Understanding the effect of computer-supported, case-based instruction on third-year medical students' ethical reasoning
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The major focus of this study was to determine whether or not providing third-year medical students with example videos that exhibit experts' ethical reasoning and with opportunities to engage in online asynchronous ethical case discussions would stimulate change and improvement in students' ethical reasoning. It was speculated that the medical students would be able to reflect on both their own reasoning and others' reasoning and thus develop complexity in how they reason. In this study ethical reasoning consisted of four components: (1) identification of ethical issues (ethical sensitivity); (2) adoption of multiple viewpoints (ethical viewpoint); (3) resolution of ethical dilemmas (ethical options); and, (4) justification of decisions and actions (ethical justification). In addition to examining the effectiveness of the instructional activities, the impact of the ethics curriculum on students' perception of the relevance and effectiveness of medical ethics teaching on their ability to handle ethical issues in daily clinical practice was also examined. Finally, another aim of this study was to understand how medical students interacted with their peers during online asynchronous ethical case discussions. ANOVA results did not show any significant difference between the computer-supported, case-based (CSCB) instruction and non computer-supported, case-based (non-CSCB) instruction groups on the four sub-scores (ethical sensitivity, ethical viewpoint, ethical options, and ethical justification) from the pre-test to post-test. Results revealed, however, a significant increase on participants' perception of their ability to deal with ethical issues in clinical settings after the ethics curriculum in the Internal Medicine clerkship rotation. Two levels of content analyses using pre-determined coding schemes were applied in order to identify interaction patterns in the online asynchronous ethical case discussions.