“He Bore it Like a Scarlet Letter”: Medical Student Reflections on Substance Use Disorders

Objective Substance abuse in the context of the opioid crisis presents a major public health concern. Despite some evidence that medical students’ attitudes towards substance use disorders worsen during medical school, very few studies have examined how students’ early clinical experiences with substance use disorders shape their views of this clinical population. This study uses student reflective essays to explore these formative educational experiences. Methods Using content analysis, the authors analyzed a collection of 802 medical student reflective essays written during core clerkships (excluding Psychiatry), coding for ethical and professional themes as well as descriptions of substance use disorders. In addition to the qualitative identification of themes, the authors used chi-square analysis to determine which themes had statistically significant associations with substance use disorders. Results Fifty-three essays described patients with substance use disorders. The most common substances described were opioids ( n = 25), alcohol ( n = 18), and cocaine ( n = 11). There were five themes statistically associated with substance use disorders ( p