Abstract
BACKGROUND
Early residency is a crucial time in the professional development of physicians. As interns assume primary care for their patients, they take on new responsibilities. The events they find memorable during this time could provide us with insight into their developing professional identities.
OBJECTIVE
To evaluate the most critical events in the lives of interns.
PARTICIPANTS
Forty-one internal medicine residents at one program participated in a two-day retreat in the fall of their first year. Each resident provided a written description of a recent high point, low point, and patient conflict.
MEASUREMENTS
We used a variant of grounded theory to analyze these critical incidents and determine the underlying themes of early internship. Independent inter-rater agreement of >90% was achieved for the coding of excerpts.
MAIN RESULTS
The 123 critical incidents were clustered into 23 categories. The categories were further organized into six themes: confidence, life balance, connections, emotional responses, managing expectations, and facilitating teamwork. High points were primarily in the themes of confidence and connections. Low points were dispersed more generally throughout the conceptual framework. Conflicts with patients were about negotiating the expectations inherent in the physician–patient relationship.
CONCLUSION
The high points, low points, and conflicts reported by early residents provide us with a glimpse into the lives of interns. The themes we have identified reflect critical challenges interns face the development of their professional identity. Program directors could use this process and conceptual framework to guide the development and promotion of residents’ emerging professional identities.
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Acknowledgements
This study was conceptualized by Dr. Steven Miller who dedicated much of his career to the study and development of curricular methods aimed at cultivating humanism and professionalism in medicine. A short version of this paper was presented at an oral abstract session of the Research in Medical Education Conference, Association of American Medical Colleges annual meeting, Boston, M.A., November, 2004. Tragically, Dr. Miller was killed in a plane crash just two weeks prior to this meeting. This line of research, as it was developing, was very dear to Steve. We hope that we represented it as he would have intended, yet we realize that our words can never replace the caring and insightful perspective of Dr. Steve Miller.
This project was funded by: The Arnold P. Gold Foundation
We appreciate the contributions of Kenneth Roberts M.D., who provided review and comment on an earlier version of this manuscript.
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Ackerman, A., Graham, M., Schmidt, H. et al. Critical Events in the Lives of Interns. J GEN INTERN MED 24, 27–32 (2009). https://doi.org/10.1007/s11606-008-0769-8
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DOI: https://doi.org/10.1007/s11606-008-0769-8