Abstract
BackgroundEfforts have begun to characterize the ethical and professional issues encountered by medical students in their clinical years. By applying previously identified taxonomies to a national sample of medical students, this study seeks to develop generalizable insights that can inform professional identity formation across various clerkships and medical institutions.MethodsIn a national survey of medical students, participants answered an open-ended survey item that asked them to describe a clinical experience involving an ethical or professional issue. We conducted a content analysis with these responses using the Kaldjian taxonomy of ethical and professionalism themes in medical education through an iterative, consensus-building process. Noting the emerging virtues-based approach to ethics and professionalism, we also reexamined the data using a taxonomy of virtues.ResultsThe response rate to this survey item was 144 out of 499 eligible respondents (28.9%). All 144 responses were successfully coded under one or more themes in the original taxonomy of ethical and professional issues, resulting in a total of 173 coded responses. Professional duties was the most frequently coded theme (29.2%), followed by Communication (26.4%), Quality of care (18.8%), Student-specific issues of moral distress (16.7%), Decisions regarding treatment (16.0%), and Justice (13.2%). In the virtues taxonomy, 180 total responses were coded from the 144 original responses, and the most frequent virtue coded was Wisdom (23.6%), followed by Respectfulness (20.1%) and Compassion or Empathy (13.9%).ConclusionsOriginally developed from students’ clinical experiences in one institution, the Kaldjian taxonomy appears to serve as a useful analytical framework for categorizing a variety of clinical experiences faced by a national sample of medical students. This study also supports the development of virtue-based programs that focus on cultivating the virtue of wisdom in the practice of medicine.
Highlights
Efforts have begun to characterize the ethical and professional issues encountered by medical students in their clinical years
Placing ethics education in the pre-clinical years is limiting, for at least three reasons: it neglects what is widely recognized as the longitudinal nature of ethics formation [2]; it does not provide opportunities for practical reasoning when students most need it as they encounter concrete ethically complex clinical situations [3]; and the clinical clerkships contain powerful experiences conducive to professional identity formation [4,5,6] in which students learn to navigate ethical or professional issues that arise over the course of learning to care for patients
The Kaldjian taxonomy included 7 major coded themes (Decisions regarding treatment, Communication, Professional duties, Justice, Studentspecific issues, Quality of care, and Miscellaneous) which attempted to capture a wide range of experience-based observations from medical students rather than relying on abstract concepts in ethics and professionalism curricula
Summary
Efforts have begun to characterize the ethical and professional issues encountered by medical students in their clinical years. The Kaldjian taxonomy included 7 major coded themes (Decisions regarding treatment, Communication, Professional duties, Justice, Studentspecific issues, Quality of care, and Miscellaneous) which attempted to capture a wide range of experience-based observations from medical students rather than relying on abstract concepts in ethics and professionalism curricula. Given that this was limited to a single institution, we wanted to test whether this same taxonomy would prove useful when analyzing data from a national sample of medical students, yielding more generalizable insights from the taxonomy to inform professional identity formation more broadly
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