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Table 5 ER strategies and excerpts from participants’ narratives of incidents

From: (How) do medical students regulate their emotions?

Inaction A mother and her son arrived in the emergency department and the boy had a fracture in his arm. He was in pain and he was crying. I tried to ask a resident to look after the boy but the answer was “I have more serious things now, they can wait”. I was shocked for the answer but I couldn’t do anything more (065, male student, 3 rd year)
Trying to comfort the patient The doctor was explaining the use of an external pacemaker- which was supporting a patient after the surgery- While the patient was conscious and could listen to what the doctor was explaining to us- the doctor removed the battery of the external pacemaker for a few seconds- making a joke that the battery is crucial for the survival of the patient. Then he left the patient uncovered and as a result the patient started trembling from cold. I was shocked from the behavior of this doctor who was irresponsible and inhuman. They only thing we could do was to cover the patient in order for her not to feel cold” (037, female student, 4th year)
Challenging the situation [while a doctor was trying to convince a patient to undergo the same medical procedure for teaching purposes and the patient looked really uncomfortable]…We were all feeling awkward so my colleague asked directly the doctor: do you think what you do is appropriate? (010, male student, 4th year)
Focusing on a task as a way to avoid the emotion The doctor had an argument with the wife of the patient but it happened that I was also there to take the history. I was listening to the argument and I was feeling really uncomfortable being there and seeing how sad the patient was but I had to complete my task and leave (036, female student, 4th year)
Denial I didn’t want to believe that the doctor was listening to the patient screaming from pain, and he was ignoring her and continuing the lesson (061, female student, 4 th year)
I could not believe the doctor made such an inappropriate comment for the patient, I pretend I did not hear it
(032, female student, 4 th year)
Reappraisal: Justifying unprofessional behavior I thought that the doctor was tired or stressed or maybe something had happened before between the patient and himself and taht it why he behaved like this (006, female student 4 th year)
Reappraisal: Putting emphasis on clinical competencies of a doctor I was very shocked with his [consultant] behavior towards the patient, because he is very good at his job (086, female student, 5 th year)
Suppression I remembered a time when I had to take history from a patient, who was in a quite serious condition. When I approached her, I introduced myself and I explained the reason I was there and I asked her the reason she was in the hospital. She answered to me: “what do you want to know? I tried to commit suicide” I remembered I was shocked, I did not know what to say. I tried to remain calm, to be emotionally neutral and not show my bewilderment. I continued the history taking as usual but I continued thinking of it (057, male student, 4 th year)
Discussing with peers When the incident happened, I did not do anything, but I know all my fellow students thought the same as me and we commented on the doctor’s behavior after the lesson (001, female student, 4 th year)