Medical students learning intimate examinations without valid consent: a multicentre study

Rees, Charlotte E.; Monrouxe, Lynn V.

doi:10.1111/j.1365-2923.2010.03911.x

Cited by 53 publications

(63 citation statements)

References 19 publications

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“…The second finding suggests that students' empathy for patients related to unjustified unethical events does not decline across their education, but remains steady [2]. Indeed, across many of our studies investigating students' dilemmas, students frequently reported experiencing distress during and sometimes up to a year after these events and narrated events with a great deal of negative emotion [2,[6][7][8]11]. Having examined students' emotional reactions to their experiences of professionalism dilemmas, we now consider in greater depth students' actions in the face of their dilemmas and the reasons they give for such actions.…”

Section: Moral Distress and Its Correlatesmentioning

confidence: 99%

“…Rees and Monrouxe also examined 71 narratives of medical students who were asked by senior clinicians to undertake intimate examinations without valid patient consent to understand students' reasoning concerning why they complied or resisted and, if they resisted, how [11]. Only 18 percent reported resisting senior clinicians' requests to conduct intimate examinations without valid patient consent.…”

Section: Professionalism Dilemmas: Acts Of Resistance and Compliancementioning

confidence: 99%

“…Only 18 percent reported resisting senior clinicians' requests to conduct intimate examinations without valid patient consent. Students cited multiple reasons for complying including, most commonly, their desire to fulfill their higher-order obligations to observe and perform, the strong climate of social acceptability (i.e., their peers and other seniors did not complain), their strong desire to learn, and their belief that doing so benefited the patient [11]. Reasons for resisting included the lack of consent, belief that the examination was inappropriate or unnecessary, and that features of the situation facilitated refusal (e.g., the request came from a less senior person) [11].…”

Section: Professionalism Dilemmas: Acts Of Resistance and Compliancementioning

confidence: 99%

“…Each situation will have different affordances highlighting one facet or another of any given moral value. Thus, when faced with morally dubious situations-such as being asked to participate in lapses of patient consent by senior clinicians during workplace learning events-medical students' subsequent actions (compliance or resistance) differ [10,11].…”

Section: Moral Decision Making: Ethics Of Conduct Character and Dutymentioning

confidence: 99%

“…Thus the dilemma students experience when witnessing professionalism lapses by seniors is whether to report such behaviors or turn a blind eye, and their dilemma when asked to participate in professionalism lapses is whether to comply with the request or resist [7]. Given the high degree of abuse that medical students report at the hands of their seniors within the health care workplace [2], resistance strategies need careful deliberation [8,11,12]. Thus, professionalism dilemmas require medical students to undertake some form of moral decision making.…”

Section: Professionalism Dilemmasmentioning

confidence: 99%

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Antecedents and Consequences of Medical Students' Moral Decision Making during Professionalism Dilemmas

Monrouxe

Shaw

Rees

2017

AMA Journal of Ethics

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Medical students often experience professionalism dilemmas (which differ from ethical dilemmas) wherein students sometimes witness and/or participate in patient safety, dignity, and consent lapses. When faced with such dilemmas, students make moral decisions. If students' action (or inaction) runs counter to their perceived moral values-often due to organizational constraints or power hierarchies-they can suffer moral distress, burnout, or a desire to leave the profession. If moral transgressions are rationalized as being for the greater good, moral distress can decrease as dilemmas are experienced more frequently (habituation); if no learner benefit is seen, distress can increase with greater exposure to dilemmas (disturbance). We suggest how medical educators can support students' understandings of ethical dilemmas and facilitate their habits of enacting professionalism: by modeling appropriate resistance behaviors. IntroductionFor many, medical school is a time of great stress. Indeed, a systematic review of research examining psychological distress in medical students suggests they suffer a high degree of depression and anxiety and greater psychological distress than the general population [1]. In this article, we consider medical students' distress, focusing on moral distress, i.e., emotional distress arising from the dissonance between one's ethical/moral beliefs and one's behavior, which occurs when one's actions are perceived as being limited by institutional constraints or unequal power relations [2][3][4]. By highlighting the concepts of professionalism dilemmas and moral decision making, we examine various types of dilemmas encountered by students, how they respond to those dilemmas, and any resultant moral distress they experience. Finally, we offer suggestions for how medical educators, working at the student, faculty, and organizational levels, can reduce or prevent students' professionalism lapses in the face of ethical dilemmas, thereby reducing their moral distress.

