Over the study period, 16 critical incident forms were completed by members of faculty from a cohort of 228 students. Of these 2 were excluded following connoisseur review as they failed to meet the criteria set. The 14 forms related to 9 students, some of whom had multiple forms. Of the 14 incidents forms, 7 had a reflective response.
Seven elements of professionalism were raised by staff. These were poor communication, unexplained absence, record keeping, meeting deadlines, positive commitment to studying, honesty, and patient confidentiality. Students did not always recognise the same areas of professionalism as a concern within their reflections.
The following major themes emerged from analysis of the transcripts.
Impacts and consequences
All students who reflected on the incidents considered the impact and consequences of their actions. There was recognition of how the student was involved.
Extract 1: 'This affected me and my studies.' (Student A)
There was also recognition that members of staff, patients and other students may also have been affected. Students described the impact that their actions had on others, what burdens may have been placed upon them and what additional work, if any, the student had created for them.
Extract 2: 'It affected me and the people at my placement. I was not as useful and productive as I could have been...it affected my colleagues at the placement as they may have had to perform a greater share of the work that would have otherwise been the case.' (Student B)
Extract 3: 'I did not attend my sessions in which I appreciate my clinical tutor has given up valuable time to come in' (Student C)
The ideas of wasting the time of others and failure to complete their own work emerge from the explanations. Students are also concerned about how the incident may have changed perceptions of themselves and other students.
Extract 4: 'my patient may have been let down and lost respect for the responsibility of medical students' (student A)
The concern of student concentrates on patient perception of the student which has been affected in a negative manner.
Identification of the responsibilities of a medical student is a necessary step to remediation. These reflections on the incidents fell into two sub themes: those of acceptance and those of rejection.
With acceptance reactions, students demonstrated the recognition of fault in themselves, showed guilt and remorse for their actions and acknowledged a lack of knowledge could be the cause. Students included clear statements of acceptance.
Extract 5: 'I fully accept that my behaviour has been unacceptable'
'My failure to provide explanations and consult with the tutor is unacceptable' (Student C)
Students also show the ability to describe how the event has affected them emotionally and their intended future response.
Extract 6: 'I feel very bad that I let this happen and it certainly won't happen again'
'I now realise that it was very serious and should not even have considered it' (student D)
There is also student acceptance of blame which had been previously unrecognised.
Extract 7:'For some reason it did not occur to me that the same principles applied in the lecture theatre' (student D)
Not all students in the study felt the reports were an accurate description of the event which occurred, and described aspects which they felt were out of their control.
Extract 8: '...haven't received the test results from the medical centre'
'I was falsely led to believe...' (Student E)
Denial of the accuracy of the event also occurred, and students disputed the incident. Students felt that their actions have been misinterpreted by the staff and that their actions were not unprofessional. These rejection reactions could also be seen to be both defiant and possibly complacent.
Extract 9: 'I was not listening to music during lectures' (Student E)
Some responses do not deny that the event occurred, but reflected a denial of the significance of the event which occurred. Students did not always agree that what was reported constituted a critical incident or problem with professionalism.
Extract 10: 'No event, I missed a few important lectures.' (Student A)
A minority of students recognised that their behaviour was unprofessional from the view of staff involved, but believed that their actions were justified due to the circumstances surrounding the issue.
Extract 11: 'I worked most of the holiday and believe this time would have been necessary regardless'
'due to lack off work earlier in the year that I needed to catch up'
'... but I believe that the alternative would have hindered my revision' (Student A)
Students frequently identified further actions, which in turn related to whether they had made acceptance or denial responses. Acceptance responses included remediation in the form of apologies:
Extract 12: 'I will write a personal letter of apology' (Student C)
Extract 13: 'I take full responsibility for my actions and sincerely apologise to both X and Y, whose lectures I enjoy very much.' (Student E)
Apologies can also relate to the theme of impact and consequences, with students being concerned with the perceptions staff may have of them in light of the incident. By apologising, students may hope to prevent this perception of them.
Rejection responses include suggestions for further actions by others, which could be constructive. Students feel that their experiences could be used to make practical changes to the course, and would as such be of benefit to their fellow students.
Extract 14: '...instead of having three lectures on one topic, the student should be given a book to study with a certain time period. Then at the end of this time period there will be a review lecture to ensure everyone has understood.' (Student F)