Identity construction in medical student stories about experiences of disgust in early nursing home placements: a dialogical narrative analysis

OBJECTIVES: To explore medical students’ reflective essays about encounters with residents during preclinical nursing home placements. DESIGN: Dialogical narrative analysis aiming at how students characterise residents and construct identities in relation to them. SETTING: Medical students’ professional identity construction through storytelling has been demonstrated in contexts including hospitals and nursing homes. Some preclinical students participate in nursing home placements, caring for residents, many living with dementia. Students’ interactions with these residents can expose them to uncontained body fluids or disturbing behaviour, evoking feelings of disgust or fear. PARTICIPANTS: Reflective essays about experiences as caregivers in nursing homes submitted to a writing competition by preclinical medical students in New Zealand. RESULTS: Describing early encounters, students characterised residents as passive or alien, and themselves as vulnerable and dependent. After providing care for residents, they identified them as individuals and themselves as responsible caregivers. However, in stories of later encounters that evoked disgust, some students again identified themselves as overwhelmed and vulnerable, and residents as problems or passive objects. We used Kristeva’s concept of abjection to explore this phenomenon and its relationship with identity construction. CONCLUSIONS: Providing personal care can help students identify residents as individuals and themselves as responsible caregivers. Experiencing disgust in response to corporeal or psychic boundary violations can lead to abjection and loss of empathy. Awareness of this possibility may increase students’ capacity to treat people with dignity and compassion, even when they evoke fear or disgust. Medical education theory and practice should acknowledge and address the potential impact of strong negative emotions experienced by medical students during clinical encounters.