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Lewis G, McCullough M, Maxwell AP, et al. Ethical reasoning through simulation: a phenomenological analysis of student experience. Adv Simul (Lond). 2016;1:26doi: 10.1186/s41077-016-0027-9.
Lewis, G., McCullough, M., Maxwell, A. P., & Gormley, G. J. (2016). Ethical reasoning through simulation: a phenomenological analysis of student experience. Advances in simulation (London, England), 126. https://doi.org/10.1186/s41077-016-0027-9
Lewis, Gareth, et al. "Ethical reasoning through simulation: a phenomenological analysis of student experience." Advances in simulation (London, England) vol. 1 (2016): 26. doi: https://doi.org/10.1186/s41077-016-0027-9
Lewis G, McCullough M, Maxwell AP, Gormley GJ. Ethical reasoning through simulation: a phenomenological analysis of student experience. Adv Simul (Lond). 2016 Aug 08;1:26. doi: 10.1186/s41077-016-0027-9. eCollection 2016. PMID: 29449995; PMCID: PMC5806291.
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Adv Simul (Lond). 2016 Aug 08;1:26. doi: 10.1186/s41077-016-0027-9. eCollection 2016.

Ethical reasoning through simulation: a phenomenological analysis of student experience.

Advances in simulation (London, England)

Gareth Lewis, Melissa McCullough, Alexander P Maxwell, Gerard J Gormley

Affiliations

  1. 1Centre for Medical Education, Queen's University Belfast, Belfast, Northern Ireland.
  2. 2Department of Clinical Medicine, Brighton and Sussex Medical School, Brighton, UK.
  3. 3Regional Nephrology Unit, Belfast City Hospital, Belfast, Northern Ireland.

PMID: 29449995 PMCID: PMC5806291 DOI: 10.1186/s41077-016-0027-9

Abstract

BACKGROUND: Medical students transitioning into professional practice feel underprepared to deal with the emotional complexities of real-life ethical situations. Simulation-based learning (SBL) may provide a safe environment for students to probe the boundaries of ethical encounters. Published studies of ethics simulation have not generated sufficiently deep accounts of student experience to inform pedagogy. The aim of this study was to understand students'

METHODS: This qualitative study was underpinned by an interpretivist epistemology. Eight senior medical students participated in an interprofessional ward-based SBL activity incorporating a series of ethically challenging encounters. Each student wore digital video glasses to capture point-of-view (PoV) film footage. Students were interviewed immediately after the simulation and the PoV footage played back to them. Interviews were transcribed verbatim. An interpretative phenomenological approach, using an established template analysis approach, was used to iteratively analyse the data.

RESULTS: Four main themes emerged from the analysis: (1) 'Authentic on all levels?', (2)'Letting the emotions flow', (3) 'Ethical alarm bells' and (4) 'Voices of children and ghosts'. Students recognised many explicit ethical dilemmas during the SBL activity but had difficulty navigating more subtle ethical and professional boundaries. In emotionally complex situations, instances of moral compromise were observed (such as telling an untruth). Some participants felt unable to raise concerns or challenge unethical behaviour within the scenarios due to prior negative undergraduate experiences.

CONCLUSIONS: This study provided deep insights into medical students' immersive and embodied experiences of ethical reasoning during an authentic SBL activity. By layering on the human dimensions of ethical decision-making, students can understand their personal responses to emotion, complexity and interprofessional working. This could assist them in framing and observing appropriate ethical and professional boundaries and help smooth the transition into clinical practice.

Keywords: Ethics; Phenomenology; Professionalism; Simulation

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