Interpreting values conflicts experienced by obstetrics-gynecology clerkship students using reflective writing.
OBJECTIVE
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.


METHODS
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.
Cohn
Felicia G
FG
Department of Internal Medicine, University of California, Irvine School of Medicine, Irvine, California 92697, USA.
Shapiro
Johanna
J
Lie
Désirée A
DA
Boker
John
J
Stephens
Frances
F
Leung
Lee Ann
LA
D001291:Attitude of Health Personnel; D002982:Clinical Clerkship; D004992:Ethics, Medical / Q000193:education*; D006176:Gynecology / Q000193:education; D006801:Humans; D009014:Morals; D009774:Obstetrics / Q000193:education; D011361:Professional Competence; D012945:Social Values; D014956:Writing