Journal Club

Use of Critical Incident Reports in Medical Education- A Perspective. Branch WTJr. J Gen Intern Med, 2005 Nov; 20(11):1063-7.

Reviewed by Harold Bland, Florida State University

The author reviewed the literature on the use of critical incident reporting in medical education, and then provided his perspective as to the benefits of this type of reporting on reflective thinking by medical students.

Definition of critical incident reporting: Critical incident reports are narrative accounts that focus on an event chosen by the student as having especially influenced his or her professional development. This reporting may be in the written or oral format.

Background: Critical incident reports are being widely used in medical and nursing education. Their first published large-scale educational use in medical education was a component of Harvard Medical School's required third-year Patient-Doctor Relationship Course.

Who was studied?
600 medical students

How was the study done?
Each medical student wrote 3 critical incident reports each year, and shared them with other medical students.

What was found?
1. By focusing the reports on experiences in doctoring, they are never unrelated to professional development

2. The use of these reports in group-reflection provides emotionally charged and meaningful material as the point of departure for discussion

3. Being personal, these reports engage the learner on the level of deeply held professional values and attitudes

4. Although these reports are used for self-reflection, their educational value is most pronounced when critical incidents are used as a focus for group reflection

5. Individuals are generally more willing to write about emotionally charged events than they are to tell such stories

6. A sense of trust in the group emerges when a member shares a personal story and then receives support from others. This encourages other participants to share their stories of critical incidents

7. Critical incidents shared with others may reframe experiences from "negative" to "positive' or constructive. Such group support is generally experienced as healing and reaffirming

8. Critical incident reports provide an effective learning method to address ethics and professional values in medical education

9. Students utilizing critical incident reporting were significantly more adept at patient-centered interviewing in blindly judged videotaped interviews.

(Comment: The critical incident report is rapidly becoming one of the most accepted teaching and evaluation methods for the professionalism competency in residency education. This study, and work done by others such as Tom Inui, has provided important information of how to use these sensitive data effectively. I have recently begun a similar session within our clerkship. I would be very interested to hear others' experience, both good and bad, with this tool. - Leslie Fall)