'You put up a certain attitude': a 6-year qualitative study of emotional socialisation.

CONTEXT: Emotions play a central role in the professional development of doctors; however, research into how students are socialised to deal with emotions throughout medical school is still lacking. OBJECTIVES: This study aimed to gain a better understanding of the emotional socialisation of medical students (e.g. how they learn to express and respond to emotions evoked in clinical practice in the process of becoming a doctor). METHODS: In this longitudinal study, 12 medical students participated in annual, individual, semi-structured interviews, capturing the full 6-year medical school period. We carried out a thematic analysis, which was iterative and inductive. RESULTS: The socialisation of emotion in the process of becoming a doctor happens in a complex interplay between student and context. We identified two modes of emotional socialisation (e.g. explicit and implicit teaching about emotions), the latter including how the people observed by students express their emotions and how they respond to the emotions expressed by students. Although the main message conveyed to students still seemed one about hiding or suppressing emotion, we found that students were able to identify and build upon the emotional expression and responses they observed in positive role models and managed to create their own opportunities to express their emotions. We found large differences between students in how they perceived, presented and developed themselves. CONCLUSIONS: Students differ in how they respond to and what they need from their environment and thus may benefit from tailored supervision in learning how to experience, express and respond to emotion. Providing students with real and authentic responsibility for patients and allowing them time and opportunity to talk about emotion might help them to create an emotional space.

Emotional Learning and Identity Development in Medicine: A Cross-Cultural Qualitative Study Comparing Taiwanese and Dutch Medical Undergraduates.

PURPOSE: Current knowledge about the interplay between emotions and professional identity formation is limited and largely based on research in Western settings. This study aimed to broaden understandings of professional identity formation cross-culturally. METHOD: In fall 2014, the authors purposively sampled 22 clinical students from Taiwan and the Netherlands and asked them to keep audio diaries, narrating emotional experiences during clerkships using three prompts: What happened? What did you feel/think/do? How does this interplay with your development as a doctor? Dutch audio diaries were supplemented with follow-up interviews. The authors analyzed participants' narratives using a critical discourse analysis informed by Figured Worlds theory and Bakhtin's concept of dialogism, according to which people's spoken words create identities in imagined future worlds. RESULTS: Participants talked vividly, but differently, about their experiences. Dutch participants' emotions related to individual achievement and competence. Taiwanese participants' rich, emotional language reflected on becoming both a good person and a good doctor. These discourses constructed doctors' and patients' autonomy in culturally specific ways. The Dutch construct centered on "hands-on" participation, which developed the identity of a technically skilled doctor, but did not address patients' self-determination. The Taiwanese construct located physicians' autonomy within moral values more than practical proficiency, and gave patients agency to influence doctor-patient relationships. CONCLUSIONS: Participants' cultural constructs of physician and patient autonomy led them to construct different professional identities within different imagined worlds. The contrasting discourses show how medical students learn about different meanings of becoming doctors in culturally specific contexts.