#KeyLIMEPodcast 317: Moral Dilemmas in #MedEd

In this qualitative study presented by Lara, the authors look at moral dilemmas experienced by medical education students, specifically the nature of these dilemmas, how the students emotionally reactions to them, and how they affected the students’ professional development.

Listen here to learn about their research.


KeyLIME Session 317

Listen to the podcast


Ribeiro DL, M Costa, E Helmich et al. 2021 ‘I found myself a despicable being!’: Medical students face disturbing moral dilemmas. Med Educ. 55(7):857-871.


Lara Varpio (@LaraVarpio)


  • Moral dilemma: “a situation in which students have to deal with 2 or more conflicting values, and the available choices support mutually inconsistent courses of action”


  • The authors set out to answer 3 questions:
      • What is the nature of of the moral dilemmas experienced by medical students at the onset of clinical practice?
      • How do medical students emotionally react to those dilemmas
      • How do medical students understand the impact of those dilemmas on their professional development

Key Points on the Methods

  • Qualitative study that collected data via interviews with 13 students in Brazil who were in their 6th year of medical school.
  • The interviews used rich pictures elicitation technique.
  • Used template analysis but a modification of the one we’ve discussed in previous recordings (See Episode 311)

Key Outcomes

  • 1st RQ: Authors found moral dilemmas to be complex and multidimensional. Psychologically, the learners struggled to prioritize, balance and apply conflicting moral values in clinical interactions. They also had to balance their own personal moral values with the context they were in, including things like the hierarchy of the medical system. They experienced conflict between their current moral values and those of the doctor they aspired to become
  • 2nd RQ: Authors described how the learners had intense emotional experiences with long lasting implications. When the decisions made in the clinical context were not aligned with participants’ own moral compass, they expressed negative feelings like frustration, disgust, shame, solitude and sadness
  • 3rd RQ: Researchers saw that these dilemmas did impact future behavior and development

Key Conclusions

  • 3 Recommendations:
    • 1: acknowledge that moral dilemmas exist and are ambiguous and multifaceted
    • 2: Find role models who can help you navigate through dilemmas. And if you can’t find role models, they advocate to create mentoring groups that can support learners and advocate for them
    • 3: Several different approaches to reflection — all of which are aimed to help learners engage in moral reasoning and find emotional closure, should be used to help learners deal with moral dilemmas in the future

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