''My most meaningful patient'' - Reflective learning on a general medicine service

OBJECTIVE: To determine the usefulness of critical-incident reports in facilitating reflective learning and the types of experiences that learners found meaningful on a general medicine service. DESIGN:Team members wrote about their most meaningful patient of the month and what was learned from the patient. They shared their narratives during teaching rounds at the end of each month. The written reports were collected and subjected to qualitative thematic analysis. SETTING: General medicine teaching service of an academic medical center. PATIENTS/PARTICIPANTS: Medical students, residents, and attending physicians. MEASUREMENTS AND MAIN RESULTS: Ninety-eight reports were collected over 10 months and subjected to thematic analysis. Reports were coded for six major themes, with a mean of 2.09 themes per narrative. The number of reports containing each theme was 47 for biomedical, 46 for communication with patients and families, 38 for psychosocial, 32 for the physician's role, 30 for personal feelings, and 14 for ethics. Communication issues constituted the theme most frequently reported by third-year students; biomedical and psychosocial themes by interns; biomedical by supervising residents; and the physician's role by attending physicians. Reports from men and women contained a similar mean number (men 2.101; women 2.128) and distribution of themes. CONCLUSIONS: The critical-incident technique promoted reflection on the meaning of clinical experiences. Qualitative thematic analysis revealed the diversity of meaningful experiences on a general medicine service and the high frequency of nonbiomedical themes. This study suggests that reflective exercises can provide a window into the experience of students and residents.