Experiential learning in disaster psychiatry: a qualitative study of medical students’ reflections on clinical reasoning, empathy, and professional identity

Abstract

Background

Disaster settings pose substantial challenges to health-care delivery while simultaneously offering distinctive experiential learning opportunities for medical students. Exploring how students reflect on participation in psychiatric and mental health care during disasters may provide insight into the developmental dimensions of medical education, including clinical reasoning, relational practice, and professional identity formation.

Methods

This qualitative study analyzed written reflective narratives from sixteen medical students (eleven fourth-year and five sixth-year) from a single medical school who participated in supervised psychiatric and mental health care during a flood-related disaster response in southern Thailand. Data were analyzed using inductive thematic analysis. Participants were anonymized using identifiers (P1-P16).

Results

Participants described disaster-based learning as emotionally demanding and professionally significant. Reflections emphasized the importance of addressing basic needs, including safety, shelter, food security, and access to medication, as foundational to mental health care in crisis settings. Through observing psychiatric faculty, students identified attentive listening and regulated empathy as core clinical competencies. They described a shift toward holistic, patient-centered perspectives incorporating patients’ life histories and family contexts. Participants also observed resilience enacted within families and communities, where social connectedness and shared caregiving appeared to support meaning-making amid adversity. These experiences were associated with evolving understandings of professional responsibility and, for some students, reflection on personal values.

Conclusions

Participation in disaster-related psychiatric and mental health care appeared to function as an integrative learning context. Disaster settings supported reflection on systems-oriented clinical reasoning, empathy as professional practice, holistic care, and professional identity development. When accompanied by supervision and structured reflection, such experiential learning may contribute to integrative development across cognitive, relational, and ethical dimensions of practice.

Introduction

Disasters pose substantial challenges to health-care systems and are associated with significant psychological and psychiatric consequences. Disruption of social structures, displacement, resource scarcity, and prolonged uncertainty contribute to increased risks of acute psychological distress and longer-term psychiatric morbidity among affected populations [1]. International guidance for mental health in humanitarian emergencies emphasizes the integration of mental health services into broader emergency response systems, highlights safety, stabilization, and restoration of basic functioning as foundational principles of intervention [2].

In parallel, medical education increasingly emphasizes preparing students to practice in complex, uncertain, and resource-constrained environments. Despite increasing recognition of the importance of disaster medicine, substantial variation remains in how disaster-related competencies are incorporated into undergraduate medical education worldwide [3]. Previous studies and reviews have identified persistent gaps in disaster-related training and preparedness among medical students [3–5]. Existing research in disaster medicine education has largely focused on curriculum content, preparedness, and self-reported readiness for disaster response [3–5].

Experiential learning in clinical education has been conceptualized as a process through which learners construct meaning from participation in authentic practice, supported by reflection and supervision [6]. Experiential learning is also considered important for the development of professional competencies that require contextual judgment, interpersonal engagement, and adaptation to complex care environments. Contemporary perspectives on professional formation emphasize that competencies are developed not only through knowledge acquisition but also through participation in authentic clinical and community-based practice [7–9].

Clinical contexts characterized by uncertainty and emotional intensity may therefore foster integrative learning that links knowledge, ethical awareness, and professional development. Similar learning processes have been described among medical students during the COVID-19 pandemic, where exposure to uncertainty, rapidly evolving clinical environments, and social responsibility contributed to professional growth and identity development [10].

Professional identity formation has been described as a developmental process shaped through participation in practice and socialization within professional communities [11]. Empathy, defined as a clinical capacity involving perspective-taking and emotional attunement within professional boundaries, has been associated with improved patient care and professional practice [12]. Disaster contexts may uniquely foreground relational, ethical, and systems-based dimensions of care, offering opportunities for reflection that extend beyond technical skill acquisition.

Recent reviews of disaster medicine education highlight the need for deeper qualitative exploration of how students experience and interpret disaster-related learning contexts [3]. Limited research has specifically examined how participation in disaster-related psychiatric and mental health care shapes students’ understanding of systems-oriented clinical reasoning, defined as the ability to integrate clinical, psychosocial, and contextual factors when understanding and responding to patients’ health concerns, and relational practice, which emphasizes therapeutic and collaborative relationships grounded in empathy, communication, and responsiveness to patients’ lived experiences. Such learning may also influence empathy as professional practice, holistic patient-centered care, and emerging professional identity.

