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Early Clinical Experiences from Students' Perspectives: A Qualitative Study of Narratives

Dyrbye, Liselotte N. MD; Harris, Ilene PhD; Rohren, Charles H. MD

Academic Medicine:
doi: 10.1097/ACM.0b013e318149e29c
Clinical Education

Purpose: To gain insight into how early clinical experiences contribute to medical students' professional development.

Method: Qualitative content analysis of second-year Mayo Medical School students' reflective journal essays pertaining to their first experiences with inpatients (from 2002 to 2004) was done using a grounded theory approach. The apprenticeship model of professional learning (knowledge and cognitive abilities, technical skills, and ethical standards) and perspectives from learning theory provided the conceptual framework. Major themes were identified, and member checking and interrater reliability was assessed to support the validity and reliability of the content analysis.

Results: Four major themes related to the purposes that the early clinical experiences with patients served for students were identified in analysis of reflections from 76 students (participation rate 95%). The themes were issues related to relationships and learning in early encounters with hospitalized patients; integration with learning in the entire curriculum; aspects of doctoring learned; and affiliation with the physician role and professional development. Select quotes illustrate these themes and provide thick description. Member checking supported the analysis; interrater reliability was 91%.

Conclusions: Early hospital-based clinical experiences provide opportunities for apprenticeships in the habits of the head, hand, and heart. Medical students' growth and learning occurs within these apprenticeship domains through contextual experiential learning.

Author Information

Dr. Dyrbye is assistant professor of medicine, Mayo Clinic Department of Internal Medicine, Rochester, Minnesota.

Dr. Harris is professor of medical education, Department of Medical Education, the University of Illinois–Chicago, Chicago, Illinois.

Dr. Rohren is associate professor of medicine, Mayo Clinic Department of Internal Medicine, Rochester, Minnesota.

Correspondence should be addressed to Dr. Dyrbye, 200 First Street SW, Rochester, MN 55906; telephone: (507) 284-2511; fax: (507) 266-2297; e-mail: (

© 2007 Association of American Medical Colleges