Dorene F. Balmer,Texas Children's Hospital/Baylor College of Medicine,Houston,TX,Michael J. Devlin,Columbia University's College of Physicians and Surgeons,New York,NY,Boyd F. Richards,Columbia University's College of Physicians and Surgeons,New York,NY
Background: The stories students tell about their peak experiences in medical school shed light on who students uniquely are, and who they imagine becoming (diversity). At the same time, medical schools strive to produce students who achieve competence in personal/professional development (PPD) as defined by the AAMC (standardization).
Objective: To explore the tension between standardization and diversity by examining and comparing medical students’ peak experience stories via competency domains and narrative analysis.
Method: 22 medical students participated in this 4-year, longitudinal case study. We interviewed students and obtained peak experience stories at six time points: 3 in preclinical training, 2 in the major clinical year (MCY), and 1 eight months prior to graduation. For the analysis, we coded interview transcripts by inductively creating codes, iteratively revising codes and attaching codes to segments of data. Then, we “standardized” stories by categorizing codes in Physician Competency Reference Set (PCRS) competency domains. Finally, we used narrative analysis to examine “diversity”. We read and re-read the collection of stories for each student, focusing on first-person statements and, for each student, deriving a theme that tied their stories together.
Results: Codes assigned to students’ peak experience stories overwhelming aligned with one PCRS competency domain: PPD. Narrative analysis revealed that students faced similar complicating events as they progressed through medical school (e.g. second-guessing their decision to go to medical school in the first semester; gaining confidence in themselves as physicians in MCY). However, how students gauged their progress was quite diverse, and this diversity revealed aspects of their unique selves. For example, one student pursuing pediatrics mirrored her development in the response of her peers, while another student pursuing surgery gauged his development by the extent to which he used his hands.
Discussion: Addressing competence in PPD is helpful if it brings development to the forefront of medical education. However faculty who are called to teach and assess PPD should recognize, and listen for, students’ unique selves and the diversity of ways they gauge their development.