Context and study aims

During the study period, severe flooding affected large areas of Hat Yai District in Songkhla Province, southern Thailand. The disaster resulted in widespread displacement of residents, with more than 16,000 people evacuated to temporary shelters as floodwaters inundated residential areas and disrupted essential infrastructure [13]. These disruptions created substantial challenges for local health-care services and generated urgent physical and psychological needs among affected populations. In response, health-care services were partially reorganized to support community-based disaster response, including the provision of psychiatric and mental health care in evacuation centers and flood-affected communities. This study aimed to explore medical students’ reflective narratives following participation in disaster-related psychiatric and mental health care, using qualitative analysis to examine how experiential learning in disaster settings influenced their understanding of clinical reasoning, relational practice, and professional identity formation.

Methods

Study design

This qualitative study employed written reflective narratives to examine medical students’ experiential learning in disaster-related psychiatric and mental health care. An inductive thematic analysis was conducted to explore how students described and interpreted their clinical, emotional, and professional experiences.

Participants and setting

The program took place during a large-scale flood affecting Hat Yai District in southern Thailand, which led to population displacement and the establishment of temporary evacuation shelters across the city. Conventional ward-based teaching was temporarily replaced with supervised community-based psychiatric and mental health care delivered in evacuation shelters and affected communities.

Participants were recruited from the entire cohort of fourth- and sixth-year medical students who participated in this modified psychiatric training program. All students involved in the disaster-related clinical activities were invited to submit reflective narratives following completion of the program, and all agreed to participate. The study therefore included all learners exposed to this unique educational experience, reflecting convenience sampling of an available educational cohort. This approach was selected because the aim was to explore the experiences of all students who participated in the disaster-related training rather than to achieve theoretical representation across predefined participant characteristics.

Students participated in community-based psychiatric and mental health care activities in evacuation shelters and flood-affected communities for approximately 3–6 h per day over seven days. Activities included supervised patient assessments, psychosocial support, community outreach, and assistance in addressing the physical and mental health needs of evacuation shelter residents and other affected individuals. Clinical activities were supervised by faculty psychiatrists throughout the program. All sixteen submitted reflective narratives were included in the analysis.

Data collection

Rather than participating in interviews, students were invited to prepare approximately one page of free-text reflection guided by several semi-structured prompts. The prompts were developed by the teaching team for this educational activity to encourage reflection on learning, challenges, emotions, and professional development arising from participation in disaster-related psychiatric and mental health care. They were not adapted from a specific reflective practice framework or guideline. These prompts asked students to reflect on: (1) what they learned from the experience, (2) challenges they encountered, (3) how the experience influenced their understanding of psychiatric and mental health care, (4) emotions they experienced during participation, and (5) how the experience might influence their future practice as a physician. Students were encouraged to respond freely and elaborate on aspects they considered most meaningful. The final dataset comprised 16 reflective narratives, totaling approximately 16 pages of text for analysis.

Data analysis

Data were analyzed using a predominantly inductive thematic analysis, informed by sensitizing concepts related to relational practice and professional identity formation, following the approach described by Braun and Clarke [14]. Initial coding remained grounded in the data, with themes developed through iterative comparison across the dataset. Analysis prioritized interpretive depth over frequency counts. Themes were refined through constant comparison across narratives, and discrepancies in coding were resolved through discussion until consensus was reached. Coding and initial theme development were conducted by AB, CD, and EF (psychiatrists involved in medical education). GH and IJ (psychologists) contributed to analytic discussions and refinement of themes. All authors participated in the interpretation of the findings and approved the final thematic structure. Reflexivity was addressed through explicit discussion of researchers’ dual roles as educators and analysts. An audit trail was maintained throughout the analytic process. Credibility was enhanced through prolonged engagement with the data, team-based analysis, reflexive dialogue, and inclusion of representative quotations.

Ethical considerations

Ethical approval was obtained from the Ethics Committee of the Faculty of Medicine, Prince of Songkla University (REC.69-078-3-1). Participation was voluntary, and all reflective narratives were anonymized before analysis. Written informed consent was obtained from all participants, and the study adhered to ethical principles for research involving human subjects.

