How Residents Develop Virtues: A Qualitative Longitudinal Study

Medical specialists in training not only develop competences, but also personal qualities. These are known in moral philosophy as virtues. They enable a person to decide and to do the right thing in each situation anew. It is generally assumed in virtue ethical and medical educational literature that people develop virtues and character through experience in practice. Yet, how this process takes place during postgraduate medical education has hardly been investigated. An empirically informed account of this development may support further improvement in medical specialty training.

We conducted a qualitative, multicenter, longitudinal study of otolaryngology residents and their educators. Fifteen residents were interviewed twice (semi-structured). In between the interviews, residents were observed during various daily activities. After coding and analysis, a group member check was carried out. Thirteen educators were also interviewed (semi-structured). Using virtue ethics as a broad conceptual framework, thematic analysis was employed to describe residents' development and learning strategies related to virtues.

Results were clustered in 4 themes. Residents appear to develop their virtues in phases. In an early phase, they develop mainly cardinal and intellectual virtues. Further along training, professional and moral virtues come to the fore. Residents, often implicitly, change their conception of their professional goals over time. Role models, and context and culture at the workplace appear to influence residents' virtue formation.

Our findings indicate that ENT residents implicitly develop virtues in distinct phases throughout their training, transitioning from cardinal and intellectual virtues to professional and moral one as they progress. Understanding these developmental trajectories and the influential role of role models and workplace culture offers important insights into developing desirable attitudes such as context-sensitive judgement in surgical education. Supporting discussions about personal views and purposes with peers and surgeons could further enhance this development.