Conflict and coping strategies: a qualitative study of student attitudes to significant event analysis.

OBJECTIVES: To explore the attitudes of students to reflection in the form of significant event analysis (SEA), to categorise the factors influencing these attitudes and to develop a conceptual framework from the data to help ensure future students have a positive experience of this method of learning. CONTEXT: In May 1999, SEA, based on the critical incident technique, was introduced as part of coursework within a 3-week general practice clinical rotation for fourth year students at the School of Medicine, Imperial College, London. METHOD: Four focus groups of fourth year students were conducted. From these, a topic guide for use in in-depth interviews was developed. Eighteen interviews were conducted, which were recorded, transcribed and analysed. Themes grounded in the data were developed. RESULTS: Dominant themes emerged from the analysis. The process of SEA evoked conflicts within the students. The sources of conflict were categorised as internal, relating to phenomena specific to the student in question, or external, such as the medical curriculum and the student's relationships with others. Coping strategies employed by students and teachers also emerged from the data. DISCUSSION: Significant event analysis has the potential to provoke a number of conflicts within the student, which may reduce students' engagement with and perception of the utility of the task. By employing coping strategies, the negative effect of the conflict can be minimised. Applying this conceptual framework may inform further initiatives to promote reflective practice in undergraduate education.