Do critical incidents lead to critical reflection among medical students?

Context: Medical students are exposed during their training to a wide range of experiences and behaviors that can affect their learning regarding professionalism and their behavior and attitudes towards patient-centered care. The aim of the study is to explore learning associated with critical incidents and levels of critical reflection among medical students. 

Approach: Medical students’ were invited to narrate a critical incident and reflect on the learning associated with it. All students’ narratives were audio-recorded and analyzed thematically. Mezirow’s theory of transformative learning was used to analyze the level of reflection reached in students’ narratives. 

Findings: For the present analysis critical incidents narrated by 70 clinical students (4th–6th year) were included. Fifty-two of them were females. Students’ experiences are derived from three types of interactions: observed interactions between doctors and patients, personal interactions between students and patients, and interactions between doctors and students. Reflections deriving from the experiences included: behaving to patients as humans not as cases, emotional aspects of care, doctors as role models, skills needed when working under pressure, ‘tasting’ the real profession, emotional management, the importance of communication skills, teaching qualities of doctors, becoming a doctor, and reflections of future practice. Analyzing the actual level of reflection indicated that only 32 (45.7%) students were categorized as reflectors. 

Conclusions: Student interactions with doctors and patients provide insights about; the daily experience of being a doctor, the most common challenges, what qualities are necessary for being a doctor and what do they need to develop their professional identity. However, it is noteworthy that while the majority of students shared a critical incident crucial to their professional development, there is little evidence of critical reflection.