Abstract
BackgroundWhereas 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.MethodsA 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.ResultsThirty 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.ConclusionsMedical 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.
Highlights
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 inability to act upon moral judgements causes moral distress [17], and this emotional response may be a factor in the disruption of moral development
We explore medical student moral judgement development in the clinical setting through the lens of Baxter Magolda’s self-authorship theory [7]
Summary
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. Modern medical practice requires the synthesis of knowledge, skills and wisdom to ensure optimal care matches patient need, context and available resources. This requires access to the latest literature and clinical guidelines, but sound moral judgement [1]. Medical students are vulnerable to moral distress because of their low place in the healthcare system hierarchy. They are required to accept the right answer in a clinical setting rather than to use critical reasoning to solve problems [9] or their moral judgement
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