Journal of General Internal Medicine

, Volume 23, Issue 7, pp 958–963

Between Two Worlds: A Multi-Institutional Qualitative Analysis of Students’ Reflections on Joining the Medical Profession


    • University of Massachusetts Medical School
    • Meyers Primary Care Institute
  • Heather E. Harrell
    • University of Florida College of Medicine
  • Heather-Lyn Haley
    • Clinical Faculty Development CenterUniversity of Massachusetts Medical School
  • Adam S. Cifu
    • The University of Chicago
  • Eric Alper
    • University of Massachusetts Medical School
  • Krista M. Johnson
    • The University of Chicago
  • David Hatem
    • University of Massachusetts Medical School
Original Article

DOI: 10.1007/s11606-008-0508-1

Cite this article as:
Fischer, M.A., Harrell, H.E., Haley, H. et al. J GEN INTERN MED (2008) 23: 958. doi:10.1007/s11606-008-0508-1



Recent changes in healthcare system and training mandates have altered the clinical learning environment. We incorporated reflective writing into Internal Medicine clerkships (IMcs) in multiple institutions so students could consider the impact of clerkship experiences on their personal and professional development. We analyzed student reflections to inform curricula and support learning.


We qualitatively analyzed the reflections of students at 3 US medical schools during IMcs (N = 292) to identify themes, tone, and reflective quality using an iterative approach. Chi-square tests assessed differences between these factors and across institutions.


Students openly described powerful experiences. Major themes focused on 4 categories: personal issues (PI), professional development (PD), relational issues (RI), and medical care (MC). Each major theme was represented at each institution, although with significant variability between institutions in many of the subcategories including student role (PI), development-as-a-physician (PD), professionalism (PD) (p < 0.001). Students used positive tones to describe student role, development-as-a-physician and physician–patient relationship (PD) (p < 0.01–0.001), and negative tones for quality and safety (MC) (p < 0.05). Only 4% of writings coded as professionalism had a positive tone. Students employed a “reporting” voice in writing about clinical problem-solving, healthcare systems, and quality/safety (MC).


Reflection is considered important to professional development. Our analysis suggests that students at 3 institutions reflect on similar experiences. Theme variability across institutions implies curricula should be tailored to local culture. Reflective quality analysis suggests students are better equipped to reflect on certain experiences over others, which may impact learning. Student reflections can function as a mirror for our organizations, offer institutional feedback for support and improvement, and inform curricula for learners and faculty.


medical educationclinical learning environmentqualitative analysisstudents’ reflectionsphysician–patient relationship

Copyright information

© Society of General Internal Medicine 2008