Exploring Medical Student Experiences of Ethical Issues and Professionalism in Australian General Practice

Student experiences of ethics and professionalism during clinical placements have a powerful influence on their future attitudes and behaviour. International literature in this area has focused predominantly on hospital placement experiences, and relied heavily on analyses of graded student essays. This study aims to explore the medical student lens on ethics and professionalism in the primary care setting, using a different method of data collection. During weekly tutorials medical students recounted, and reflected on, their general practice placement experiences. Tutors logged the ethical and professional practice issues raised by 43 students over 76 hours of tutorial time. The logs were submitted to a qualitative content analysis from which major themes emerged: mixed messages; uncertainty about professional roles; and a ‘medical student predicament’ (including unsettled boundaries, emotions and personal health concerns). Findings suggest that the extent of compromise in general practice may challenge student expectations. Students may perceive that their clinical teacher is out of step with previous teaching, especially in areas that are considered ethically grey by their teachers. Students may need support to maintain professional boundaries and personal precautions. Clinical teachers should consider exploring common ethical issues like confidentiality, writing medical certificates, professional boundaries and affordability of health care in contexts which are relevant to students. Medical students are interested in the limits and scope of professional roles. These findings provide insights for general practitioner and other practice-based clinical teachers to reflect on their ethics and professionalism teaching, mentoring and role-modelling.