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Section: Moral Distress and Its Correlatesmentioning

confidence: 99%

Section: Professionalism Dilemmas: Acts Of Resistance and Compliancementioning

confidence: 99%

Section: Professionalism Dilemmas: Acts Of Resistance and Compliancementioning

confidence: 99%

Section: Moral Decision Making: Ethics Of Conduct Character and Dutymentioning

confidence: 99%

Section: Professionalism Dilemmasmentioning

confidence: 99%

See 3 more Smart Citations

Antecedents and Consequences of Medical Students' Moral Decision Making during Professionalism Dilemmas

Monrouxe

Shaw

Rees

2017

AMA Journal of Ethics

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Patient involvement in medical education

Spencer

McKimm

2013

Understanding Medical Education

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Thinking about research

Illing

2013

Understanding Medical Education

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Research is concerned with critical or scientific enquiry. It differs from audit, as research is concerned with discovering the right thing to do, and audit, with ensuring that it is done right. Evaluation aims to assess the worth or value of something.• Theoretical perspectives provide the framework for research and inform the basic assumptions that guide the research. A theoretical perspective encompasses important elements: ontology, epistemology and methodology.• Can research combine qualitative and quantitative research methods? One perspective is that the ontological and epistemological assumptions of these approaches are incompatible, and therefore it is not feasible to combine methods. An opposing view sees the two approaches as compatible, and combined approaches become feasible •Researchers are expected to minimise the risk of harm or discomfort to people. Harm from educational or social research is more likely to take the form of psychological distress than physical injury. Research that aims to be published requires an ethical review. How does research differ from audit?Research is concerned with discovering the right thing to do, and audit, with ensuring that it is done right.(5) Following this definition, audit focuses on what is given and asks questions about the given, while research has the freedom to ask questions about the given, including 'Is this the best or only way to do something?' How does research differ from evaluation?According to Clarke,( 6) what differentiates evaluation from research is the question of purpose. 'An evaluation is action orientated. It is conducted to determine the value or impact of a policy, programme, practice, intervention or service, with a view to making recommendations for change'. Robson(7) states that 'to evaluate is to assess the worth or value of something'. Following this definition, evaluation is about setting out to make a judgement. Going back to our definition of research, there is no mention of research leading to judgement, but to the discovery of findings by critical inquiry. Evaluation research is part of research, but in evaluation the aim involves assessing the worth of something. Theoretical Frameworks in Education and the Social SciencesKneebone(8) published a personal view about his attempt to engage with the education and social science literature. He wrote, 'At first and to my great surprise I found this literature almost impenetrable, of course it was peppered with unfamiliar words … I had the disquieting sensation of moving into alien territory, where familiar landmarks had disappeared'. Kneebone came to the realisation that all his medical training had been based within one view of science, the positivist paradigm, and that this was a very narrow and limited view. He ended with a plea to include an exploration of what the humanities have to offer the medical curriculum, and also with explicit guidance on how to gain access to this world. The aim of this chapter is to make this other 'world' penetrable.The focus of this section is to prese...

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Medical students learning intimate examinations without valid consent: a multicentre study

Cited by 53 publications

References 19 publications

Antecedents and Consequences of Medical Students' Moral Decision Making during Professionalism Dilemmas

Antecedents and Consequences of Medical Students' Moral Decision Making during Professionalism Dilemmas

Patient involvement in medical education

Thinking about research

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