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

Abstract

Background Critical Incidents (CI) during clinical practice can provide relevant information regarding students' stress, weaknesses in the teaching process, psychological safety, and the healthcare system. This study aimed to determine the elements considered by students to be CI during the COVID-19 pandemic in Chile. Methods This qualitative study was conducted on a sample of voluntary medical interns. Data production techniques were documentary analysis of the CI described in portfolios and two focus groups. Two researchers performed a reflexive thematic analysis of the CI and the focus groups. The Institutional Ethics Committee approved the research protocol. Results Twenty-four interns voluntarily participated. The coding process identified 22 definitive codes that were synthesized into nine subthemes and three themes that described types of CIs, factors that influence them, and effects generated by CI. The main findings were that CI were mainly related to non-Covid pathologies, causing negative emotions. They were cases of high biopsychosocial complexity, in which the ethical dimension of difficult decisions or "questionable" or "unacceptable" behaviors emerges. Some CI were linked to the human relationship between students and teachers or between the health team, or communication with patients and their families. Elements related to hospital organization were less described. The adaptations, learning, and reflections referred to the intern's professional role, ethics, communication skills, and self-care; and were produced autonomously, with little teaching support. Discussion CI analysis allows interns to reflect and imagine how to bring learnings into their future practice. The primary emotions associated with CI were negative, and their adaptations were autonomous. The school could improve with more teacher support and better role models to manage CI and support the interns' mental health better. One important topic to address is if the teachers are really available and prepared to be supportive, or if they are part of the causes of the CI.