Abstract
BackgroundMedical students transitioning into professional practice feel underprepared to deal with the emotional complexities of real-life ethical situations. Simulation-based learning (SBL) may provide a safe environment for students to probe the boundaries of ethical encounters. Published studies of ethics simulation have not generated sufficiently deep accounts of student experience to inform pedagogy. The aim of this study was to understand students’ lived experiences as they engaged with the emotional challenges of managing clinical ethical dilemmas within a SBL environment.MethodsThis qualitative study was underpinned by an interpretivist epistemology. Eight senior medical students participated in an interprofessional ward-based SBL activity incorporating a series of ethically challenging encounters. Each student wore digital video glasses to capture point-of-view (PoV) film footage. Students were interviewed immediately after the simulation and the PoV footage played back to them. Interviews were transcribed verbatim. An interpretative phenomenological approach, using an established template analysis approach, was used to iteratively analyse the data.ResultsFour main themes emerged from the analysis: (1) ‘Authentic on all levels?’, (2)‘Letting the emotions flow’, (3) ‘Ethical alarm bells’ and (4) ‘Voices of children and ghosts’. Students recognised many explicit ethical dilemmas during the SBL activity but had difficulty navigating more subtle ethical and professional boundaries. In emotionally complex situations, instances of moral compromise were observed (such as telling an untruth). Some participants felt unable to raise concerns or challenge unethical behaviour within the scenarios due to prior negative undergraduate experiences.ConclusionsThis study provided deep insights into medical students’ immersive and embodied experiences of ethical reasoning during an authentic SBL activity. By layering on the human dimensions of ethical decision-making, students can understand their personal responses to emotion, complexity and interprofessional working. This could assist them in framing and observing appropriate ethical and professional boundaries and help smooth the transition into clinical practice.Electronic supplementary materialThe online version of this article (doi:10.1186/s41077-016-0027-9) contains supplementary material, which is available to authorized users.
Highlights
Medical students transitioning into professional practice feel underprepared to deal with the emotional complexities of real-life ethical situations
Participants recounted the Simulation-based learning (SBL) activity as feeling both true to life, yet at the same time recognising its artificial nature—‘a nice touch’: It was the fact that there was other things going on as well there were people walking around you could see, you know you were looking about seeing and noticing that there were different things going on
This study provided an opportunity to gain a deeper insight into the lived experiences of students as they encounter ethical dilemmas in an immersive SBL environment
Summary
Medical students transitioning into professional practice feel underprepared to deal with the emotional complexities of real-life ethical situations. Clinicians encounter many ethical dilemmas in practice that require careful management to avoid significant harm occurring to patients, carers and healthcare providers. These ethical issues are acute for medical students in their transition to becoming junior doctors. Ethical dilemmas and the associated interpersonal interactions are cited by junior doctors as key areas of unpreparedness in which they often encounter moral distress [1] This moral distress can occur when a conviction as to what is the ethically correct thing to do is constrained by institutions and structures that prevent realisation of this desired course of action. This distress can result in moral injury manifesting as psychological and emotional harm suffered when individuals are repeatedly subject to taxing ethical and emotional situations for which they feel unprepared and which go against moral norms or expectations [2]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
