DiBrito Sandra, Mago Jacob, Reczek Annika, Suresh Dharshini, Kim Daniel, Jacoby Liva, Shelton Wayne
Department of Surgery, Albany Medical College, Albany NY.
Department of Surgery, Albany Medical College, Albany NY; Alden March Bioethics Institute, Albany Medical College, Albany NY.
J Surg Educ. 2024 Nov;81(11):1720-1729. doi: 10.1016/j.jsurg.2024.08.018. Epub 2024 Sep 18.
The norms governing surgical training warrant a deeper understanding of students' experiences and interpretations of professionalism issues in their learning environment. However, there is scant empirical evidence to describe this process. To fill this gap, we analyzed students' perceptions related to professionalism, moral distress, and communication in the surgical clerkship, particularly regarding their clinical supervisors, whom we refer to as mentors.
We retrospectively evaluated written case vignettes and survey responses from medical students on their surgical clerkships regarding their experiences of cases which raised professionalism concerns. Vignettes and surveys were part of standard curricular exercises and analyzed using both qualitative and quantitative methods.
Our study was conducted at a private academic medical college in the northeast with an affiliated institute of bioethics.
Two-hundred forty-one third year medical students on their surgical clerkships participated through required curricular submissions of case vignettes and surveys.
Vignettes and surveys from all 241 students were collected and analyzed. Of these, 106 (43.9%) were identified by the students as relating to professionalism, whereas the research team identified 148 (61.4%) cases as such. Major subtypes of professionalism concerns were categorized as "not showing proper respect" (38.5%), bias (30.4%) and "failure to meet medical standards of care" (29.1%). In professionalism cases, only 27.7% of students would emulate their mentor, 19.7% shared concerns with the mentor, and 58.8% experienced moral distress, all significantly worse than in nonprofessionalism cases (p < 0.001).
With an abundance of professionalism concerns noted, students experienced high rates of moral distress and were unlikely to share concerns with clinical mentors who they generally did not wish to emulate. Attention should be paid to providing a formal curricular venue in which students can discuss their concerns, as untoward experiences in the learning environment risk harming their learning and professional identity development.
规范外科培训的准则需要我们更深入地了解学生在学习环境中对专业素养问题的经历和理解。然而，几乎没有实证证据来描述这一过程。为了填补这一空白，我们分析了学生在外科实习期间对专业素养、道德困扰和沟通的看法，特别是关于他们的临床带教老师（我们称之为导师）的看法。
我们回顾性评估了医学生在外科实习期间就引发专业素养问题的病例经历所撰写的病例 vignettes 和调查回复。vignettes 和调查是标准课程练习的一部分，并采用定性和定量方法进行分析。
我们的研究在东北部一所私立学术医学院及其附属生物伦理研究所进行。
241 名三年级医学生通过课程要求提交病例 vignettes 和调查参与了研究。
收集并分析了所有 241 名学生的 vignettes 和调查。其中，106 名（43.9%）学生认为与专业素养相关，而研究团队认定此类病例有 148 名（61.4%）。专业素养问题的主要子类型被归类为“缺乏应有的尊重”（38.5%）、偏见（30.4%）和“未达到医疗护理标准”（29.1%）。在专业素养相关病例中，只有 27.7%的学生会效仿他们的导师，19.7%的学生与导师分享了担忧，58.8%的学生经历了道德困扰，所有这些情况均显著比非专业素养相关病例更糟（p < 0.001）。
鉴于发现了大量的专业素养问题，学生经历了高比例的道德困扰，并且不太可能与他们通常不想效仿的临床导师分享担忧。应该注意提供一个正式的课程场所，让学生可以讨论他们的担忧，因为学习环境中的不良经历可能会损害他们的学习和职业身份发展。
