Dataset Information

Ethical dilemma of identity disclosure faced by medical students in clinical clerkships: A nationwide multicenter study in China.

ABSTRACT:

Objective

Medical students in China are currently facing a dilemma of whether to clarify their identity as students to patients. Further investigation is needed to support policy-making. The aim was to identify factors influencing medical students' decision on whether or not to clarify their identity to patients and to examine the effects of their decision.

Methods

The study was a cross-sectional nationwide multicenter survey consisting of 947 medical students. A self-designed questionnaire was composed of 19 structured questions investigating the present situation and participants' perception of the ethical dilemma surrounding medical student identity. The questionnaires were distributed randomly in teaching hospitals affiliated with 13 medical schools across China from June 2015 to January 2016.

Results

A total of 947 valid questionnaires were retrieved with a valid response rate of 83.7%. Most medical students (71.4%) tended to be ambiguous about their student identity in front of patients. The frequency of encountering distrust and patients' or patient relatives' refusal to allow students to perform procedures was significantly lower for students who explicitly stated their identity than for those who were ambiguous about their identity (p<0.001). Less experience in clinical rotations (<0.5 y/0.5-1 y, OR 2.7, 95% CI 1.7-4.3; <0.5 y/>1 y, OR 3.6, 95% CI 2.0-6.5), preceptors' straightforward introduction of the students (OR 8.7, 95% CI 5.4-13.8) and students' acknowledgment of patients' right to know (OR 2.3, 95% CI 1.2-4.5) were related to students' clear self-introduction to patients.

Conclusion

It is beneficial for medical students to clearly explain their identity to patients in order to decrease patient distrust and prevent the refusal to have certain appropriate procedures performed. Several methods, including emphasizing the role of mentors, developing curriculum for medical students, and creating clear regulations and guidelines for revealing the identity of medical students on the healthcare team can help address and ideally resolve this ethical dilemma of identity disclosure.

SUBMITTER: Zhao Y

PROVIDER: S-EPMC6040732 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Publications

Ethical dilemma of identity disclosure faced by medical students in clinical clerkships: A nationwide multicenter study in China.

Zhao Yi Y Cao Yihan Y Che Lu L Fu Qining Q Song Shuang S Zhao Bingbin B Zhang Shuo S Zhang Weiwen W Li Xiang X Choi Stephanie S Zhao Jun J Zhang Hanwen H Li Yunzhu Y Xu Haopeng H Pan Hui H

PloS one 20180711 7

<h4>Objective</h4>Medical students in China are currently facing a dilemma of whether to clarify their identity as students to patients. Further investigation is needed to support policy-making. The aim was to identify factors influencing medical students' decision on whether or not to clarify their identity to patients and to examine the effects of their decision.<h4>Methods</h4>The study was a cross-sectional nationwide multicenter survey consisting of 947 medical students. A self-designed que ...[more]

PMID: 29995928

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Project description:BackgroundEfforts have begun to characterize the ethical and professional issues encountered by medical students in their clinical years. By applying previously identified taxonomies to a national sample of medical students, this study seeks to develop generalizable insights that can inform professional identity formation across various clerkships and medical institutions.MethodsIn a national survey of medical students, participants answered an open-ended survey item that asked them to describe a clinical experience involving an ethical or professional issue. We conducted a content analysis with these responses using the Kaldjian taxonomy of ethical and professionalism themes in medical education through an iterative, consensus-building process. Noting the emerging virtues-based approach to ethics and professionalism, we also reexamined the data using a taxonomy of virtues.ResultsThe response rate to this survey item was 144 out of 499 eligible respondents (28.9%). All 144 responses were successfully coded under one or more themes in the original taxonomy of ethical and professional issues, resulting in a total of 173 coded responses. Professional duties was the most frequently coded theme (29.2%), followed by Communication (26.4%), Quality of care (18.8%), Student-specific issues of moral distress (16.7%), Decisions regarding treatment (16.0%), and Justice (13.2%). In the virtues taxonomy, 180 total responses were coded from the 144 original responses, and the most frequent virtue coded was Wisdom (23.6%), followed by Respectfulness (20.1%) and Compassion or Empathy (13.9%).ConclusionsOriginally developed from students' clinical experiences in one institution, the Kaldjian taxonomy appears to serve as a useful analytical framework for categorizing a variety of clinical experiences faced by a national sample of medical students. This study also supports the development of virtue-based programs that focus on cultivating the virtue of wisdom in the practice of medicine.

