Journal of General Internal Medicine

, Volume 20, Issue 11, pp 1063–1067 | Cite as

Use of critical incident reports in medical education

A perspective
Perspectives
Received:
Revised:
Accepted:

Abstract

Critical incident reports are now being widely used in medical education. They are short narrative accounts focusing on the most important professional experiences of medical students, residents, and other learners. As such, critical incident reports are ideally suited for addressing values and attitudes, and teaching professional development. This manuscript describes critical incident reports and gives examples of their use, provides a theoretical underpinning that explains their effectiveness, and describes the educational impacts of critical incident reports and similar methods that use reflective learning. The author recommends critical incident reports as an especially effective means to address learners’ most deeply held values and attitudes in the context of their professional experiences.

Key Words

critical incident reports narratives professionalism medical ethics medical education 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Branch WT Jr., Pels RJ, Lawrence RS, Arky RA. Becoming a doctor: “critical-incident” reports from third-year medical students. N Engl J Med. 1993;329:130–2.CrossRefGoogle Scholar
  2. 2.
    Brady DW, Corbie-Smith G, Branch WT Jr. “What’s important to you?”: the use of narratives to promote self-reflection and to understand the experiences of medical residents. Ann Intern Med. 2002;137:220–3.PubMedGoogle Scholar
  3. 3.
    Hupert N, Pels RJ, Branch WT Jr. Learning the art of doctoring: use of critical incident reports. Harvard Student BMJ. 1995;3:99–100.Google Scholar
  4. 4.
    Branch WT Jr., Pels RF, Calkins D, et al. A new educational approach for supporting the professional development of third year medical students. J Gen Intern Med. 1995;10:691–4.PubMedCrossRefGoogle Scholar
  5. 5.
    Branch WT Jr., Hafler JP, Pels RJ. Medical students development of empathic understanding of their patients. Acad Med. 1998;73:361–2.CrossRefGoogle Scholar
  6. 6.
    Lichstein PR, Young G. “My most meaningful patient.” Reflective learning on a general medicine service. J Gen Intern Med. 1996;11406–9.Google Scholar
  7. 7.
    Niemi PM. Medical students’ professional identity: self-reflection during the preclinical years. Med Educ. 1997;31:408–15.PubMedCrossRefGoogle Scholar
  8. 8.
    Branch WT Jr., Suchman AS. Meaningful experiences in medicine. Am J Med. 1990;88:56–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Horowitz CR, Suchman AL, Branch WT Jr., Frankel R. What do doctors find meaningful about their work? Ann Intern Med. 2003;138:772–6.PubMedGoogle Scholar
  10. 10.
    Inui TS. A Flag in the Wind: Educating for Professionalism in Medicine. Washington, DC: AAMC; 2003.Google Scholar
  11. 11.
    Svahn DS, ed. Let Me Listen to Your Heart. Writings by Medical Students, Collected by Alan J. Kozak. New York: Bassett Healthcare; 2002.Google Scholar
  12. 12.
    Baernstein A, Fryer-Edwards K. Promoting reflection on professionalism: a comparison trial of educational interventions for medical students. Acad Med. 2003;78:742–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Locke S. Controversies. Interview with Gordon Harper. Med Encounter. 2003;17:17–21.Google Scholar
  14. 14.
    McDonannell-Baum B. Dilemmas in nursing care: a student’s reflection of a critical incident. Contemp Nurse. 1998;7:32–4.CrossRefGoogle Scholar
  15. 15.
    Ta L. Critical incident analysis: nursing a dying man. Contemp Nurse. 1997;6:72–4.PubMedCrossRefGoogle Scholar
  16. 16.
    Parker DL, Webb J, D’Souza B. The value of critical incident analysis as an educational and its relationship to experiential learning. Nurse Educ Today. 1995;15:111–6.PubMedCrossRefGoogle Scholar
