Identity and uncertainty: art-mediated medical student reflections in a time of transition

Figures & data

Figure 1. Categorization of codes within schemas of participants’ self-understandings. The personal self related to internal values or life goals, the professional self related to their role as doctors in training, and the social self related to friends, family, and society at large. This figure demonstrates how each of the codes from the initial codebook was categorized into these schemas/themes of self-understanding, and how each was interrelated. Bidirectional arrows indicate codes that often co-occurred in the students’ responses. Colors indicate grouping of codes within spheres of self-understanding. Double arrows indicate subthemes within state of society.

Table 1. Explanation of codes with sample quotes. Codes are organized in order of expanding influence, starting at the individual level and ending at the societal level.

Code	Explanation	Sample quote (s)
Identity	Aspirations and concerns related to personal values, life purpose, and life goals, often including an element of self-exploration or introspection.	The owl figure has to hone so many different parts of its identity and talents in order to succeed at the task at hand. Some of these talents may be obscure but are necessary for the one-of-a-kind product that is being made. I hope to bring out the best parts of my character and abilities.
Uncertainty	Perception of ambiguity about what comes next	The field is wide open, with so many possibilities. It looks beautiful, and surely will turn out to be so, but still unpredictable. No one knows what is beyond the expanse, as with my future. This upcoming year is filled with unknowns and uncertainties. It will surely turn out beautiful, but I don’t know exactly what is in store.
Knowledge acquisition/gaps	Reflections about amount of content or process of learning during medical school	I selected this image because to me the wave collapsing over the boat represents the vast amount of knowledge, skills, and other learning that we are expected to attain over the next two years. At times, it seems a bit daunting and like everything around you can come crashing down at any time, kind of like waves crashing over a boat.
Medical school clinical performance	Reflections about how students may perform, fit in, and/or be evaluated during clinical clerkships	I thought this tidal wave image represented how I feel about starting my SubI in July. I feel overwhelmed by returning to a clerkship where I have to perform very well and the expectations are very high for me when I have been absent from the wards for some time and have lost clinical skills.
Professional trajectory beyond medical school	Reflections about the overall career path in medicine after medical school	… I can see I’m in a valley of sorts … no matter how I choose to leave, it will be an uphill climb. This brought to mind the application process, the interview process and the hope to match at my school of choice. There is a lot of beauty and possibility in this painting, and that both excites and scares me.
Culture of medicine	Perceptions about what medicine as a profession might demand and how it might affect identity and relationships.	I think until fairly recently, I had always worried I would have to leave behind my other passions in the pursuit of a medical career … I hadn’t realized it until this year, but this thought had always really bothered me. I had thought I would have to put my outside interests on the back burner and that they would remain in my childhood dreams.
Social connections	Relationships with friends, partners, and/or family	This scene looks like a family sitting down to share dinner together, and it resonates with me because sharing a meal with my friends or family is usually my #1 way to destress and enjoy myself. It’s a universal language of sharing, caring, and relaxing.
State of society	Sentiments about events or challenges impacting society at large. If COVID-19 or Black Lives Matter were specifically mentioned, these were co-coded.	This year more than ever – this has been, and I envision will continue to be, one of the most dysfunctional years of our lifetime. It’s hard not to feel like everything is falling apart around us – the health and safety of our communities, our trust in the institutions that are supposed to protect us, our plans for the future. And yet, we have to keep living in the midst of that, finding our joy whenever we can.
Racial injustice	Reflections on racial injustice and the Black Lives Matter movement	This picture of two young Black children joyfully enjoying the spray from a fire hydrant, especially with the young Black boy positioned in front, portrays ironies that highlight my concerns for the coming year … Another concern is how we as a society will continue to keep the issues of systemic racism and police brutality at the forefront of our actions, even after people stop talking about these issues on social media or the news stops covering protests.
COVID	Reflections on the COVID-19 pandemic and its myriad effects	As a fourth year medical student, over the past several weeks I have been spending a lot of time thinking about a personal future and envisioning residency. I am grateful for all that has changed for me personally in the past three years here at Hopkins and the peaceful landscape of the painting seems emotionally similar to my perspective in that sense. At the same time, I have also been feeling guilt and sadness for all of those who are losing loved ones to COVID.

Figure 2. Ravine, Vincent van Gogh, 1889.