A Qualitative Study of US Medical Student Experiences of Clinically Significant Adverse Events

Clinically significant adverse events (CSAE) place medical students at risk for secondary traumatic stress, feelings of guilt, anxiety, failure, decreased confidence, and alterations of career trajectories and specialty choice. The CSAE literature focuses on clinicians or nursing students, leaving medical students relatively understudied. Understanding medical students' CSAE experiences, within the context of their role as a learner, is important because students may be uniquely vulnerable due to their relative lack of experience with adverse events, lower position in the medical hierarchy, and absence of formalized CSAE curricular or co-curricular support. Thus, the purpose of this study is to explore medical students' experience of CSAE and identify ways to support learning during the recovery process.

We used a constructivist narrative approach to explore medical students' stories of CSAE holistically. From December 2024 through February 2025, we conducted semi-structured interviews with 16 second- through fourth-year civilian and military medical students in the United States. This study is constructivist in that both the authors' and the participants' experiences of CSAE are contextually specific realities where meaning is relational and often co-created. We elected to use a narrative approach, which is a story-centered methodology, because CSAE is a chronological phenomenon and stories are one way that humans make sense of traumatic events. We followed a chronological approach to develop the interview protocol and used narrative analysis to interpret the data. The Institutional Review Board at the Uniformed Services University of the Health Sciences in Bethesda, MD approved this research (DBS.2024.783).

Narratives highlighted intense emotional responses to CSAEs, including helplessness, guilt, fear, and grief, shaped by their limited power, inexperience, and pressure to perform. Their role as learners often left them excluded from care decisions, debriefings, and formal support, leading to feelings of invisibility within the medical hierarchy. While emotional and social support from faculty and residents was often absent, students sought help from peers, therapists, or medically trained family members. Informational and esteem support, especially when faculty explained clinical reasoning, helped students process events and regain a sense of competence.

Medical students often feel unprepared for the emotional impact of CSAEs and face barriers to seeking support due to hierarchy and fear of negative evaluation. Participants described experiences of isolation, emotional distress, and invisibility within clinical teams but also identified moments of growth when supported by faculty and peers. These findings highlight the need for curricula that prioritize emotional preparedness and social support.