Moral judgement development during medical student clinical training

Abstract

Background Whereas experience and cognitive maturity drives moral judgement development in most young adults, medical students show slowing, regression, or segmentation in moral development during their clinical years of training. The aim of this study was to explore the moral development of medical students during clinical training. Methods A cross-sectional sample of medical students from three clinical years of training were interviewed in groups or individually at an Australian medical school in 2018. Thematic analysis identified three themes which were then mapped against the stages and dimensions of Self-authorship Theory. Results Thirty five medical students from years 3–5 participated in 11 interviews and 6 focus groups. Students shared the impacts of their clinical experiences as they identified with their seniors and increasingly understood the clinical context. Their accounts revealed themes of early confusion followed by defensiveness characterised by desensitization and justification. As students approached graduation, some were planning how they would make moral choices in their future practice. These themes were mapped to the stages of self-authorship: External Formulas, Crossroads and Self-authorship. Conclusions Medical students recognise, reconcile and understand moral decisions within clinical settings to successfully reach or approach self-authorship. Curriculum and support during clinical training should match and support this progress.

Tough Clinical Decisions: Experiences of Polish Physicians

“…Fourthly, “insensitivity” to difficult ethical (or other non-medical) aspects of healthcare practice can be acquired in the process of informal and tacit modes of secondary socialization (so called “hidden curriculum”) by which professional cultures are communicated to new members, i.e., medical students and young physicians (Hafferty & Franks, 1994 ; Vaidyanathan 2015 ). When senior physicians, i.e., the main agents of the professional socialization, act paternalistically towards their patients, stick to the rigid hierarchical authority structure of the medical teamwork and healthcare decision-making, and when they present themselves as being desensitized and morally detached, there is a high risk that their younger colleagues will mimic these emotional and behavioral patterns in their future professional life (Lind, 2000 ; Hren et al, 2011 ; McDonald et al, 2021 ). The revealed reduction in frequency of ethical (and other non-medical) problems encountered by Polish physicians, when considering their years of experience, provides support for this explanation.…”

Moralische Kompetenz bei Medizinstudierenden – Vergleich zwischen Studierenden des ersten Semesters und des Praktischen Jahres

“…Somit scheint wie bereits in vorangegangenen Studien berichtet die moralische Kompetenz in höheren Studiensemestern eher zu stagnieren bzw. sogar abzunehmen 1 3 4 28 . Weder die größere praktische Erfahrung der Studierenden in höheren Fachsemestern noch die erfolgte Teilnahme am Studienfach Ethik scheinen sich daher auf die moralische Kompetenz der Studierenden positiv auszuwirken 29 .…”

“…Wären diese Studierenden hypothetisch eingeschlossen worden, wäre mit einer Verfälschung der Ergebnisse zu rechnen gewesen, da beide Aspekte sich eigenständig auf die moralische Kompetenz auswirken können 25 26 27 . Zudem muss Erwähnung finden, dass die erreichten C-Werte der Studierenden insgesamt deutlich unter den zu erwartenden Werten im Vergleich zu Vorstudien lagen 1 4 28 . Möglicherweise ist dies mit der relativ geringen Teilnehmendenzahl und dem damit verbundenen Stichprobencharakter zu erklären.…”

“…Diverse Studien untersuchten in der Vergangenheit die Entwicklung der moralischen Kompetenz im Studienverlauf bei Studierenden unterschiedlichster Fachdisziplinen 1 2 3 4 . Entgegen der allgemeinen Annahme einer Weiterentwicklung der moralischen Kompetenz im Studienverlauf und mit fortschreitendem Lebensalter wurde jedoch eine Regression derselbigen bei Studierenden der Medizin konstatiert 1 .…”

Exploring Professionalism Dilemma and Moral Distress through Medical Students’ Eyes: A Mixed-Method Study

“…Research suggested the distress resulting from professionalism dilemmas induced long-lasting emotional episodes compromising mental well-being. Medical students felt burnout [ 14 ], emotional breakdown [ 15 , 16 ], and guilty [ 5 , 17 ] in the face of professionalism dilemmas. Some students have even dropped out of medical school or chosen a non-clinical specialty as a result [ 18 ].…”