Project description:ObjectivesWhile literature provides substantial evidence that undergraduate rural clerkships may contribute to attract medical students to rural careers, so far little is known about how to convince medical students to choose rural teaching sites for their clerkships, which is usually optional. Thus, this study aimed to investigate students' preferences and perceptions regarding different rural teaching and clerkship formats, important side conditions and suitable communication strategies to promote rural clerkships.DesignCross-sectional study based on a quantitative survey among medical students in advanced study years.SettingTwo German medical schools (Leipzig and Halle-Wittenberg).ParticipantsMedical students in third to fifth year (of six).ResultsResponse rate was 87.1% with n=909 analysable questionnaires. Participants' mean age was 25.0 years and 65.2% were women. For 97.9% of the students completing some kind of rural clerkship was imaginable, for 90.8% even participation in a rural clerkship of 4 weeks and longer. Nearly half of the students (48.0%) specified that a rural clerkship 4 weeks and longer was 'absolutely imaginable'. Younger age, having grown up in a rural or small-town region, being able to imagine future working in a small-town or rural area, and general practice as favoured, or at least conceivable career option were independently associated with a higher willingness to complete longer rural clerkships. Financial and organisational issues including remuneration of the clerkship, cost absorption for travelling and accommodation, and accessibility by public transport were the most important side conditions to increase the attractiveness of rural clerkships. Experience reports by fellow students, social media and informational events were stated to be the most suitable ways to advertise rural teaching offers.ConclusionsThe majority of the students are open-minded regarding even longer rural clerkships. This study adds new insights into measures that should be taken to convince them to actually chose this option.

Project description:The mini clinical evaluation exercise (mini-CEX)-a tool used to assess student-patient encounters-is increasingly being applied as a learning device to foster clinical competencies. Although the importance of eliciting self-assessment for learning is widely acknowledged, little is known about the validity of self-assessed mini-CEX scores. The aims of this study were (1) to explore the variability of medical students' self-assessed mini-CEX scores, and to compare them with the scores obtained from their clinical supervisors, and (2) to ascertain whether learners' self-assessed mini-CEX scores represent a global dimension of clinical competence or discrete clinical skills.In year 4, medical students conducted one to three mini-CEX per clerkship in gynaecology, internal medicine, paediatrics, psychiatry and surgery. Students and clinical supervisors rated the students' performance on a 10-point scale (1?=?great need for improvement; 10?=?little need for improvement) in the six domains history taking, physical examination, counselling, clinical judgement, organisation/efficiency and professionalism as well as in overall performance. Correlations between students' self-ratings and ratings from clinical supervisors were calculated (Pearson's correlation coefficient) based on averaged scores per domain and overall. To investigate the dimensionality of the mini-CEX domain scores, we performed factor analyses using linear mixed models that accounted for the multilevel structure of the data.A total of 1773 mini-CEX from 164 students were analysed. Mean scores for the six domains ranged from 7.5 to 8.3 (student ratings) and from 8.8 to 9.3 (supervisor ratings). Correlations between the ratings of students and supervisors for the different domains varied between r =?0.29 and 0.51 (all p <?0.0001). Mini-CEX domain scores revealed a single-factor solution for both students' and supervisors' ratings, with high loadings of all six domains between 0.58 and 0.83 (students) and 0.58 and 0.84 (supervisors).These findings put a question mark on the validity of mini-CEX domain scores for formative purposes, as neither the scores obtained from students nor those obtained from clinical supervisors unravelled specific strengths and weaknesses of individual students' clinical competence.

Dataset Information

Ethical dilemma of identity disclosure faced by medical students in clinical clerkships: A nationwide multicenter study in China.

Objective

Methods

Results

Conclusion

Publications

Ethical dilemma of identity disclosure faced by medical students in clinical clerkships: A nationwide multicenter study in China.

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