Predictors of medical students' ethical decision-making: A pilot study using the Theory of Interpersonal Behavior

To understand medical students' (MS) ethical decision-making using the Theory of Interpersonal Behavior (TIB).

We conducted two rounds of focus groups to develop a TIB-based questionnaire by eliciting students' perspectives on an ethical dilemma they will encounter in a standardized patient (SP) station, in which an SP "surgeon" asked them to intubate a sedated patient whom the student knew had requested no student involvement. We administrated questionnaires to 241 third-year MS following this SP station, asking for their decisions in the SP station and if a surgeon made the same request in their clerkship. Confirmatory factor analysis (CFA) was used to test whether observed data fit the proposed TIB-based model.

The CFA provided an acceptable fit to the a priori proposed model. Fifty-five percent of students indicated they would intubate in an actual situation versus 18% in the SP station (p < 0.05). Using logistic regression, TIB domains affect and facilitating factors reported significant association with students' decisions in both the SP and hypothesized actual situations.

The TIB appears to be an effective theoretical framework for explaining students' ethical decision-making.

The TIB may guide design and assessment of educational programs for professional formation.