Critical incidents experienced by medicine interns in pandemics: a qualitative study at a South American medical school.

BACKGROUND

Critical Incidents (CI) during clinical practice offer valuable insights into medical students' experiences of stress, gaps in the teaching process, psychological safety, and systemic issues within healthcare. This study explored the elements that students identified as CIs during their clinical internships during the COVID-19 pandemic in Chile.

METHODS

This qualitative study involved voluntary participation from 24 final-year medical interns. Researchers collected data through documentary analysis of CI narratives from learning portfolios and two focus groups. The research team performed a reflexive thematic analysis.

RESULTS

Analysis yielded 22 definitive codes, grouped into nine subthemes and three themes: types of CIs, influencing factors, and personal impact on interns. Most CIs were unrelated to COVID-19 itself and triggered by complex biopsychosocial cases involving ethical dilemmas, questionable or unacceptable behaviors of healthcare personnel, and emotionally charged situations. Some CI related to the human relationship between interns and supervisors, between the health team, or in communication with patients and their families. Interns' reflections focused on their professional role, ethics, communication, and self-care. Most adaptations described were self-directed due to limited faculty involvement.

DISCUSSION: CI analysis allows interns to reflect on their roles and envision improvements for future practice. The primary emotions associated with CI were predominantly negative, and their adaptations were self-directed. One important topic to address is whether faculty are available and prepared to support interns, or whether they may themselves be contributors to CIs. These findings suggest the need for structured faculty support to improve psychological safety and reflective learning during internships.