Academic Psychiatry

, Volume 40, Issue 2, pp 287–294 | Cite as

What Do Medical Students Perceive as Meaningful in the Psychiatry Clerkship Learning Environment? A Content Analysis of Critical Incident Narratives

  • Molly M. GathrightEmail author
  • Carol Thrush
  • J. Benjamin Guise
  • Lewis Krain
  • James Clardy
Empirical Report



In order to better understand the professional development of medical students during their psychiatry clerkship, this study identifies common themes and characteristics of students’ critical incident narratives which are designed to capture a recount of clerkship experiences they perceived as meaningful.


A total of 205 narratives submitted by psychiatry clerkship students in 2010–2011 were subjected to a thematic analysis using a methodological approach and adaptation of categories derived from prior similar research. Descriptive content analysis was also carried out to assess the valence of the narrative content, characters involved, and whether there was evidence that the experience changed students’ perspectives in some way.


Narratives contained a variety of positive (19 %) and negative content (24 %) and many contained a hybrid of both (57 %). The most common theme (29 %) concerned issues of respect and disrespect in patient, clinical, and coworker interactions. In general, the majority (68 %) of students’ meaningful experience narratives reflected a change in their perspective (e.g., I learned that….). Narratives containing positive and hybrid content were associated with a change in students’ perspective (χ 2 = 10.61, df = 2, p < 0.005).


Medical students are keenly aware of the learning environment. Positive and hybrid critical incident narratives were associated with a stated change in their beliefs, attitudes, or behaviors due to the experience. Understanding the events that are meaningful to students can also provide rich feedback to medical educators regarding the ways in which students perceive clinical learning environments and how to best foster their professional development.


Professional development Medical education Psychiatry clerkship Learning environment 



The authors declare that they have no conflict of interest.


  1. 1.
    Tresolini CP, the Pew-Fetzer Task Force. Health professions education and relationship-centered care. San Francisco: Pew Health Professions Commission; 1994.Google Scholar
  2. 2.
    Suchman AL. A new theoretical foundation for relationship-centered care. Complex responsive processes of relating. J Gen Intern Med. 2006;21:S40–4.PubMedCentralCrossRefPubMedGoogle Scholar
  3. 3.
    Branch WT. Use of critical incident reports in medical education. A perspective. J Gen Intern Med. 2005;20:1063–7.PubMedCentralCrossRefPubMedGoogle Scholar
  4. 4.
    Charon R. Narrative and medicine. N Engl J Med. 2004;350(9):862–4.CrossRefPubMedGoogle Scholar
  5. 5.
    Bernard AW, Malone M, Kman NE, Caterino JM, Khandelwal S. Medical student professionalism narratives: a thematic analysis and interdisciplinary comparative investigation. BMC Emerg Med. 2011;11:227X-11-11.CrossRefGoogle Scholar
  6. 6.
    Rabow MW, Remen RN, Parmelee DX, Inui TS. Professional formation: extending medicine’s lineage of service into the next century. Acad Med. 2010;85:310–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Branch W, Pels R, Lawrence R, Arky R. Becoming a doctor: critical-incident reports from third-year medical students. N Engl J Med. 1993;329:1130–2.CrossRefPubMedGoogle Scholar
  8. 8.
    Karnieli-Miller O, Vu TR, Holtman MC, Clyman SG, Inui TS. Medical students’ professionalism narratives: a window on the informal and hidden curriculum. Acad Med. 2010;85:124–33.CrossRefPubMedGoogle Scholar
  9. 9.
    Karnieli-Miller O, Vu TR, Frankel RM, Holtman MC, Clyman SG, Hui SL, et al. Which experiences in the hidden curriculum teach students about professionalism? Acad Med. 2011;86:369–77.CrossRefPubMedGoogle Scholar
  10. 10.
    Shorey JM. Signal versus noise on the wards: what “messages” from the hidden curriculum do medical students perceive to be importantly meaningful? Trans Am Clin Climatol Assoc. 2013;124:36–45.PubMedCentralPubMedGoogle Scholar
  11. 11.
    Bernard AW, Malone M, Kman NE, Caterino JM, Khandelwa S. Medical student professionalism narratives: a thematic analysis and interdisciplinary comparative investigation. BMC Emerg Med. 2011; 11-227X-11-11.Google Scholar
  12. 12.
    Cohn FG, Shapiro J, Lie DA, Boker J, Stephens F, Leung LA. Interpreting values conflicts experienced by obstetrics-gynecology clerkship students using reflective writing. Acad Med. 2009;84:587–96.CrossRefPubMedGoogle Scholar
  13. 13.
    Karnieli-Miller O, Taylor AC, Cottingham AH, Inui TS, Vu TR, Frankel RM. Exploring the meaning of respect in medical student education: an analysis of student narratives. J Gen Intern Med. 2010;25:1309–14.PubMedCentralCrossRefPubMedGoogle Scholar
  14. 14.
    Helmich E, Bolhuis S, Dornan T, Laan R, Koopmans R. Entering medical practice for the very first time: emotional talk, meaning and identity development. Med Educ. 2012;46:1074–86.CrossRefPubMedGoogle Scholar
  15. 15.
    Murinson BB, Klick B, Haythornthwaite JA, Shochet R, Levine RB, Wright SM. Formative experiences of emerging physicians: gauging the impact of events that occur during medical school. Acad Med. 2010;85(8):1331–7.CrossRefPubMedGoogle Scholar

Copyright information

© Academic Psychiatry 2015

Authors and Affiliations

  • Molly M. Gathright
    • 1
    Email author
  • Carol Thrush
    • 1
  • J. Benjamin Guise
    • 1
  • Lewis Krain
    • 1
  • James Clardy
    • 1
  1. 1.University of Arkansas for Medical SciencesLittle RockUSA

Personalised recommendations