and the development of the physician as a person during these critical transitions.
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Notes
Getting pimped—phrase to describe a more knowledgeable person questioning one with less experience as a way to test that person's knowledge (Detsky 2009).
Although students knew that their non-anonymous comments would be submitted to the course director, they were advised that the assignments would not be graded for content. We feel students wrote more freely because of this and that may explain some of the emotional and uncensored language in some of the quotes.
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Acknowledgments
We would like to thank Dr. Gary Hnatko for allowing us access to his course assignment materials and Ms. Joanna Gye for anonymizing written narrative reflection assignments.
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Ethical approval has been approved for human subjects. University of Alberta Health Research Ethics Board. Pro00038600.
Previous Presentations
CCME oral presentation 2014 April Ottawa, Creating Spaces 2013 Quebec City.
Appendices
Appendix 1
Professional identity: self-reflection exercise: “on the precipice … transitioning to the clinical years”
As introduced in class last week and represented by your three classmates who have been wearing short white coats this week…. we are aware that at this point in your medical career you are just a few months away from clerkship. While you will experience your sense of becoming a physician, and your sense of professional identity, as a constant and continuing journey of becoming, our final NRP session provides an opportunity for you to reflect on your learning journey, especially at this moment as you near the end of the PCC2 block, and are looking forward to transitioning from preclinical to clinical medicine.
In preparation for the NRP session on Tuesday, please write a short personal reflection (narrative) about (1) your learning journey to date, as you are about to enter into the clinical clerkship years, and (2) reflect on the kind of physician you imagine yourself becoming, or hope to become.
Write a short narrative (1/2 page, no more than 3/4 of a page). Please submit on MedSis via the google document link we have provided (we are evolving to optimize use of the new MedSis courseware!). You can read from your google document, or bring a printed version of your narrative to the session on Tuesday afternoon.
Specific writing instructions
Feel free to write about something that has been particularly significant to your development as a medical student, during the pre-clinical years. You may reflect on your learning journey in general, or reflect on a key significant moment or event in the past year that was significant to you or taught you something about who you feel you are becoming or hope to become as a physician.
Perhaps you might want to consider what you have learned from a patient you have met over the past year or two. You might consider a memorable patient you met through Gilbert Scholars, or through shadowing, or perhaps through your community-based experience, or recalling the commemorative ceremony from 2 weeks ago, you may want to write about “your first patient”—reflecting on your introduction to life and death through anatomy teaching through cadaver dissection.
Writing offers a powerful means for developing insights, enhancing understanding, and creating meaning. Your personal narrative will help you to give shape to something that is significant to you. You may want to reflect on your continuing journey and commitment to becoming a caring, compassionate and ethical health practitioner and other aspects of your evolving sense of professional identity at this stage of your medical education. As has occurred in previous sessions, this narrative will be shared with your peers in your facilitated small group.
Just allow yourself to write. Start with anything that comes to you. The possibilities are limitless. Although you may notice some similar themes across the narrative reflections that you and other students share in your small group, there is no one correct way to approach this assignment. Your reflections should be personal, and unique to you. You should write from a first-person perspective.
You are strongly encouraged NOT to approach this as a formal essay assignment (or assume a detached stance or perspective in writing your reflection).
You should also not just write a descriptive narrative (i.e., “what” happened), but begin to explore the layers of meaning related to what you have selected to write about.
Be curious about what you are writing about. You may want to include some reflection on “why” you selected to write on a specific incident, feeling, or situation; you might explore an emotional response you had, or how something has changed you. Or you may wonder about what went well, or might have happened differently. You might want to relate the story to other aspects of your life. As you learn to be curious about, and attend more carefully to your own stories, you will also learn skills that will be helpful when you are listening to, and caring for patients.
Write a brief narrative reflection (a half page or so, and no more than 2/3 a page) that you would be comfortable sharing with your group. You may want to write your reflection in a Word document, and then cut and paste it into the google doc form.
NB. Submission of this assignment via MedSis will be used to record its completion. Please know that the assignment will not be marked or evaluated in relation to style or structure.
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Soo, J., Brett-MacLean, P., Cave, MT. et al. At the precipice: a prospective exploration of medical students’ expectations of the pre-clerkship to clerkship transition. Adv in Health Sci Educ 21, 141–162 (2016). https://doi.org/10.1007/s10459-015-9620-2
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DOI: https://doi.org/10.1007/s10459-015-9620-2