Learning in Critical Spaces: Qualitative Analysis of Medical Students' Reflections in the ICU.

BACKGROUND

Research on ICU experiences from medical students' perspectives and their impact on professional development is limited. Reflective practices like storytelling enhance wellness and cultivate empathy among medical professionals, yet student involvement remains limited.

OBJECTIVE

To qualitatively analyze fourth-year medical student reflections from a required critical care clerkship, identify key themes, and suggest curricular improvements.

METHODS

Inductive qualitative methods were employed to develop a codebook through thematic analysis with consensus building and inter-rater reliability testing (Cohen's kappa ≥0.65). Frequency and collocation analyses identified patterns and contextual relationships.

RESULTS

Fifty-four percent of students participated, yielding 119 coded reflections. Six themes and 15 elements emerged, with top themes being "communicating with patient, family, or care team" (36.1%), "grappling with end-of-life, death, or dying" (26.1%), and "witnessing role modeling" (10.1%). Leading elements included "humanity" (44.5%), "professional development" (35.3%), "teamwork" (33.6%), and "duty" (32.8%). Reflections emphasized complex patient interactions, moral ambiguity, and personal growth over medical knowledge acquisition.

CONCLUSION

The Critical Care Sub-Internship is a formative experience in which fourth-year medical students not only learn clinical medicine but also engage in professional identity formation. Qualitative analysis of student reflections identified six dominant themes: navigating social challenges; addressing ethical dilemmas; observing role modeling; communicating with patients, families, and interprofessional teams; grappling with end-of-life care; and coping with emotional distress. Findings support targeted curricular enhancements including structured education in serious illness communication and end-of-life care, and intentional faculty development for positive role modeling.