An investigation of change in medical students' ethical thinking

Changes in wellbeing and professional values among medical undergraduate students: a narrative review of the literature

BACKGROUND

Educators are concerned by the high prevalence of emotional distress among medical students, and by the alleged decline in their humanitarian values.

OBJECTIVE

To re-examine these concerns by reviewing studies of medical students' wellbeing and development.

METHOD

Narrative review of the literature.

MAIN FINDINGS

(a) Medical students' emotional distress increases during their undergraduate training. However, although higher than in the general population, the prevalence of distress among medical students is similar to that among other university students. (b) Medical students' distress is independently related to endogenous factors (personality traits and life events) and to their perception of the medical learning environment. (c) Medical students do not display a measurable increase in moral reasoning, empathy and tolerance of uncertainty. (d) Students' wellbeing, moral development, reflectivity and tolerance of uncertainty have been shown to be interrelated, and associated with clinical performance.

CONCLUSIONS

The findings of this review endorse the concerns about the wellbeing and development of undergraduate medical students. The design of the reviewed studies does not permit inferences about causality. Yet, these findings are consistent with the hypothesis that medical training causes emotional distress that delays students' development and affects their clinical performance.

The defining issues test and the four component model: contributions to professional education

This article reviews studies examining the effect of professional education on ethical development. Most studies limit assessment to the measurement of moral judgement, observing that moral judgement plateaus during professional school unless an ethics intervention is present. Whereas interventions influence the shift to postconventional reasoning (the DIT P score), a more illuminating picture of change may emerge if researchers examined DIT profiles. More importantly, limiting assessment to measures of moral judgement ignores important aspects of moral functioning suggested by the Four Components Model. Assessment methods have been validated for sensitivity, role concept and ethical implementation that could be adapted to provide individuals in a particular profession with a more complete picture of abilities needed for real-life professional practice.

Evaluating professionalism in emergency medicine: clinical ethical competence

While the teaching and assessing of technical skills have been an integral part of residency training, the demonstration of ethical and humanistic skills has been more or less left to chance. Only in the last two decades has the formal teaching of bioethics become an accepted component of Western medical education. In spite of the many ethics lectures, discussions, conferences, and courses, the clinical impact of this educational paradigm shift remains unclear. Most ethics assessments to date are conducted retrospectively by risk managers and attorneys. The few prospective evaluations of trainees have focused on single-researcher observations or student attitude surveys that are fraught with observer and recall biases, respectively. More reliable and valid methods of identifying clinical ethical competence are needed. This paper reviews a variety of evaluative tools and suggests a three-level approach to monitoring the ethical knowledge, capacity, and real-time performance of emergency medicine residents.

Moral reasoning and behavior of striking physicians in Israel

Routine daily experience does not always provide physicians and moral researchers the opportunity to focus on the ways in which personal moral values are put into practice. An extreme situation—a physicians' strike—provided such an opportunity. This paper is based on interviews with 50 Israeli striking physicians. The extent to which the physicians' justifications of their action reflected their moral competence, is discussed.