A window on professionalism in the emergency department through medical student narratives

Study objective: We use medical students' reflections to deepen understanding of professionalism in the emergency department (ED), including the ideals that students wish to model and the lapses they hope to avoid.

Methods: Fourth-year students in a mandatory ED clerkship were required to write 2 narrative reflections during the month. The authors conducted a qualitative analysis to determine professionalism themes.

Results: Sixty-one of 150 student reflections contained professionalism themes. Positive behaviors included compassion, tension between respecting diversity and respecting other core values, and balance between patient-centered care and effective care. In addition, the students wrote about commitment to excellent medical care and ethical principles. Many students struggled with how to deal with patients who might be "drug seekers" and when to prescribe narcotics. They were concerned about the balance of compassion, often noting differences in the patients' backgrounds compared with their own. On the other hand, many students observed unprofessional behaviors. Particularly concerning were the absence of compassion, physicians lying, and a lack of teamwork. Students reflected on how their own professional behavior could improve according to their experiences in the ED.

Conclusion: Students' reflective narratives are a rich source of information about good professional behavior, as well as threats to professionalism. Their experiences shaped the students' perceptions of emergency medicine and its values. Such reflections may constitute an important resource for faculty, student, and resident development.