Results

Participant characteristics

Sixteen medical students participated in the study, including eleven fourth-year and five sixth-year students. The cohort comprised nine females and seven male students. Participant characteristics were reported in aggregate to preserve anonymity and confidentiality.

Thematic findings

Inductive thematic analysis generated six interrelated themes describing medical students’ experiential learning in disaster-related psychiatric and mental health care. These themes reflect changes in clinical reasoning, relational understanding, and professional self-concept arising from direct engagement with disaster-affected individuals and their families during disaster response activities.

Themes 1–4 primarily illustrate shifts in clinical perspective and relational awareness, whereas Themes 5–6 describe developments in professional identity formation and personal value orientation (Table 1).

Table 1.

Overview of themes and illustrative quotations

Theme	Core focus	Illustrative quotation
Prioritizing basic needs as the foundation for psychological stabilization	Recognizing safety, shelter, and access to essential services as prerequisites for psychological recovery, and differentiating distress related to deprivation from primary psychiatric conditions	“Mental health care must begin with meeting basic needs. When patients receive food, shelter, and medical care without having to struggle through complicated systems, their mental state gradually improves.” (P1)
Developing empathy as a reflective and regulated professional competency	Understanding empathy as an intentional clinical practice that requires emotional awareness, regulation, and balance between professional engagement and personal boundaries	“I learned to practice empathy rather than sympathy. If I only felt sorry for patients, I would not be able to care for them properly.” (P3)
Recognizing patients as whole persons beyond diagnostic categories	Moving from disease-centered perspectives toward appreciating patients’ identities, social roles, and lived experiences	“We are not treating only the illness. We are treating a person who has a past, a family, and a role in others’ lives.” (P6)
Observing resilience and meaning-making in the context of disaster	Identifying resilience as expressed through adaptive coping, everyday hope, and interpersonal support within affected communities	“Disaster does not always break the human mind. Sometimes it reveals how strong people already are.” (P1)
Professional identity formation through experiential learning and role modeling	Describing how clinical exposure, mentorship, and interdisciplinary collaboration contributed to evolving perceptions of what it means to be a physician	“Being a good doctor is not only about diagnosing disease, but about standing beside patients in their most vulnerable moments.” (P9)
Personal reflection and reorientation of values through patient encounters	Reflecting on how encounters with patients prompted reconsideration of dignity, compassion, and the human dimensions of medical practice	“Listening to a trembling voice, seeing empty eyes, or witnessing a smile despite suffering, these are lessons that textbooks cannot teach. Being a doctor requires using the heart as much as the mind.” (P8)

Theme 1: prioritizing basic needs as the foundation for psychological stabilization

Participants consistently described recognizing that psychological distress in disaster contexts was closely linked to unmet basic needs. Direct encounters with displaced individuals and medically vulnerable patients reshaped their understanding of psychiatric care as inseparable from social and material stability.

Many participants observed that effective mental health care often required addressing fundamental needs such as food, shelter, safety, and continuity of medical treatment before formal psychiatric interventions could be effective.

“Mental health care must begin with meeting basic needs. When patients receive food, shelter, and medical care without having to struggle through complicated systems, their mental state gradually improves.” (P1)

Some participants encountered individuals whose symptoms initially appeared psychiatric but were later understood as responses to deprivation.

“Some patients did not have psychiatric illness at all. They were simply lacking basic needs. In those cases, the most appropriate intervention was not psychiatric treatment, but social support.” (P7)

These reflections expanded students’ understanding of disaster psychiatry as inherently multidisciplinary and closely connected to broader social care systems.

Theme 2: developing empathy as a reflective and regulated professional competency

Participants described a shift from viewing empathy as an emotional reaction to understanding it as a deliberate professional competency requiring intention, self-regulation, and boundaries. Several participants distinguished empathy from sympathy, emphasizing the importance of maintaining therapeutic clarity while remaining emotionally present. Participants often described empathy as involving an understanding of patients’ perspectives while maintaining the capacity to respond constructively to their needs. Rather than becoming overwhelmed by patients’ suffering, they emphasized remaining attentive to patients’ experiences and responding in ways that supported care and problem-solving.

