title: An exploratory study on the elements that might affect medical students' and residents' responsibility during clinical training.
abstract: We are now more or less confronting a "challenge of responsibility" among both undergraduate and postgraduate medical students and some recent alumni from medical schools in Iran. This ethical problem calls for urgent etiologic and pathologic investigations into the problem itself and the issues involved. This study aimed to develop a thematic conceptual framework to study factors that might affect medical trainees' (MTs) observance of responsibility during clinical training. A qualitative descriptive methodology involving fifteen in-depth semi-structured interviews was used to collect the data. Interviews were conducted with both undergraduate and postgraduate MTs as well as clinical experts and experienced nurses. Interviews were audio-recorded and then transcribed. The data was analyzed using thematic content analysis. The framework derived from the data included two main themes, namely "contextual conditions" and "intervening conditions". Within each theme, participants recurrently described "individual" and "non-individual or system" based factors that played a role in medical trainees' observance of responsibility. Overall, contextual conditions provide MTs with a "primary or basic responsibility" which is then transformed into a "secondary or observed responsibility" under the influence of intervening conditions. In conclusion three measures were demonstrated to be very important in enhancing Iranian MTs' observance of responsibility: a) to make and implement stricter and more exact admission policies for medical colleges, b) to improve and revise the education system in its different dimensions such as management, structure, etc. based on regular and systematic evaluations, and c) to establish, apply and sustain higher standards throughout the educational environment.
authors.affiliation: Department of Medical Ethics and Philosophy of Health, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Omid
authors.initials: O
authors.lastname: Asemani
authors.affiliation: Department of Sociology, Shiraz University, Shiraz, Iran.
authors.forename: Mohammad Taghi
authors.initials: MT
authors.lastname: Iman
authors.affiliation: Department of Nursing, College of Nursing & Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Marzieh
authors.initials: M
authors.lastname: Moattari
authors.affiliation: Department of Medical Ethics and Philosophy of Health, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Seyed Ziaadin
authors.initials: SZ
authors.lastname: Tabei
authors.affiliation: Department of Psychiatric Nursing, Community Based Psychiatric Care Research Center, and College of Nursing & Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Farkhondeh
authors.initials: F
authors.lastname: Sharif
authors.affiliation: College of Education and Psychology, Shiraz University, Shiraz, Iran.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Khayyer
keywords: clinical training; medical resident; qualitative descriptive study; responsibility; undergraduate medical student