Check out this interesting article for our upcoming Fall 2022 issue!
Background: Little is known about the ethical issues confronting medical students during their first exposure to emergency medicine (EM). The aim of this study was to review student narratives to determine the type and frequency of ethical issues that beginning students confront in the ED.
Methods: This was a prospective, qualitative observational study of consecutive first- and second-year medical students electing to do a pre-clinical clerkship in Emergency Medicine (EM) at five university- affiliated hospitals. Students were asked to write a short description of three cases that had the greatest impact on them during the month-long clerkship. Each essay was independently analyzed by five members of the research team. Descriptive and kappa statistics were used to summarize the data.
Results: During the four-year study period, 292 consecutive student essays were evaluated from 103 medical students. A total of 194 specific incidents were coded across 15 categories of ethical standards. Overall, 71.1% (138/194) were depictions of exemplary instances of ethical issues, 13.9% (27/194) were considered normal interactions, and 14.9% (29/194) were categorized as unethical behavior. While generally impressed by the admirable behavior of faculty and staff, students were quick to describe instances of improper treatment of patients, such as poor communication, discrimination, improper pain management, or a perceived lack of empathy.
Conclusions: Narrative essays describe a wide variety of interesting ethical situations that beginning medical students confront during their clerkships. Many of these ethical interactions seem to be connected to the student’s role as an observer of the health care team and how that role can lead to ethical tension. As educators, we need to shine a light on the subtle ethical issues that clerkship students struggle with daily and give them practical tools to deal with moral decisions required of them in medical practice.