Feeling the responsibility: Exploring the emotional experiences of final-year medical students when carrying out clinical tasks

The concept of Entrustable Professional Activities (EPA) is increasingly used to operationalize learning in the clinical workplace, yet little is known about the emotions of learners feeling the responsibility when carrying out professional tasks. We explored the emotional experiences of medical students in their final clerkship year when performing clinical tasks. We used an online reflective diary. Text entries were analysed using inductive-deductive content analysis with reference to the EPA framework and the control-value theory of achievement emotions. Students described a wide range of emotions related to carrying out various clinical tasks. They reported positive-activating emotions, ranging from enjoyment to relaxation, and negative-deactivating emotions, ranging from anxiety to boredom. Emotions varied across individual students and were related to the characteristics of a task, an increasing level of autonomy, the students’ perceived ability to perform a task and the level of supervision provided. Emotions are widely present and impact on the workplace learning of medical students which is related to key elements of the EPA framework. Supervisors play a key role in eliciting positive-activating emotions and the motivation to learn by providing a level of supervision and guidance appropriate to the students’ perceived ability to perform the task.可委托专业活动（Entrustable Professional Activities，EPA）这一概念正日益被用于实现临床工作场所学习的可操作化落地，但目前学界对学习者在执行专业任务时所承担责任带来的情绪体验仍知之甚少。本研究探讨了医学生在临床实习最后学年执行临床任务时的情绪体验。研究采用在线反思日记作为数据收集工具，结合EPA框架与成就情绪的控制-价值理论，通过归纳-演绎式内容分析法对日记文本条目进行分析。医学生们描述了与各类临床任务执行相关的多样情绪体验：既存在从愉悦到放松的积极激活型情绪，也涵盖从焦虑到无聊的消极去激活型情绪。情绪体验存在显著的个体差异，且与任务特征、自主权限提升程度、学生自身感知的任务执行能力以及所获得的监督强度密切相关。情绪广泛存在于临床实习场景中，并会对医学生的工作场所学习产生影响，这一关联与EPA框架的核心要素紧密相关。督导者可通过提供与学生感知任务执行能力相匹配的监督与指导，在激发积极激活型情绪与学习动机方面发挥关键作用。