Entering medical practice for the very first time: emotional talk, meaning and identity development


Esther Helmich, Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Internal Postal Code 166, PO Box 9101, 6500 HB Nijmegen, the Netherlands. Tel: 00 31 24 365 5301; Fax: 00 31 24 354 1862; E-mail: e.helmich@elg.umcn.nl


Medical Education 2012: 46: 1074–1087

CONTEXT  During early clinical exposure, medical students have many emotive experiences. Through participation in social practice, they learn to give personal meaning to their emotional states. This meaningful social act of participation may lead to a sense of belonging and identity construction.

OBJECTIVES  The aim of this study was to broaden and deepen our understanding of the interplay between those experiences and students’ identity development. Our research questions asked how medical students give meaning to early clinical experiences and how that affects their professional identity development.

METHODS  Our method was phenomenology. Within that framework we used a narrative interviewing technique. Interviews with 17 medical students on Year 1 attachments to nurses in hospitals and nursing homes were analysed by listening to audio-recordings and reading transcripts. Nine transcripts, which best exemplified the students’ range of experiences, were purposively sampled for deeper analysis. Two researchers carried out a systematic analysis using qualitative research software. Finally, cases representing four paradigms were chosen to exemplify the study findings.

RESULTS  Students experienced their relationships with the people they met during early clinical experiences in very different ways, particularly in terms of feeling and displaying emotions, adjusting, role finding and participation. The interplay among emotions, meaning and identity was complex and four different ‘paradigms’ of lived experience were apparent: feeling insecure; complying; developing, and participating.

CONCLUSIONS  We found large differences in the way students related to other people and gave meaning to their first experiences as doctors-to-be. They differed in their ability to engage in ward practices, the way they experienced their roles as medical students and future doctors, and how they experienced and expressed their emotions. Medical educators should help students to be sensitive to their emotions, offer space to explore different meanings, and be ready to suggest alternative interpretations that foster the development of desired professional identities.