Purpose: To examine students’ responses to reflective practice assignments used in medical ethics and professionalism education. The study goals include an examination of what reflective writing reveals about students’ personal and professional values, identification of the narrative typologies students use to tell stories of ethical dilemmas, and a determination of the usefulness of reflective writing in informing ethics/professionalism curricula assessment and development.
Method: This study employed a mixed-methods design generating both descriptive data and interpretive analysis. Students’ reflective writing assignments, guided by a series of six questions designed to elicit students’ perceptions of moral conflicts they have encountered and their personal and professional ethical values, were collected from three successive cohorts of third-year medical students (n = 299) from July 2002 to January 2006 during an obstetrics-gynecology clerkship at the University of California, Irvine, School of Medicine. Content, thematic, and global narrative analyses of students’ reflective writing were conducted, drawing on content analysis, grounded theory, and narrative methodologies.
Results: Values conflicts usually were patient centered (181; 60.5%) and student centered (172; 57.5%), without much regard for important contextual issues such as patients’ socioeconomic status, insurance coverage, or culture. Common personal values included religious beliefs (82; 27.4%), respect (72; 24.1%), and the Golden Rule (66; 22.1%); frequent professional values were respect (72; 25.1%), beneficence (71; 23.7%), nonmaleficence (69; 23.1%), and autonomy (65; 21.7%). Whereas 35.5% (106) claimed to have addressed conflicts, 23.4% (70) said they did nothing. Restitution narratives (113; 37.8%) dominated.
Conclusions: This analytic approach facilitated assessment of student values, conflict sources, and narrative types. Findings reveal aspects of the influence of the hidden curriculum and can inform strategies for effective implementation of bioethics/professionalism curricula.
Dr. Cohn is director of medical ethics and associate professor, Department of Internal Medicine, University of California, Irvine School of Medicine, Irvine, California.
Dr. Shapiro is director of medical humanities and professor, Department of Family Medicine, University of California, Irvine School of Medicine, Irvine, California.
Dr. Lie is director, Research and Faculty Development, Department of Family Medicine, University of California, Irvine School of Medicine, Irvine, California.
Dr. Boker is vice president for academic affairs, Geisinger Health System, Danville, Pennsylvania.
Ms. Stephens is a research associate, Office of Medical Education, University of California, Irvine School of Medicine, Irvine, California.
Ms. Leung is a research assistant, Office of Medical Education, University of California, Irvine School of Medicine, Irvine, California.
Please see the end of this article for information about the authors.
Correspondence should be addressed to Dr. Cohn, University of California, Irvine School of Medicine, Educational Affairs, Berk Hall, Bldg 802, Irvine, CA 92697; telephone: (949) 824-9158; fax: (949) 824-2485; e-mail: (firstname.lastname@example.org).