An exploration of how Malaysian medical students completing a partner medical school programme develop their understanding of the ethical dimensions of practice

Vassallo, Claire Marie (2019) An exploration of how Malaysian medical students completing a partner medical school programme develop their understanding of the ethical dimensions of practice. Doctoral thesis, Northumbria University.

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Abstract

Ethics is a significant topic within medical and other healthcare undergraduate curricula. Advances in technology, changes within our population, e.g. an increasing ageing population, those living with disabilities and chronic conditions, and increasing demands on resources have resulted in an increase in the ethical dilemmas experienced within healthcare practice. The globalisation of medicine and the increased mobility of students and professionals has resulted in a need to explore their understanding of ethical issues inherent to the clinical area.

This research seeks to address how Malaysian medical students on a partner medical school programme understand the ethical dimensions of practice, by focusing on the processes through which this understanding develops, the factors that influence this and what the participants’ understand by the ethical dimensions of practice.

A qualitative approach to the study was adopted, as it concerns itself with the feelings and personal experiences. An interpretive methodology was applied as this paradigm is concerned with understanding the world from the participants’ perspective, and how “human beings make sense of their subjective reality and attach meaning to it” (Weber 1964).

A purposive sample of 16 Malaysian medical students in the final year of a partner medical school programme participated. Data was collected using a mixture of semi-structured focus groups and individual interviews. Interviews were transcribed and analysed using a descriptive phenomenological analysis based on an adaptation of Hycner’s (1985) model of thematic analysis.

Key findings reveal that students develop their understanding through observed practices and patient interactions. The unique experiences offered by the partner medical school programme, such as placements in two distinct settings, influence the development of their ethical understanding. Students exhibited uncertainty and cognitive anxiety when ethical issues arose in practice. The relationship between the factors which influence the understanding of the ethical dimensions of healthcare and cognitive anxiety creates a cycle of reflexivity, leading to students developing their ethical sensitivity.

Existing literature suggests that ethical sensitivity is related to achieving ethical competence and a reduction in moral distress amongst clinicians, as well as enhancing patient wellbeing. Within the current globalization of medical education, and the increase in international students and workforce, there is a fundamental need to explore the students’ experiences and perspectives on how they develop their ethical understanding whilst undertaking a partner medical school programme, as there is currently a lack of research in this area. The findings reveal the development of ethical sensitivity through the interrelationship between factors influencing students’ understanding of the ethical dimensions of practice and the cognitive anxiety they experience during this process.

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