  17. 17.
    Hunter K. Doctors’ Stories: The Narratives Structure of Medical Knowledge. Princeton, NJ: Princeton University Press; 1991.Google Scholar
  18. 18.
    Verghese A. The physician as storyteller. Ann Intern Med. 2001;135:1012–7.PubMedGoogle Scholar
  19. 19.
    Greenhalgh T, Hurwitz B. Narrative Based Medicine: Dialogue and Discourse in Clinical Practice. London: BMJ Books; 1998.Google Scholar
  20. 20.
    Bolton G. Reflective Practice: Writing and Professional Development. London: Paul Chapman Publishing/Sage; 2001:117–8.Google Scholar
  21. 21.
    Charon R. Narrative and medicine. N Engl J Med. 2004;350:862–4.PubMedCrossRefGoogle Scholar
  22. 22.
    Kasman DL. Doctor, are you listening? A writing and reflection workshop. Fam Med. 2004;36:549–51.PubMedGoogle Scholar
  23. 23.
    Flanagan JC. The critical incident technique. Psychol Bull. 1954;51327–58.Google Scholar
  24. 24.
    Mitchell AM, Sakraida TJ, Kameg K. Critical incidents stress-debriefing: implications for best practice. Disaster management and response. DMR. 2003;1:46–51.PubMedGoogle Scholar
  25. 25.
    Kaine RM, Ter-Bagdasarin L. Early identification and management of critical incident stress. Crit Care Nurse. 2003;23:59–65.Google Scholar
  26. 26.
    Garcia E, Horton DA. Supporting the federal emergency management agency rescuers: a variation of incident stress management. Military Med. 2003;168:87–90.Google Scholar
  27. 27.
    Hammond J, Brooks J. The World Trade Center attack. Helping the helpers: the role of critical incident stress management. Crit Care. 2001;5:315–7.PubMedCrossRefGoogle Scholar
  28. 28.
    Orner RJ, Avery A, Boddy C. Status and development of critical incident stress management services in the United Kingdom national health service and other emergency services combined: 1993–1996. Occup Med. 1997;47:203–9.CrossRefGoogle Scholar
  29. 29.
    Cottrell D, Kilminster S, Jolly B, Grant J. What is effective supervision and how does it happen? A critical incident study. Med Educ. 2002;36:1042–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Keating D. Versatility flexibility: attributes of the critical incident technique in nursing research. Nurs Health Sci. 2003;4:33–9.CrossRefGoogle Scholar
  31. 31.
    Byrne M. Critical incident technique as a qualitative research method. AORN J. 2001;74:536–9.PubMedCrossRefGoogle Scholar
  32. 32.
    Narayanasamy A, Owens J. A critical incident study of nurses’ responses to the spiritual needs of their patients. J Adv Nurs. 2001;33:446–55.PubMedCrossRefGoogle Scholar
  33. 33.
    Bjorklund M, Fridlund B. Cancer patients’ experiences of nurses behavior and health promotion activities: a critical incident analysis. Eur J Cancer Care. 1999;8:204–12.CrossRefGoogle Scholar
  34. 34.
    Redfern S, Norman I. Quality of nursing care perceived by patients’ and their nurses: an application of the critical incident technique part 2. J Clin Nurs. 1999;8:414–21.PubMedCrossRefGoogle Scholar
  35. 35.
    Allery LA, Owen PA, Robling MR. Why general practitioners and consultants change their clinical practice: a critical incident study. BMJ. 1997;314:870–4.PubMedGoogle Scholar
  36. 36.
    Holmwood C. How do general practice registrars learn from their clinical experience? A critical incidence study. Austral Fam Phys. 1997;26(suppl):36–40.Google Scholar
  37. 37.
    Metcalfe DH, Matharu M. Students’ perception of good and bad teaching: report of a critical incident study. Med Educ. 1995;29:193–7.PubMedCrossRefGoogle Scholar
  38. 38.
    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: Jossey-Bass; 1990:1–20.Google Scholar
  39. 39.
    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: Jossey-Bass; 1990:177–93.Google Scholar
  40. 40.
    Ofri D. Torment. N Engl J Med. 2004;350:2233–6.PubMedCrossRefGoogle Scholar
