Moral distress in medical students: what ethical dilemmas did Hong Kong medical students identify in their clinical clerkships?

Abstract

Background & Purpose: Medical students in clinical clerkship are often confronted with ethically difficult situations, where behaviours they witness conflicted with their knowledge and understanding of professionalism. Students often do not act on these situations as they feel powerless. Moral distress is the negative feelings of a person who believes he or she knows the morally correct response to a situation, but is unable to act accordingly due to external constraints. (1) This distress can have a negative impact on the student and affect patient care. This study examines the kinds of dilemmas medical students encounter and how they respond to them. Methods: A retrospective qualitative thematic analysis was done on the assignment submissions from Year 4 medical students during their Junior Clerkship. Students were asked to identify an ethical issue they encountered during their clerkship and to discuss and justify possible resolutions compared to what actually occured. The anonymised assignments were coded and analysed for recurrent themes.ety, burn out, doctors, medical college teachers Results: Students identified ethical issues regarding patient autonomy, informed consent, tension between patient care and student learning, patient care approaches (e.g. use of restraints, unnecessary prescriptions, end-of-life options) and resource allocation. Most students, who might not be able to act or voice out on the spot, were able to use ethical principles to examine the various issues underpinning the dilemma and possible resolutions. Conclusions: Medical students experienced various kinds of ethical dilemmas during clerkships most of which were consistent with what has been reported in the international literature. Opportunities to share, have open discussions and to debrief about such issues in a safe environment is essential in medical education. Reference: 1. Jameton A. Nursing practice: The ethical issues. Englewood Cliffs, NJ: Prentice-Hall; 1984.