Ethical learning on international medical electives: a case-based analysis of medical student learning experiences

Gemma Bowsher,Anna Georgeson,Laura Parry-Billings,Paula Baraitser

doi:10.1186/s12909-018-1181-7

Abstract

BackgroundStudents on international medical electives face complex ethical issues when undertaking clinical work. The variety of elective destinations and the culturally specific nature of clinical ethical issues suggest that pre-elective preparation could be supplemented by in-elective support.MethodsAn online, asynchronous, case-based discussion was piloted to support ethical learning on medical student electives. We developed six scenarios from elective diaries to stimulate peer-facilitated discussions during electives. We evaluated the transcripts to assess whether transformative, experiential learning took place, assessing specifically for indications that 1) critical reflection, 2) reflective action and 3) reflective learning were taking place. We also completed a qualitative thematic content analysis of the discussions.ResultsOf forty-one extended comments, nine responses showed evidence of transformative learning (Mezirow stage three). The thematic analysis identified five themes: adopting a position on ethical issues without overt analysis; presenting issues in terms of their effects on students’ ability to complete tasks; describing local contexts and colleagues as “other”; difficulty navigating between individual and structural issues, and overestimation of the impact of individual action on structures and processes.ConclusionResults suggest a need to: frame ethical learning on elective so that it builds on earlier ethical programmes in the curriculum, and encourages students to adopt structured approaches to complex ethical issues including cross-cultural negotiation and to enhance global health training within the curriculum.

Highlights

Students on international medical electives face complex ethical issues when undertaking clinical work
This study examines whether such a programme can assist students on their electives undergo Mezirow’s Transformative learning, and develop skills in 1) critical reflection, 2) reflective action and 3) reflective learning [6, 7]
We did not find evidence that medical students on our ethical electives programme went through a process of transformative learning as defined by Mezirow, in response to the complex ethical issues they experienced on electives

Summary

Introduction

Students on international medical electives face complex ethical issues when undertaking clinical work. Electives offer experiential learning through exposure to different models of heath care, unfamiliar professional cultures and new social contexts [4]. They may encourage transformative learning [5] whereby students become more aware of the assumptions they make regarding unfamiliar situations, and question and modify these in response [6, 7]. One way in which electives may stimulate both experiential and transformative learning is by presenting ethically complex situations, such as opportunities to practice beyond competence [8, 9], exposure to alternative ethical paradigms and use of scarce local resources for learning [10]. Rahim et al (2016) have described 13 ethical situations that medical students should be prepared to manage on elective [11]

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Conclusion