Article Review: Formative experiences during medical school

What were your most impactful experiences during medical school?

This study surveyed 216 medical students from Johns Hopkins about a wide spectrum of formative experiences and the impact on their lives.

The goal of this study was to determine which experiences are the most commonly shared and most impactful. Because these experiences contribute to each student's emotional development and early professional competence, faculty mentors should be cognizant of these events when advising medical students.


An online survey instrument was developed using various focus groups, which included students, residents, and faculty advisors. A list of 34 distinct events/experiences were determined. In the study, students were were asked:
  1. Did you experience this event during medical school?
  2. What magnitude of impact did it have on you?
A Relative Impact Score was calculated for each item based on the numeric values for verbal descriptors:
  • 0 = Experienced event but no impact
  • 1 = Little impact
  • 2 = Some impact
  • 3 = A lot of impact
  • 4 = Tremendous impact
The numerical values for each item were summed across all of the student responses, divided by the total number of events experienced, and scaled to 100.

Of the 216 graduating residents, 181 completed the questionnaire (84%). Anything over 70% is generally considered a "reasonable" response rate for surveys. Obviously the higher the better.

Look at this table from the article, which lists the 34 "events". For each event, there is a corresponding exposure rate (% of students who experienced the event), Relative Impact Score, % of students who ranked the event as moderate impact, and % of students who ranked the event as high impact. The list is presented in descending order, based on the percentage of students who list the event as high impact.

I highlighted the 10 events with the highest Relative Impact Score in yellow. Click table to enlarge the size.

In general, impactful experiences were grouped into one of three categories (in descending order of "impactfulness"):

1. Inspiring experiences
  • Being inspired by a special patient-care related experience
  • Encountering a truly exceptional role model in medicine
  • Working well with a team
  • Seeing a patient whose life was saved by medical intervention
2. Mortality-related experiences
  • Seeing someone undergo resuscitation/intervention
  • Seeing someone die
  • Encountering a corpse in the anatomy lab
3. Negative experiences in the learning environment
  • Seeing/experiencing mistreatment by colleagues, staff, or faculty
  • Receiving genuinely inappropriate feedback
  • Getting a grade very much below expectations
This list of formative experiences during medical school is extremely useful for both medical students and faculty advisors. First-year medical students can anticipate what experiences will come. And faculty advisors can be more attuned to and ask about the moderate-to-high impact experiences for their advisees.

Murinson BB, Klick B, Haythornthwaite JA, Shochet R, Levine RB, & Wright SM (2010). Formative Experiences of Emerging Physicians: Gauging the Impact of Events That Occur During Medical School. Academic medicine : journal of the Association of American Medical Colleges, 85 (8), 1331-1337 PMID: 20671460
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