“Empathy allows us to understand the difficulties patients face and help solve problems where possible. This differs from sympathy, which may focus primarily on emotional reactions without leading to action.” (P4)

“I learned to practice empathy rather than sympathy. If I only felt sorry for patients, I would not be able to care for them properly.” (P3)

Empathy was commonly expressed through attentive listening, respectful silence, and nonjudgmental presence.

“Sometimes relieving suffering does not require complicated interventions. Just listening without judgment is enough.” (P1)

Participants also recognized that empathic engagement extended beyond patients to include caregivers, who often experienced emotional and physical exhaustion during disaster situations.

“Encouraging caregivers and acknowledging that they are doing their best can restore their strength and confidence.” (P11)

Through these experiences, empathy was reframed as a structured and sustainable clinical competency rather than solely an emotional response.

Theme 3: recognizing patients as whole persons beyond diagnostic categories

Clinical exposure in disaster settings prompted students to move beyond a disease-centered framework toward a person-centered perspective. Several participants reflected on visits to bedridden patients and individuals with chronic disabling conditions, where they observed that dignity and personhood remained intact despite significant loss of physical function.

“Even when disease takes away many abilities, the value of being human never disappears.” (P10)

These encounters also highlighted the importance of understanding patients’ life histories, family roles, and social identities beyond their diagnoses and functional limitations.

“We are not treating only the illness. We are treating a person who has a past, a family, and a role in others’ lives.” (P6)

These experiences reinforced recognition of human dignity and personhood as central principles guiding psychiatric and medical care.

Theme 4: observing resilience and meaning-making in the context of disaster

Participants frequently described witnessing resilience among disaster-affected individuals and communities. Rather than perceiving disaster solely as psychologically destructive, they observed adaptation, acceptance, and meaning-making.

Resilience was often described as emerging through relationships and shared efforts among families, healthcare teams, and community members. Strength during crisis situations was perceived not only as an individual capacity but also as a collective phenomenon sustained through social connection.

“Disaster does not always break the human mind. Sometimes it reveals how strong people already are.” (P1)

Coping strategies were frequently grounded in small daily actions and future-oriented thinking.

“Happiness does not need to be grand. Sometimes, just being alive tomorrow is enough.” (P5)

Participants described evacuation centers as environments where solidarity and caregiving became visible.

“In this flood crisis, I saw the kindness and cooperation of both healthcare personnel and ordinary citizens. It clearly reflected the power of humanity.” (P4)

Evacuation facilities were portrayed not merely as physical shelters but as spaces sustained by coordinated acts of care.

“At the shelter, I saw volunteers cooking and organizing supplies. I saw relatives closely caring for bedridden and elderly patients. Even in difficult circumstances, they were not abandoned.” (P6)

Family caregiving was repeatedly described as a stabilizing force during uncertainty.

“My mother and sister had already felt exhausted from long-term treatment, yet they continued feeding, cleaning, and caring for him, bringing him with them to escape the flood together.” (P9)

“I perceived the love between siblings, the love of parents, and the love of healthcare professionals for patients. This flood did not make us wither; it made us bloom.” (P12)

Across narratives, disaster was therefore not described solely in terms of vulnerability. Participants increasingly understood resilience as relationally enacted within families and social networks, where visible acts of support and coordinated caregiving appeared to buffer distress and sustain meaning.

Theme 5: professional identity formation through experiential learning and role modeling

Experiential learning in disaster psychiatry contributed to students’ developing professional identities. Observing senior psychiatrists and interdisciplinary teams enabled students to integrate clinical reasoning, empathy, ethical boundaries, and collaborative practice into a coherent professional role.

“I learned that being a good doctor is not only about diagnosing disease, but about standing beside patients in their most vulnerable moments.” (P9)

Participants recognized both the limits of individual competence and the importance of interdisciplinary collaboration.

“We cannot solve every problem ourselves. Knowing when to involve other professionals is part of being a responsible physician.” (P16)

For several participants, the experience reshaped their perception of psychiatry and reinforced its relevance across medical specialties.

