Characterizations of motivation and identity in medical students’ reflections about challenging patient interactions

Abstract

Purpose: Students’ negative emotions in patient interactions can relate to their learning motivation and identity. Educators can support learning from these interactions by advocating for reflection. We explored how students, in reflection essays about emotionally difficult patient interactions that challenged their notions of professionalism, described aspects of motivation and identity.

Materials and Methods: All third-year medical students on the ob-gyn clerkship complete written reflections about a “clinical situation that challenged or affirmed your professionalism.” We conducted directed content analysis of essays (academic years 2014–2017) using relevant theories (self-determination, goal orientation and identity formation) based on previous work and organized the data into categories.

Results: In 265 essays (of 396, 67%), students described patient interactions that challenged their notions of professionalism, of which 90% included descriptions of their emotions. When reflecting on these interactions, students described psychological needs acknowledged in self-determination theory, competence, autonomy in patient care and connection to the team. Students indicated challenges in identity when advocating for patients due to team hierarchy and evaluation concerns.

Conclusions: Reflection essays about difficult patient interactions allow students to explore emotions, motivation and identity. They help educators understand whether the clinical learning environment is meeting students’ needs to support learning in challenging interactions.

Additional information

Notes on contributors

Jody E. Steinauer

Jody E. Steinauer, MD, PhD, is Professor and Vice Chair of Education in the Department of Obstetrics, Gynecology, and Reproductive Sciences at the University of California, San Francisco.

Arianne Teherani

Arianne Teherani, PhD, is Professor of Medicine in the Division of General Internal Medicine and Education Scientist in the Center for Faculty Educators at the University of California, San Francisco.

Robin Mangini

Robin Mangini, MPH, is an Analyst at the University of California, San Francisco.

Jessie Chien

Jessie Chien is an MHS student at Johns Hopkins University Bloomberg School of Public Health.

Olle ten Cate

Olle ten Cate, PhD, is Professor and Director of the Center for Research and Development of Education at the University Medical Center Utrecht.

Patricia O’Sullivan

Patricia O’Sullivan, EdD, is Professor in the Department of Medicine and Director of Research and Development in Medical Education in the Center for Faculty Educators at the University of California, San Francisco.