Research article

Proximity morality in medical school – medical students forming physician morality "on the job": Grounded theory analysis of a student survey

Hans O Thulesius^{* 1,3} , Karl Sallin^{* 2} , Niels Lynoe^{* 2} and Rurik Löfmark^{* 2}

¹Department of Clinical Sciences Malmö, Division of Family Medicine, Lund University, Sweden

²Centre for Bioethics, LIME, Karolinska Institutet, Stockholm, Sweden

³Research and Development Centre, Kronoberg County Council, Box 1223, SE-351 12 Växjö, Sweden

author email corresponding author email* Contributed equally

BMC Medical Education 2007, 7:27doi:10.1186/1472-6920-7-27

Published:	6 August 2007

Abstract

Background

The value of ethics education have been questioned. Therefore we did a student survey on attitudes about the teaching of ethics in Swedish medical schools.

Methods

Questionnaire survey on attitudes to ethics education with 409 Swedish medical students participating. We analyzed > 8000 words of open-ended responses and multiple-choice questions using classic grounded theory procedures.

Results

In this paper we suggest that medical students take a proximity morality stance towards their ethics education meaning that they want to form physician morality "on the job". This involves comprehensive ethics courses in which quality lectures provide "ethics grammar" and together with attitude exercises and vignette reflections nurture tutored group discussions. Goals of forming physician morality are to develop a professional identity, handling diversity of religious and existential worldviews, training students described as ethically naive, processing difficult clinical experiences, and desisting negative role modeling from physicians in clinical or teaching situations, some engaging in "ethics suppression" by controlling sensitive topic discussions and serving students politically correct attitudes.

Conclusion

We found that medical students have a proximity morality attitude towards ethics education. Rather than being taught ethics they want to form their own physician morality through tutored group discussions in comprehensive ethics courses.