Go backSearch 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.