“I previously perceived psychiatry as abstract and difficult to understand. Now I recognize its relevance to everyday life.” (P8)

Theme 6: personal reflection and reorientation of values through patient encounters

Beyond professional development, participants described internal transformation prompted by encounters with patients and families in disaster-affected contexts. Witnessing resilience, relational commitment, and caregiving under conditions of adversity led many students to reassess their own values and perspectives on suffering.

Several participants described learning to recognize small sources of meaning amid hardship and integrating this perspective into their own lives.

“Seeing patients search for small happiness amid illness and flood-related suffering helped me practice finding small joys and positive meaning in my own life.” (P3)

Exposure to community perspectives also facilitated cognitive reframing of personal challenges.

“Just breathing and moving forward, this made me reflect on my own problems and realize that every problem has a way forward.” (P3)

Participants emphasized that these lessons extended beyond formal curricula. Encounters with vulnerability and resilience were described as forms of learning that could not be acquired through textbooks alone.

“Listening to a trembling voice, seeing empty eyes, or witnessing a smile despite suffering, these are lessons that textbooks cannot teach. Being a doctor requires using the heart as much as the mind.” (P8)

Profound reflections emerged particularly in relation to long-term family caregiving in chronic psychiatric and neurological illness. Witnessing sustained caregiving prompted students to reconsider dignity and reciprocity across the life course.

“It broadened and deepened my perspective on humanity. Visiting the patient made me realize that a ‘good family’ is the essential foundation of love.” (P5)

“It made me see the power of family. When we see a bedridden patient, we may forget that they were once strong, cheerful, and raised their children well. Their children grew up to be grateful and beautifully repay that kindness.” (P6)

“It allowed me to witness the bond of love between siblings who would never abandon each other, even in the most difficult times.” (P9)

Across narratives, familial love was described not only as emotional attachment but also as an enduring moral commitment shaped by memory, gratitude, and shared life experiences. These encounters prompted participants to reconsider their own assumptions about dignity, reciprocity, and responsibility in both professional and personal contexts.

Discussion

This study explored medical students’ reflective narratives following participation in disaster-related psychiatric and mental health care. Rather than focusing on the acquisition of discrete clinical competencies, the findings highlight how students made sense of emotionally and ethically complex clinical encounters. The disaster setting appeared to function as an integrative learning environment in which clinical reasoning, relational competence, and ethical awareness intersected. Although participants occasionally described emotionally demanding encounters, these experiences were generally framed as opportunities for learning and reflection rather than as barriers to participation. This may help explain why themes related to professional growth, empathy development, and meaning-making were more prominent than themes focused on distress or difficulty.

Compared with routine community placements, the disaster context was characterized by greater intensity, resource limitations, and visible disruptions to health and social systems, which may have heightened opportunities for reflection and learning. Taken together, the six themes suggest that experiential exposure in disaster psychiatry may support ongoing processes of professional identity formation while also prompting reflection on personal values and the human dimensions of medical practice.

Experiential and transformative learning in disaster contexts

Students’ reflections align with experiential and constructivist learning theories, which emphasize the transformation of concrete experience into reflective insight [6, 15]. The disaster context provided immersive exposure to uncertainty, resource constraints, disrupted systems of care, and visible human suffering. These features appeared to intensify reflective processing, encouraging students to move beyond procedural learning toward interpretive and moral sense-making.

Transformative learning theory proposes that disorienting experiences can catalyze perspective shifts through critical reflection [16]. The immediacy and emotional intensity of disaster-related psychiatric care may help explain why students described changes not only in knowledge but also in how they understood professional roles and responsibilities. Consistent with prior work linking transformative learning and professional identity development in emotionally salient contexts [17], our findings suggest that disaster exposure may function as a catalyst for integrative developmental processes extending beyond technical competence.

Systems-oriented clinical reasoning and social determinants of mental health

A prominent finding was students’ recognition that effective mental health care in disaster settings depends on addressing basic human needs. Reflections emphasizing safety, shelter, food security, and access to medication as prerequisites for psychological stabilization are consistent with international humanitarian mental health guidance [2, 18]. Students observed that distress often diminished when environmental stability was restored, reinforcing the foundational role of social and material conditions in mental well-being.

