Shaping medical students' empathy, reflection and moral judgement : the effects of undergraduate medical education

Abstract

Background: "The Art of Doctoring" or what is referred to as "professionalism" consists of not only skills and knowledge but also, attitudes and behaviours which include; competence, caring, compassion, altruism, self-regulation, and devotion to the collegial nature of the profession and to the public good. These can be achieved through basic qualities such as empathy, reflection and moral judgement. Medical education, specifically the hidden curriculum, can have major influences on these qualities. Aim: The purpose of this study was to investigate the effect of undergraduate medical education on important personal qualities that are necessary in medical students in order to graduate doctors that have satisfactory levels of professionalism. I selected three important qualities that create a foundation for professional behaviour. These qualities were: (1) empathy, (2) reflection-ability and (3) moral judgment. I studied the effect of medical education on those qualities in an attempt to understand how we can enhance them, or prevent their decline, in our medical students so that the end product is an empathic and reflective medical graduate with superior moral reasoning skills. Method: I investigated the above qualities in three separate, yet interrelated, studies. In a cross-sectional study, the Jefferson Scale of Physician Empathy (JSPE), Groningen Reflection Ability Scale (GRAS), and Moral Judgement Test (MJT) were employed to measure the levels of empathy, reflection and moral judgement, respectively, in undergraduate medical students (years one to five). The scales were administered to all medical students enrolled at the University of Western Sydney in 2011. Attached to the scales was a survey containing questions on demographics, stage of medical education, previous education, and level of completion of particular programmes that aim at promoting personal and professional development (PPD). For verification reasons, the MJT was readministered to all students enrolled at the University in 2012. Results: The results showed that empathy and reflection were maintained during medical education, contrary to other research studies, while moral judgement competence declined significantly in the later stages of medical education. This decline in moral judgement competence was found to be due to a decrease in moral reasoning of one of the two dilemmas in the MJT (i.e. the doctor's dilemma) hence was referred to as "moral segmentation". Approximately half of the students showed this phenomenon. Discussion: Preservation of empathy and reflection during medical education may be due to appropriate selection processes as well as educational efforts that aim to sensitize, raise awareness and force critical reflection e.g.; courses in medical ethics, the humanities, reflection, etc. Moral segmentation may be due to students predominantly employing cognitive processes in the doctor's dilemma (compared to the worker's dilemma). Approximately half of the population in this study did not show moral segmentation. These students may have reached a level of self-authorship rendering them resilient and providing them with an ability to defy moral segmentation. Conclusion: Moral judgment needs to include a utilitarian component (purely cognitive) as well as a deontological (ethical/emotional) one. In medical school, most of the teaching is arduous science requiring the use of the brain's dominant hemisphere. There is very little opportunity to employ and train the non-dominant hemisphere which is responsible for our creative and emotional characteristics. It is necessary for medical students to develop and practice their moral reasoning through different scenarios otherwise the utilitarian component may take precedence over the deontological component resulting in compromised moral judgement.

Date of Award	2014
Original language	English