Reasoning when it counts: students' rationales for action on a professionalism exam

Area of Science:

• Medical Education
• Professional Ethics
• Cognitive Psychology

Background:

• Previous studies examined student reasoning on professional dilemmas using interviews and video scenarios.
• Student responses to ethical dilemmas are influenced by context and format.

Purpose of the Study:

• To determine how changing the context to a written exam and format from video to text affects students' reasoning patterns.
• To compare student responses in an exam setting versus an interview setting.

Main Methods:

• Fifty-three students were randomly assigned to either videotaped or text-based scenarios within a mock written exam.
• Student responses were systematically coded by two independent raters.

Main Results:

• High interrater reliability (kappa = 0.872) was achieved.
• No significant differences in response patterns were observed between video and text scenario groups.
• Students exhibited more "acceptable" rationales in the exam context compared to interviews, but still considered self-implications.

Conclusions:

• The shift in responses suggests students perceived the exam as a serious evaluation.
• Continued consideration of self-implications may stem from students' perceived legitimacy due to their student status.
• Alternative interpretations suggest a potential divergence between student and professional understandings of altruism.