Lewis Gareth, McCullough Melissa, Maxwell Alexander P, Gormley Gerard J
1Centre for Medical Education, Queen's University Belfast, Belfast, Northern Ireland.
2Department of Clinical Medicine, Brighton and Sussex Medical School, Brighton, UK.
Adv Simul (Lond). 2016 Aug 8;1:26. doi: 10.1186/s41077-016-0027-9. eCollection 2016.
Medical 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' as they engaged with the emotional challenges of managing clinical ethical dilemmas within a SBL environment.
This 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.
Four 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.
This 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.
即将进入专业实践阶段的医学生感觉自己在应对现实生活中伦理情境的情感复杂性方面准备不足。基于模拟的学习（SBL）可能为学生提供一个安全的环境，以探索伦理遭遇的边界。已发表的伦理模拟研究尚未对学生的体验进行足够深入的描述，以指导教学。本研究的目的是了解学生在基于模拟的学习环境中应对临床伦理困境的情感挑战时的情况。
本定性研究以解释主义认识论为基础。八名高年级医学生参加了一项基于病房的跨专业SBL活动，其中包含一系列具有伦理挑战性的遭遇。每个学生都佩戴数字视频眼镜来拍摄第一视角（PoV）的影片素材。模拟结束后立即对学生进行访谈，并向他们播放PoV素材。访谈内容逐字记录。采用一种既定的模板分析方法的解释性现象学方法对数据进行迭代分析。
分析得出四个主要主题：（1）“各方面都真实吗？”，（2）“让情感流淌”，（3）“伦理警钟”和（4）“儿童与幽灵的声音”。学生们在SBL活动中认识到许多明确的伦理困境，但在处理更微妙的伦理和专业边界方面存在困难。在情感复杂的情况下，观察到了道德妥协的情况（例如说谎）。由于本科阶段之前的负面经历，一些参与者在情境中感到无法提出担忧或挑战不道德行为。
本研究深入洞察了医学生在真实的SBL活动中进行伦理推理的沉浸式和具身化体验。通过叠加伦理决策的人文维度，学生可以理解自己对情感、复杂性和跨专业合作的个人反应。这可以帮助他们构建并遵守适当的伦理和专业边界，并有助于顺利过渡到临床实践。
