Journal of General Internal Medicine

, Volume 11, Issue 7, pp 406–409 | Cite as

“My most meaningful patient”

Reflective learning on a general medicine service
  • Peter R. Lichstein
Original Articles

Abstract

OBJECTIVE: To determine the usefulness of critical-incident reports in facilitating reflective learning and the types of experiences that learners found meaningful on a general medicine service.

DESIGN: Team members wrote about their most meaningful patient of the month and what was learned from the patient. They shared their narratives during teaching rounds at the end of each month. The written reports were collected and subjected to qualitative thematic analysis.

SETTING: General medicine teaching service of an academic medical center.

PATIENTS/PARTICIPANTS: Medical students, residents, and attending physicians.

MEASUREMENTS AND MAIN RESULTS: Ninety-eight reports were collected over 10 months and subjected to thematic analysis. Reports were coded for six major themes, with a mean of 2.09 themes per narrative. The number of reports containing each theme was 47 for biomedical, 46 for communication with patients and families, 38 for psychosocial, 32 for the physician’s role, 30 for personal feelings, and 14 for ethics. Communication issues constituted the theme most frequently reported by third-year students; biomedical and psychosocial themes by interns; biomedical by supervising residents; and the physician’s role by attending physicians. Reports from men and women contained a similar mean number (men 2.101; women 2.128) and distribution of themes.

CONCLUSIONS: The critical-incident technique promoted reflection on the meaning of clinical experiences. Qualitative thematic analysis revealed the diversity of meaningful experiences on a general medicine service and the high frequency of nonbiomedical themes. This study suggests that reflective exercises can provide a window into the experience of students and residents.

Key words

critical incidents narrative reports medical education psychosocial medicine general medicine service 

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References

  1. 1.
    Suchman AL, Branch WT, Matthews DA. The role of the medical interview in the physician’s search for meaning. In: Lipkin M, Putnam SM, Lazare A, eds. The Medical Interview: Clinical Care, Education and Research. New York, NY: Springer-Verlag; 1995.Google Scholar
  2. 2.
    Flanagan JC. The critical incident technique. Psychol Bull. 1954;51:327–58.PubMedCrossRefGoogle Scholar
  3. 3.
    Glaser B, Straus AL. The Discovery of Grounded Theory. New York, NY: Basic Books; 1967.Google Scholar
  4. 4.
    Straus AL. Qualitative Analysis for Social Scientists. New York, NY: Cambridge University Press; 1987.Google Scholar
  5. 5.
    Somer R, Somer B. A Practical Guide to Behavioral Research. 2nd ed. New York, NY: Oxford University Press; 1986.Google Scholar
  6. 6.
    Freire P, Pedagogy of the Oppressed. New York, NY: Continuum; 1986.Google Scholar
  7. 7.
    Schön D. The Reflective Practitioner: How Professionals Think in Action. New York, NY: Basic Books; 1987.Google Scholar
  8. 8.
    Kolb DA. Experiential Learning: Experience as the Source of Learning and Development. Engelwood Cliffs, NJ: Prentice-Hall; 1984.Google Scholar
  9. 9.
    Arseneau R. Exit rounds: a reflective exercise. Acad Med. 1995;70:684–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Brookfield S. Using critical incidents to explore learner’s assumptions. In: Mezirow J, ed. Fostering Critical Reflection in Adulthood: A Guide to Transformative and Emancipatory Learning. San Francisco, Calif: Jossey-Bass; 1990:177–93.Google Scholar
  11. 11.
    Mezirow J. How critical reflection triggers transformative learning. In: Mezirow J, ed. Fostering Critical Reflection in Adulthood: A Guide to Transformative and Emancipatory Learning. San Francisco, Calif. Jossey-Bass; 1990:1–20.Google Scholar
  12. 12.
    Branch W, Pels RJ, Lawrence RS, Arky R. Becoming a doctor; critical-incident reports from third-year medical students. N Engl J Med. 1993;329:1130–2.PubMedCrossRefGoogle Scholar
  13. 13.
    White JA, Anderson P. Learning by internal medicine residents: differences and similarities of perceptions by residents and faculty. J Gen Intern Med. 1995;10:126–32.PubMedCrossRefGoogle Scholar
  14. 14.
    Charon R, Banks JT, Connelly JE, et al. Literature and medicine: contributions to clinical practice. Ann Intern Med. 1995;122:599–606.PubMedGoogle Scholar
  15. 15.
    Suchman AL, Matthews DA. What makes the patient-doctor relationship therapeutic? Exploring the connextional dimension of medical care. Ann Intern Med. 1988;108:125–30.PubMedGoogle Scholar
  16. 16.
    McMurray J, Schwartz M, Genero N, Linzer M. The attractiveness of internal medicine; a qualitative analysis of the experiences of female and male medical students. Ann Intern Med. 1993;119:812–8.PubMedGoogle Scholar
  17. 17.
    Marple RL, Pangaro L, Kroenke K. Third-year medical student attitudes toward internal medicine. Arch Intern Med. 1994;154:2459–64.PubMedCrossRefGoogle Scholar
  18. 18.
    Brewster A. A student’s view of a medical teaching exercise. N Engl J Med. 1993;329:1971–2.PubMedCrossRefGoogle Scholar
  19. 19.
    Sheehan KH, Sheehan DV, White K, Leibowitz A, Baldwin DC Jr. A pilot study of medical student ‘abuse’: student perceptions of mistreatment and misconduct in medical school. JAMA. 1990;263:533–7.PubMedCrossRefGoogle Scholar
  20. 20.
    Silver HK, Glicken AD. Medical student abuse: incidence, severity, and significance. JAMA. 1990;263:527–32.PubMedCrossRefGoogle Scholar
  21. 21.
    Williams GC, Wlener MW, Markakis KM, Reeve J, Deci EL. Medical students’ motivation for internal medicine. J Gen Internal Med. 1994;6:327–33.CrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 1996

Authors and Affiliations

  • Peter R. Lichstein
    • 1
  1. 1.Department of MedicineEast Carolina University School of MedicineGreenville

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