  41. 41.
    Hafferty F. Characteristics of the informal curriculum and trainees’ ethical choices. Acad Med. 1996;71:629–30.Google Scholar
  42. 42.
    Hundert EM. Characteristics of the informal curriculum and trainees’ ethical choices. Acad Med. 1996;71:624–33.PubMedCrossRefGoogle Scholar
  43. 43.
    Konner M. Becoming a Doctor: A Journey of Initiation in Medical School. New York: Viking Penguin; 1987.Google Scholar
  44. 44.
    Shem S. The House of God. New York: Dell; 1995.Google Scholar
  45. 45.
    Coulehan J, Williams PC. Vanquishing virtue: the impact of medical education. Acad Med. 2001;76:598–605.PubMedCrossRefGoogle Scholar
  46. 46.
    Coulehan J. Conflicting professional values in medical education. Cambridge Quart Health Care Ethics. 2003;12:7–20.CrossRefGoogle Scholar
  47. 47.
    Feudtner C, Christakis DA. Making the rounds. The ethical development of medical students in the context of clinical rotations. Hastings Center Rep. 1994;24:6–12.CrossRefGoogle Scholar
  48. 48.
    Christakis DA, Feudtner C. Ethics in a short white coat: the ethical dilemmas that medical students confront. Acad Med. 1993;68:249–64.PubMedCrossRefGoogle Scholar
  49. 49.
    Feudtner C, Christakis DA, Christakis NA. Do clinical clerks suffer ethical erosion? Students’ perceptions of their ethical environmental and personal development. Acad Med. 1994;69:670–9.PubMedCrossRefGoogle Scholar
  50. 50.
    Dewitt DC Jr., Baldwin DC Jr., Daugherty SR, Rowley MD. Unethical and unprofessional conduct observed by residents during their first year of training. Acad Med. 1998;73:1195–200.CrossRefGoogle Scholar
  51. 51.
    Sheehan KH, Sheeham DV, White K, Leibowitz A, Baldwin DC. A pilot study of medical student abuse. JAMA. 1990;263:533–7.PubMedCrossRefGoogle Scholar
  52. 52.
    Baldwin DC Jr., Daugherty SR, Eckenfels EJ. Student perceptions on mistreatment and harassment during medical school: a survey of 10 schools. West J Med. 1991;155:140–5.PubMedGoogle Scholar
  53. 53.
    Branch WT Jr. Supporting the moral development or medical students. J Gen Intern Med. 2000;15:505–10.CrossRefGoogle Scholar
  54. 54.
    Yalom ID. The Theory and Practice of Group Psychotherapy. 3rd ed. New York, NY: Basic Books; 1985.Google Scholar
  55. 55.
    Pennebaker JW, Seagal JD. Forming a story: the health benefits of narratives. J. Clin Psychol. 1999;55:1243–54.PubMedCrossRefGoogle Scholar
  56. 56.
    Kern DE, Wright SM, Carrese JA. Personal growth in medical faculty: a qualitative study. West J Med. 2001;175:92–8.PubMedCrossRefGoogle Scholar
  57. 57.
    Kohlberg I. The Psychology of Moral Development: The Nature and Validity of Moral Stages. San Francisco: Harper & Row; 1984:170–205.Google Scholar
  58. 58.
    Kohlberg I. The Philosophy of Moral Development: Moral Stages and the Ideal of Justice. San Francisco: Harper & Row; 1981.Google Scholar
  59. 59.
    Gilligan C. In a Different Voice: Psychological Theory and Women’ Development. Cambridge, Mass: Harvard University Press; 1982, 1993.Google Scholar
  60. 60.
    Gilligan C. Remapping the moral domain: New images of self and relationship. In: Gilligan C, Ward JV, Taylor JL, ed. Mapping the Moral Domain. Contribution of Women’s Thinking to Psychological Theory and Education. Cambridge: Harvard University Press; 1988:8.Google Scholar
  61. 61.
    Fowler JW. Levels of Faith: The Psychology of Human Development and the Quest for Meaning. San Francisco: Harper; 1995;69–77.Google Scholar
  62. 62.
    Carse AL. The “Voice of Care” implications for bioethical education. J Med Philos. 1991;16:5–28.PubMedGoogle Scholar
  63. 63.
    Noddings N. Caring: A Feminine Approach to Ethics and Moral Education. Berkeley: University of California Press; 1984.Google Scholar
  64. 64.
