Understanding the Struggles to Be a Medical Provider: View Through Medical Student Essays

Background The clinical learning environment helps to shape the professional identity of medical students. This process begins from existing personal identity and is influenced by various factors, including clinical experiences and clinical learning environment. Objective The purpose of this study was to examine medical students’ reflections as a way to identify and better characterize the modern struggles that medical students face, in order to inform the development of professional identity. Methods Students rotating in their emergency medicine clerkship wrote reflections on dilemmas that highlighted common struggles of becoming a doctor. Qualitative analysis was performed to determine common themes from the essays. The research team coded 173 reflections and identified themes and major domains. Results The first domain was Patient–Provider Conflict, including challenging patient (34%), difficult communication (25%), competing priorities between patients’ interest and trainees need to learn (19%), and bias (13%). The second domain was Provider-Specific Issues, such as the “gray zone,” in which there is not a clear standard of practice (29%), end-of-life care (14%), emotional struggle (6%), and fear of litigation (5%). The final domain was Systems Issues, such as cost of care (12%) and role of the emergency department (6%). Conclusions The reflections point to a wide variety of challenges that students confront in practice that will contribute to how they develop into physicians.