“To obey or not to obey” - Medical students’ response towards professional dilemmas in a hierarchical and collectivist culture

Abstract

Background Clinical clerkship programme in medical schools were developed to provide students with direct interactions with patients and observe clinical teachers in practice. However, professional dilemmas are prone to occur due to the nature of experiential learning. Several studies across different cultures showed that medical students responded differently towards professional dilemma. Aims This study aims to explore how medical students respond to professional dilemmas occurred during their clinical clerkships and to what extent culture influences the responses. Method A qualitative descriptive approach was used in this study. We conducted four focus group discussions with final year medical students who were selected using maximum variety sampling method. Thematic analysis was conducted following the transcription of the focus groups. Results We identified the impact of dilemmas on students’ emotions and concerns, students’ responses towards professional dilemmas, and factors affecting responses to dilemmas in clinical clerkship, which confirmed that cultures played roles in how students responded towards professional dilemmas. Conclusion This study has identified that culture, to some extent, influenced the way students responded to professional dilemmas. Therefore, it is paramount to develop a conducive and culturally sensitive educational environment and students’ ability to learn from professional dilemma experienced in the workplace for developing their professional identity.

Challenges and opportunities in cultivating medical students’ competencies: Participatory action research from a hierarchical cultural setting

“…The FOG phenomena may take place differently in different settings. Yet, it could be more influential towards students in the current setting since they might have felt discouraged to speak up and instead prioritize their acceptance and connectedness in the learning environment [ 34 ]. It is necessary to provide psychological safety, encouragement for students to seek feedback, and clear expectations from the teachers in feedback dialogue and follow-up.…”

Professional identity formation of medical students: A mixed-methods study in a hierarchical and collectivist culture

“…Encouragement of such reflective inquiries by students is necessary as it would facilitate their learning and their ability to take advantage for their professional development, even from the negative role modelling [ 42 ]. Coming from a culture where uncertainty tends to be highly avoided, this study underscores the importance of a more teacher-driven, structured, longitudinal approach, providing clear guidance and guidelines for students, to conduct reflective practice and in seeking feedback from their mentors [ 12 , 23 ].…”

“…Those behaviors require further identification of underlying problems, remediation and even case dismissal if necessary [ 22 ]. Furthermore, a study in a hierarchical and collectivist culture underscores the strong influence of the culture towards clinical year students’ responses when they encounter professional dilemma [ 23 ], showing that professionalism and professional identity formation are always contextual and should consider sociocultural backgrounds [ 24 ].…”

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

“…Studies showed that moral distress contributed to lower quality of patient care, cynical attitudes [ 35 , 36 ], diminished empathy [ 37 ], and accumulated over time and led to new morally stressful dilemmas [ 34 ]. A responsive reporting system, authority figure, and follow-up mechanism were facilitators in acting on professionalism dilemmas [ 38 ].…”