Abstracts
Abstract
Background: The education of medical students necessitates teaching not only the science of medicine but also the skills needed for ethical reflection and moral reasoning as well as professionalism. At the Université de Montréal, starting in 2004, third-year medical students were initiated to ethics and professionalism during a weekly seminar on clinical skills during their surgery rotation. Students had to recognize an ethical dilemma or a professionalism issue that occurred during the rotation and write a case narrative and reflection on the moral issue. Method: Student narratives describing ethical or professionalism incidents were collected between 2004 and 2020. These were analyzed to identify the moral challenges that students experienced, and how they reacted to ethical dilemmas or professionalism issues. Results: Of the 1145 narratives collected, 396 were coded as an ethical dilemma, subdivided into end-of-life decisions, decision for treatment, dilemmas concerning justice and resource allocation, and student educational dilemmas including relationships with residents. Professional issues were more frequently reported (n=749), subdivided into communication of bad news, professional behaviour and attitude, consent, confidentiality, truthful disclosure of sensitive results, errors, professional responsibility and commitment and relationships with colleagues. In 40% of narratives there was a positive opinion about the issues reported, while in 60% students felt the ethical decision or professional attitude or conduct was less than ideal. Conclusion: This seminar was an effective means for medical students to identify and discuss the ethical and professional issues experienced during their clerkship – issues regarding communication were the primary concern followed by professional behaviour. These narratives provide a good picture of the hidden curriculum; and they show that students can reflect meaningfully on issues concerning ethics and professionalism.
Keywords:
- narrative,
- ethical dilemma,
- professionalism,
- surgery,
- third-year medical students,
- clerkship,
- pedagogy,
- hidden curriculum
Résumé
Contexte : La formation des étudiants en médecine nécessite non seulement l’enseignement des sciences médicales, mais aussi celui des compétences nécessaires à la réflexion éthique et au raisonnement moral, ainsi qu’au professionnalisme. À l’Université de Montréal, depuis 2004, les étudiants en troisième année de médecine sont initiés à l’éthique et au professionnalisme dans le cadre d’un séminaire hebdomadaire sur les compétences cliniques pendant leur stage en chirurgie. Les étudiants doivent reconnaître un dilemme éthique ou un problème de professionnalisme survenu pendant leur stage et rédiger un récit de cas et une réflexion sur la question morale. Méthode : Les récits des étudiants décrivant des incidents éthiques ou liés au professionnalisme ont été recueillis entre 2004 et 2020. Ces récits ont été analysés afin d’identifier les défis moraux auxquels les étudiants ont été confrontés et la manière dont ils ont réagi aux dilemmes éthiques ou aux problèmes de professionnalisme. Résultats : Sur les 1 145 récits recueillis, 396 ont été codés comme des dilemmes éthiques, subdivisés en décisions de fin de vie, décisions de traitement, dilemmes concernant la justice et l’allocation des ressources, et dilemmes éducatifs des étudiants, y compris les relations avec les résidents. Les problèmes professionnels ont été plus fréquemment signalés (n=749), subdivisés en communication de mauvaises nouvelles, comportement et attitude professionnelle, consentement, confidentialité, divulgation véridique de résultats sensibles, erreurs, responsabilité et engagement professionnels et relations avec les collègues. Dans 40 % des récits, l’opinion sur les problèmes signalés était positive, tandis que, dans 60 % des cas, les étudiants estimaient que la décision éthique ou l’attitude ou la conduite professionnelle n’était pas idéale. Conclusion : Ce séminaire a été un moyen efficace pour les étudiants en médecine d’identifier et de discuter des questions éthiques et professionnelles rencontrées au cours de leur stage – les questions relatives à la communication ont été la principale préoccupation, suivies par le comportement professionnel. Ces récits donnent une bonne image du programme caché et montrent que les étudiants sont capables de réfléchir de manière significative à des questions relatives à l’éthique et au professionnalisme.
Mots-clés :
- narratif,
- dilemme éthique,
- professionnalisme,
- chirurgie,
- étudiants en troisième année de médecine,
- stage,
- pédagogie,
- curriculum caché
Appendices
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