Landa-Galindez Amalia, Armas Melissa L, Coronel-Couto Gloria
Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA.
Department of Medical Education, Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdalea, FL, USA.
Med Teach. 2025 May;47(5):835-841. doi: 10.1080/0142159X.2024.2374943. Epub 2024 Jul 16.
We aimed to develop a tool that would allow assessment of ethics competency and moral distress during the Internal Medicine Clerkship and to introduce curricular changes that could empower students to better address ethical dilemmas and challenges encountered during the clerkship.
A structured ethics assignment was introduced where students could reflect on impactful stressful scenarios and address questions related to emotional responses, identified ethical issues, management themes, and professional obligations. A 4-tiered grading rubric and individual narrative feedback was provided for each assignment, and small-group debriefing sessions were introduced for reflective thought and future planning. De-identified assignments were analyzed and classified into subgroups according to 5 main ethical issue subgroups and 10 specific management themes. Assignments were also analyzed for the presence of moral distress.
357 students completed the reflective ethics activities. The most commonly identified ethical issues were related to Shared Medical Decision Making (>40%), Primary of Patient Welfare challenges, (>20%), and Social/Organizational dilemmas. Management themes often pertained to Patient Wishes/Legal Obligations, Professional Behaviors, and Limited Resources. 87% of assignments demonstrated moral distress.
Medical school is a stressful time and challenges are augmented during clinical years. Our reflective activity demonstrated significant exposures to ethical dilemmas, reviewed earlier principles of ethics training, and provided a safe forum in which to discuss these important aspects of healthcare. We captured powerful images of challenging situations eliciting moral distress, and students greatly appreciated the activity. We encourage future investigations that support student well-being and enable smooth transitions into residency training.
我们旨在开发一种工具，用于评估内科实习期间的伦理能力和道德困扰，并引入课程改革，使学生能够更好地应对实习期间遇到的伦理困境和挑战。
引入了一项结构化的伦理作业，学生可以反思有影响力的压力情境，并回答与情绪反应、确定的伦理问题、管理主题和职业义务相关的问题。为每项作业提供了一个四级评分标准和个人叙述性反馈，并引入了小组汇报环节，以促进反思性思考和未来规划。对匿名作业进行分析，并根据5个主要伦理问题子组和10个具体管理主题进行分类。还分析了作业中道德困扰的存在情况。
357名学生完成了反思性伦理活动。最常确定的伦理问题与共同医疗决策（>40%）、患者福利首要挑战（>20%）和社会/组织困境有关。管理主题通常涉及患者意愿/法律义务、职业行为和资源有限。87%的作业表现出道德困扰。
医学院是一个压力较大的时期，临床阶段的挑战会加剧。我们的反思活动表明学生大量接触到伦理困境，回顾了早期的伦理培训原则，并提供了一个安全的论坛来讨论医疗保健的这些重要方面。我们捕捉到了引发道德困扰的具有挑战性情况的有力画面，学生们非常赞赏这项活动。我们鼓励未来开展支持学生福祉并使其顺利过渡到住院医师培训的研究。
