Narrative, emotion and action: analysing ‘most memorable’ professionalism dilemmas

Abstract

Findings extend previous research into issues related to professionalism by exploring relationships between narrative, emotion and action in the context of written narratives of most memorable dilemmas. We encourage medical educators to help students construct coherent and emotionally integrated narratives to make sense of negative professionalism dilemmas.

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

“…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.…”

“…In an examination of 680 UK medical students' written narratives of their most memorable professionalism dilemmas (both witnessing and participating in transgressions), Rees, Monrouxe, and McDonald found that 55 percent contained evidence of students' resistance to lapses, often detailing multiple acts of resistance [8].…”

“…Monrouxe and Rees [7] and Rees, Monrouxe, and McDonald [8] report that it is useful to share students' professionalism dilemma narratives with clinical teachers as part of formal faculty development in order to facilitate best practice.…”

“…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.…”

“…Such dilemmas arise in situations in which students witness and/or are asked to participate in professional lapses such as patient safety, dignity, and consent breaches [5] rather than in ethical dilemma situationstypically encountered by health care professionals-in which decisions need to be made about life-sustaining treatment or the patient's best interest is in question. For example, a professionalism dilemma can be experienced by medical students when they witness senior clinicians jeopardizing patient safety through poor hygiene practices or disrespecting patient dignity through physically exposing patients' bodies for longer than necessary [2,[6][7][8][9]. Furthermore, medical students' seniors frequently request that they undertake activities during workplace learning that violate ethical principles, including examinations (sometimes intimate examinations) without valid patient consent and covering up mistakes, both of which potentially result in patient harm [2, 6-8, 10, 11].…”