Exploring Professionalism Dilemma and Moral Distress through Medical Students' Eyes: A Mixed-Method Study

Abstract

This study aims to understand professionalism dilemmas medical students have experienced during clinical clerkships and the resulting moral distress using an explanatory mixed-method sequential design-an anonymous survey followed by in-depth interviews. A total of 153 students completed and returned the survey, with a response rate of 21.7% (153/706). The top three most frequently occurring dilemmas were the healthcare team answering patients' questions inadequately (27.5%), providing fragmented care to patients (17.6%), and withholding information from a patient who requested it (13.7%). Students felt moderately to severely distressed when they observed a ward mate make sexually inappropriate remarks (81.7%), were pressured by a senior doctor to perform a procedure they did not feel qualified to do (77.1%), and observed a ward mate inappropriately touching a patient, family member, other staff, or student (71.9%). The thematic analysis based on nine in-depth interviews revealed the details of clinicians' unprofessional behaviors towards patients, including verbal abuse, unconsented physical examinations, bias in clinical decisions, students' inaction towards the dilemmas, and students' perceived need for more guidance in applying bioethics and professionalism knowledge. Study findings provide medical educators insights into designing a professional development teaching that equips students with coping skills to deal with professionalism dilemmas.

Keywords: bioethics; medical education; medical student; moral distress; professionalism.

Figure 1

Frequency of professionalism dilemmas encountered by medical students. (1) Bar color indicates the theme of the measures: yellow = involvement in care perceived to be substandard; gray = professionalism lapses; green = responsibility exceeding students’ capabilities; orange = system constraints. (2) Dark and light color palette (From left to right): very frequently, frequently, occasionally, infrequently, and never.

Figure 2

Perceived level of moral distress in the professionalism dilemmas. (1) Bar color indicates the theme of the measures: yellow = involvement in care perceived to be substandard; gray = professionalism lapses; green = responsibility exceeding students’ capabilities; orange = system constraints. (2) Dark and light color palette (from left to right): severe distress, moderate distress, mild distress, and no distress.