Students’ narratives also reflected increasing contextualization of psychiatric symptoms within broader environmental and structural conditions, as they differentiated between distress arising from deprivation and primary psychiatric pathology. This pattern of reasoning suggests movement beyond symptom-focused diagnosis toward a more contextual and systems-oriented clinical understanding. The biopsychosocial model provides a useful framework for interpreting these observations, as students increasingly considered how biological, psychological, and social factors interacted to shape patients’ experiences and mental health needs [19]. Within this broader framework, Maslow’s theory of human motivation offers an additional lens for understanding why unmet physiological and safety needs may precede psychological recovery in disaster settings [20]. In this way, students appeared to connect theoretical concepts with real-world disaster conditions when interpreting patients’ mental health needs.

Beyond individual-level reasoning, students’ reflections also implied an emerging understanding of inter-professional and cross-sector collaboration. Recognizing that psychological stabilization depended on coordination among medical teams, social services, community actors, and relief systems suggests that disaster psychiatry can expose learners to systems-based practice in a tangible way. This observation is consistent with international humanitarian mental health frameworks, which emphasize coordinated, multi-sectoral approaches to mental health and psychosocial support in emergency settings [2, 21].

Empathy as a regulated professional practice

Participants described reframing empathy from spontaneous emotional resonance to a deliberate, bounded, and sustainable professional practice. Clinical empathy has been conceptualized as a cognitive–affective capacity involving perspective-taking, emotional attunement, and reflective regulation [22]. Students’ distinction between empathy and sympathy suggests emerging professional self-regulation rather than emotional over-identification.

This interpretation aligns with patient-centered care frameworks that emphasize validation, respect, and collaborative engagement [23]. Observing faculty psychiatrists engage calmly and respectfully with distressed patients appeared central to this learning process. Role modeling is widely recognized as a powerful pedagogical strategy in medical education [7], and our findings reinforce its importance in cultivating relational and ethical dimensions of care within complex environments.

Importantly, students extended empathic attention beyond patients to caregivers and family members, recognizing their psychological burden and moral commitment. This broader relational awareness reflects a shift toward more context-sensitive and family-aware perspectives on care. Empathy, in this sense, was not confined to dyadic physician–patient interaction but embedded within networks of caregiving relationships. Such reflections also indicate growing sensitivity to human dignity beyond functional status or diagnostic labels.

Resilience, meaning-making, and integrative identity development

Students frequently reflected on resilience and meaning-making among disaster-affected individuals. Rather than viewing disaster solely as psychologically destructive, participants observed adaptive coping, relational strength, and the ability to locate hope within adversity. These observations appeared to prompt students to reflect on the values and commitments underlying their future professional roles [17].

Contemporary frameworks conceptualize professional identity formation as dynamic, relational, and socially situated, shaped through participation in authentic clinical communities [6, 8]. Students’ recognition of the limits of individual competence, their appreciation of interdisciplinary collaboration, and their redefinition of the physician’s role as one of presence and accompaniment align with calls to integrate identity formation into medical education discourse beyond competency frameworks alone [9].

Importantly, the findings also extend beyond role-based identity development. Many students described internalizing patients’ meaning-making processes, particularly the capacity to find small sources of hope, dignity, and relational love amid suffering. These reflections suggest elements of personal value reconsideration alongside professional development. Professional growth and personal transformation appeared intertwined rather than sequential. This observation resonates with scholarship highlighting reflection, relational engagement, and resilience as core processes in identity (trans)formation [24].

Notably, students’ reflections on long-term family caregiving revealed an appreciation of reciprocity across the life course, in which past acts of care were repaid through present commitment. Such narratives point to moral dimensions of medicine grounded in relational continuity and interdependence. Disaster contexts may concentrate experiences of uncertainty, moral complexity, and relational depth that are otherwise encountered more gradually during training.

These findings may also be interpreted through contemporary competency-based frameworks for mental health education. The World Health Organization’s guidance on pre-service education in mental, neurological, and substance use care emphasizes competencies that extend beyond knowledge acquisition, including person-centered care, communication skills, ethical practice, self-reflection, and professional development. Students’ narratives demonstrated several of these competencies, particularly through critical reflection on their assumptions, greater appreciation of patients’ lived experiences, and recognition of the physician’s role in addressing psychosocial consequences of disasters. Reflective practice emerged as a particularly salient competency, as students used structured reflection to examine emotional responses, integrate experiential learning, and reconsider professional values [25].

