Sequential simulation-based clinical ethics education for clerkship students: A mixed-methods pre-post study

Area of Science:

• Medical Education
• Clinical Ethics
• Simulation-Based Learning

Background:

• Clerkship students face ethical dilemmas but lack practical training opportunities.
• Developing ethically grounded decision-making and communication skills is crucial for medical trainees.

Purpose of the Study:

• To evaluate an immersive, sequential simulation-based clinical ethics education program for clerkship students.
• To assess the program's impact on ethical knowledge, sensitivity, decision-making, and confidence.

Main Methods:

• An explanatory sequential mixed-methods pre-post study design was employed.
• Participants completed e-learning modules followed by a two-day immersive simulation with standardized patient cases.
• Quantitative data on ethics knowledge, sensitivity, decision-making, and confidence were collected, alongside qualitative data from focus groups.

Main Results:

• Significant improvements were observed in ethical knowledge, ethical sensitivity, and vignette-based ethical decision-making.
• Student confidence increased in areas such as dilemma awareness, ethical reasoning, and communication.
• High satisfaction with the simulation education was reported, with qualitative themes highlighting confidence through enactment and structured decision-making.

Conclusions:

• The simulation program led to short-term gains in ethics knowledge, decision-making, and confidence among clerkship students.
• Enactment, feedback, and reflection in simulation enhance practical ethics learning and readiness for clinical encounters.
• Sequential simulation effectively bridges theoretical ethics with practical reasoning and communication skills, though further longitudinal studies are warranted.