    Branch WT Jr. The ethics of caring and medical education. Acad Med. 2000;75:127–32.PubMedCrossRefGoogle Scholar
  65. 65.
    Branch WT Jr. Professional and moral development in medical students: the ethics of caring for patients. Trans Am Clin Clim Assoc. 1998;109:218–30.Google Scholar
  66. 66.
    Rest JR. Background: theory and research. In: Rest JR, ed. Moral Development in the Professions: Psychology and Applied Ethics. Hillsdale: Lawrence Erlbaum Associates; 1994:1–26.Google Scholar
  67. 67.
    Rest JR, Thomas S. Educational programs and interventions. In: Rest JR, ed. Moral Development: Advances in Research and Theory. New York: Praeger; 1986;59–88.Google Scholar
  68. 68.
    Self DJ, Olivarez M, Baldwin DC Jr. Clarifying the relationship of medical education and moral development. Acad Med. 1998;73:517–20.PubMedCrossRefGoogle Scholar
  69. 69.
    Self DJ, Olivarez M, Baldwin DC Jr. The amount of small-group case-study discussion needed to improve moral reasoning skills of medical students. Acad Med. 1998;73:521–3.PubMedCrossRefGoogle Scholar
  70. 70.
    Sprinthall NA. Counseling and social role taking: promoting moral and ego development. In: Rest JR, ed. Moral Development in the Profession: Psychology and Applied Ethics. Hillsdale, NJ: Lawrence Erlbaum Associates; 1994:55–100.Google Scholar
  71. 71.
    Schoen DA. Educating the Reflective Practitioner. San Francisco: Jossey-Bass; 1987.Google Scholar
  72. 72.
    Smith RC, Lyles JS, Mettler JA et al. A strategy for improving patient satisfaction by intensive training of residents in psychosocial medicine: a controlled randomized study. Acad Med. 1995;70:729–32.PubMedCrossRefGoogle Scholar
  73. 73.
    Smith R, Lyles JS, Mettler J. The effectiveness of intensive training for residents in interviewing: a randomized, controlled study. Ann Intern Med. 1998;128:118–26.PubMedGoogle Scholar
  74. 74.
    Maguire P, Booth K, Elliott C, Jones B. Helping health professionals involved in cancer care acquire key interviewing skills: the impact of workshops. Eur J Cancer. 1996;32A:1486–9.PubMedCrossRefGoogle Scholar
  75. 75.
    Moore GT, Block SD, Briggs-Style C, Mitchell R. The influence of the new pathway curriculum of Harvard medical students. Acad Med. 1194;69:983–9.CrossRefGoogle Scholar
  76. 76.
    Margalit AP, Glick SM, Benbassat J, Cohen A. Effect of a biopsychosocial approach on patient satisfaction and patterns of care. J Gen Intern Med. 2004;19:485–91.PubMedCrossRefGoogle Scholar
  77. 77.
    Suchman AL, William PR, Litzelman DK, et al. Toward an informal curriculum that teaches professionalism: transforming the social environment of a medical school. J Gen Intern Med. 2004;19:501–4.PubMedCrossRefGoogle Scholar
  78. 78.
    Swick HM, Szenas P, Danoff D, Whitcom ME. Teaching professionalism in undergraduate medical education. JAMA. 1999;282:830–2.PubMedCrossRefGoogle Scholar
  79. 79.
    Wear D, Castellani B. The development of professionalism: curriculum matters. Acad Med. 2000;75:602–1.PubMedCrossRefGoogle Scholar
  80. 80.
    Yedidia MJ, Gillespie CC, Kachur E, et al. Effect of communications training on medical student performance. JAMA. 2003;290:1157–65.PubMedCrossRefGoogle Scholar
  81. 81.
    Novack DH, Suchman AL, Clark W, Epstein RM, Najberg E, Kaplan C. Calibrating the physician: personal awareness and effective patient care. JAMA. 1997;278:502–9.PubMedCrossRefGoogle Scholar
  82. 82.
    Novack DH, Epstein RM, Paulsen RH. Toward creating physician-healers: fostering medical students’ self-awareness, personal growth, and well-being. Acad Med. 1999;74:516–20.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2005

Authors and Affiliations

  1. 1.Department of MedicineEmory University School of MedicineAtlantaUSA
  2. 2.Division of General MedicineEmory University School of MedicineAtlanta

Personalised recommendations