Session number: 1087
Abstract title: Educating for Professionalism: Medical Trainees' Emotions on Hospital Wards
Author(s):
DL Kasman - Veterans Affairs Puget Sound Health Care Systems
K Fryer-Edwards - University of Washington - Dept. of Medical History and Ethics
CH Braddock - University of Washington - Dept. of Internal Medicine
Objectives: To assess 'ordinary' emotions and experiences which trigger them for
medical trainees during inpatient rotations. Goals are to illuminate
emotional characteristics of experiences that impact professional
behaviors of physicians.
Methods: Two ward teams, one in general internal medicine at a VA hospital, and
another in general pediatrics at a large pediatric hospital, were studied
qualitatively in the spring of 2000. Students, interns, residents and
attendings were included in the study. Data were collected through two
semi-structured, open-ended interviews, (1 to 1 ½ hours long); 43 hours of observations by a non-participant; and a self-report task for trainees (not
attendings). 475 emotional experiences were analyzed from first interviews
and self-reports and coded within one of 17 standard emotions. Each experience was cross referenced for emotional triggers. Emergent trends and themes were discerned using grounded theory analysis.
Results: Experiences divided into a continuum of 'warm' to 'cool' emotions. Warm
emotions included gratitude, happiness, compassion, pride and relief, and were
elicited by connecting with patients as well as colleagues; receiving
recognition for one's labors; learning and being a part of modern
medicine; and receiving emotional support from peers, mentors, families
and patients. Cool emotions such as anxiety, guilt, sadness, anger and
shame were elicited by experiences involving uncertainty; powerlessness;
responsibility or liability; lack of respect; and a difference in values.
Tragedy and patients' suffering was the only trigger to elicit both a
warm emotion (compassion) and a cool emotion (sadness).
Conclusions: Educators have an opportunity to impact professional growth and identities
of their learners by encouraging connections with patients and colleagues,
respect, emotional support, compliments for learners, and enhancing the
joy of learning. Strategies to decrease anxiety, guilt, anger and shame
include addressing uncertainty, powerlessness, lack of respect and
different values between learners, mentors and patients. These changes
could improve trainees' satisfaction, enhance professionalism on the
wards, and possibly increase understanding and empathy toward patients.
Impact statement: Addressing pleasant and difficult experiences on the wards offers
educators opportunities to enhance professional behaviors in learners.
Uncertainty, powerlessness, differing values and a lack of respect in
training deserve more attention from educators.