| Increasing bioethics education in preclinical medical curricula: what ethical dilemmas do clinical clerks experience? | |
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MedLine Citation:
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PMID: 19318789 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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PURPOSE: The increase in bioethics education in preclinical curricula enables medical students to recognize ethical issues and determine right action. The authors sought to explore the ethical dilemmas medical students experience during clinical clerkships. METHOD: Following an e-mail invitation, 100 of 104 graduating medical students allowed their final ethics assignment, a written description of an ethical dilemma experienced during clinical clerkship, to be analyzed. After all identifiers were removed, the narratives underwent qualitative analysis and were then reanalyzed using Jameton's determinants of moral action. RESULTS: Four themes emerged: the clinical service rotation, target, source, and nature of the ethical dilemma. For many clinical clerks, the ethical dilemma arose because they recognized an ethical issue but neither brought it to their supervisors nor resolved it themselves for fear of incurring disfavor. The source of the ethical dilemma was most frequently the student's supervisor (46%), which may explain why, although all narratives demonstrated the Jameton criteria of "moral sensitivity" and 76% demonstrated "moral judgment," only 24% indicated "moral motivation" and only 4% suggested "moral courage." Patients were the most frequent target (76%), followed by students (14%). Students reported informed consent (18%) and inadequate care (17%) as the most common types of dilemmas under the nature theme. CONCLUSIONS: Clinical clerks' experiences of ethical dilemmas might be mitigated if residency education and professional development mirrored the increase in preclinical ethics education, if ethics training included encouraging students to discuss ethical issues as they arise, and if educators developed innovative models of student evaluation. |
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Authors:
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Emily Kelly; Jeff Nisker |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Academic medicine : journal of the Association of American Medical Colleges Volume: 84 ISSN: 1938-808X ISO Abbreviation: Acad Med Publication Date: 2009 Apr |
Date Detail:
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Created Date: 2009-03-25 Completed Date: 2009-04-23 Revised Date: 2009-11-19 |
Medline Journal Info:
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Nlm Unique ID: 8904605 Medline TA: Acad Med Country: United States |
Other Details:
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Languages: eng Pagination: 498-504 Citation Subset: AIM; IM |
Affiliation:
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Family Medicine, The Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Attitude of Health Personnel Bioethics / education* Clinical Clerkship* Curriculum Education, Medical, Undergraduate Humans Informed Consent / ethics Medicine Ontario Patient Care / ethics Resuscitation Orders / ethics Specialization Students, Medical / psychology* |
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