Effect of medical students’ values on their clinical decision-making
Mpatisi Moyo 1 4 , Boaz Shulruf 2 , Jennifer Weller 3 , Felicity Goodyear-Smith 1
+ Author Affiliations
- Author Affiliations
1 University of Auckland, Department of General Practice and Primary Health Care, Auckland, New Zealand
2 University of New South Wales, Medical Education, Sydney, Australia
3 University of Auckland, Centre for Medical and Health Science Education, Auckland, New Zealand
4 Corresponding author. Email: mphatomnz@gmail.com
Journal of Primary Health Care 11(1) 64-74 https://doi.org/10.1071/HC18055
Published: 15 February 2019
Journal Compilation © Royal New Zealand College of General Practitioners 2019.
This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Abstract
INTRODUCTION: Personal and professional values of health-care practitioners influence their clinical decisions.
AIM: To investigate how medical students’ values influence their clinical decisions.
METHODS: Values of 117 medical students were measured using an instrument we developed, the Healthcare Practitioner Values Scale. Factors that students consider in clinical decision-making were identified in four clinical scenarios using qualitative coding. Differences in values between students who considered given factors in decision-making and students who did not consider the same factors were analysed. Random effects models were used to investigate which differences were explained by variation in the clinical scenarios and factors considered in decision-making.
RESULTS: Six factors that students consider in clinical decision-making were identified and grouped into three categories: patient-centred (patient perspective, family and social circumstances); clinical (patient safety, symptoms and treatment efficacy); and situational factors (health-care practitioner self-awareness and service cost). Students who prioritised spirituality placed more emphasis on patient-centred factors, and less emphasis on clinical factors in different scenarios; students who prioritised critical thinking placed less emphasis on patient-centred factors; and students who prioritised capability, professionalism and safety values placed more emphasis on situational factors. Total proportion of variance in value differences explained by factors and clinical scenarios was 25.2% for spirituality and 56.2% for critical thinking.
DISCUSSION: Students who prioritise different values consider different factors in their clinical decisions. Spirituality and critical thinking values are more likely to influence students’ decision-making approaches than other values. Improving students’ awareness of how their own values influence their decisions can help them improve their clinical decision-making.
KEYWORDS: Decision-making; social values; students; medical; New Zealand; professional practice
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