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Interpreting values conflicts experienced by obstetrics-gynecology clerkship students using reflective writing.
Acad Med. 2009 May; 84(5):587-96.AM

Abstract

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.

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Authors+Show Affiliations

Cohn FG
Department of Internal Medicine, University of California, Irvine School of Medicine, Irvine, California 92697, USA.
Shapiro J
No affiliation info available
Lie DA
No affiliation info available
Boker J
No affiliation info available
Stephens F
No affiliation info available
Leung LA
No affiliation info available

MeSH

Attitude of Health PersonnelClinical ClerkshipEthics, MedicalGynecologyHumansMoralsObstetricsProfessional CompetenceSocial ValuesWriting

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19704191

Citation

Cohn, Felicia G., et al. "Interpreting Values Conflicts Experienced By Obstetrics-gynecology Clerkship Students Using Reflective Writing." Academic Medicine : Journal of the Association of American Medical Colleges, vol. 84, no. 5, 2009, pp. 587-96.
Cohn FG, Shapiro J, Lie DA, et al. Interpreting values conflicts experienced by obstetrics-gynecology clerkship students using reflective writing. Acad Med. 2009;84(5):587-96.
Cohn, F. G., Shapiro, J., Lie, D. A., Boker, J., Stephens, F., & Leung, L. A. (2009). Interpreting values conflicts experienced by obstetrics-gynecology clerkship students using reflective writing. Academic Medicine : Journal of the Association of American Medical Colleges, 84(5), 587-96. https://doi.org/10.1097/ACM.0b013e31819f6ecc
Cohn FG, et al. Interpreting Values Conflicts Experienced By Obstetrics-gynecology Clerkship Students Using Reflective Writing. Acad Med. 2009;84(5):587-96. PubMed PMID: 19704191.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Interpreting values conflicts experienced by obstetrics-gynecology clerkship students using reflective writing. AU - Cohn,Felicia G, AU - Shapiro,Johanna, AU - Lie,Désirée A, AU - Boker,John, AU - Stephens,Frances, AU - Leung,Lee Ann, PY - 2009/8/26/entrez PY - 2009/8/26/pubmed PY - 2009/9/29/medline SP - 587 EP - 96 JF - Academic medicine : journal of the Association of American Medical Colleges JO - Acad Med VL - 84 IS - 5 N2 - 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. SN - 1938-808X UR - https://www.unboundmedicine.com/medline/citation/19704191/Interpreting_values_conflicts_experienced_by_obstetrics_gynecology_clerkship_students_using_reflective_writing_ L2 - https://doi.org/10.1097/ACM.0b013e31819f6ecc DB - PRIME DP - Unbound Medicine ER -