Similarly, the Inter-Agency Standing Committee (IASC) Guidelines on Mental Health and Psychosocial Support in Emergency Settings emphasize understanding the psychological and social impacts of disasters, respecting dignity, and responding to affected populations in culturally and contextually sensitive ways. Students’ reflections on empathy, family caregiving, social determinants of mental health, and interdisciplinary collaboration suggest that experiential learning in disaster psychiatry may contribute to the development of competencies aligned with these broader humanitarian and psychosocial care principles [21].

Implications for medical education

Our findings suggest that disaster-related psychiatric and mental health care exposure offers more than situational crisis training. These contexts may provide opportunities for integrative learning in which systems thinking, empathy regulation, and professional development emerge simultaneously. Integrating structured reflection within disaster medicine curricula may support the translation of emotionally complex experiences into sustained professional development. These findings align with calls to move beyond competency-based metrics toward more holistic approaches to professional formation in medical education [8, 9].

Educationally, these findings support incorporating supervised disaster or community-based psychiatric exposure with structured debriefing and reflective facilitation. This is consistent with Kolb’s experiential learning cycle, in which concrete experiences are transformed into learning through reflective observation, abstract conceptualization, and active experimentation [26]. Without guided reflection, emotionally intense experiences may not translate into constructive developmental integration. Curriculum designers should therefore consider pairing experiential immersion with longitudinal mentorship and reflective dialogue to support both adaptive growth and psychological safety. The findings also suggest potential value in community-based placements and supervised field visits that expose students to patients’ lived environments, family contexts, and social determinants of health. Such experiences may help foster systems-oriented clinical reasoning, person-centered care, and professional identity development.

Limitations

This study has several limitations. Data were derived from reflective narratives at a single medical school, which may limit transferability. Because reflections were submitted within an educational context supervised by faculty who were also researchers, social desirability bias and power dynamics may have influenced responses. Data were collected shortly after participation; therefore, longer-term implications for professional identity development and personal transformation could not be assessed. As an interpretive qualitative study, findings reflect both participants’ perspectives and researchers’ analytic interpretations.

Further study is needed to explore the longer-term educational impact of such experiences and to identify the pedagogical features that most effectively support developmental integration. Comparative and multi-institutional studies may clarify which elements of disaster-related psychiatric exposure most strongly contribute to professional identity formation and integrative learning. Mixed-methods designs integrating qualitative inquiry with validated quantitative measures could enhance methodological rigor and strengthen transferability. Future work should also examine both adaptive and potentially adverse developmental trajectories within emotionally intense clinical contexts. Future research may benefit from exploring a broader range of learner experiences, including potential difficulties, uncertainty, and emotional burden associated with disaster-related clinical exposure.

Conclusions

Participation in disaster-related psychiatric and mental health care offered medical students a meaningful experiential learning context. Participants’ reflections indicate that disaster settings were experienced as supporting systems-oriented clinical reasoning, a more deliberate understanding of empathy as professional practice, and a shift toward holistic, person-centered care. These experiences were also described as contributing to ongoing processes of professional identity development and, for some students, reflection on personal values. Structured experiential learning in complex, real-world contexts, when accompanied by supervision and guided reflection, may provide opportunities for students to engage with the cognitive, relational, and ethical dimensions of medical practice in an integrated manner.

Authors’ contributions

WW: conception and design of the study, analysis of data; JP: conception and design of the study, data collection, analysis of data, drafting of the manuscript; SD: conception and design of the study, analysis of data; JS: conception and design of the study, analysis of data; PK: conception and design of the study, analysis of data. All authors have approved the final manuscript.

Funding

This study had no funding.

Data availability

The datasets generated and/or analyzed during the current study are not publicly available due to the sensitive nature of the data and the need to protect participant confidentiality but are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

This study was approved by the Ethics Committee of the Faculty of Medicine, Prince of Songkla University (REC.69-078-3-1). All methods were carried out in accordance with relevant guidelines and regulations and complied with the Declaration of Helsinki. Written informed consent was obtained from all participants before participation. All reflective narratives were anonymized before analysis, and no identifying information was reported.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.