Table 1. Summary of results
Author (Year) Intervention type and length Number of participants Study objectives Significant findings
Camp CL,et al., (2010) Weekly peer evaluations of professionalism with mid-point (3 weeks) and end point (6 weeks) feedback. 49 first year medical students Comparing efficacy of peer-peer feedback delivered in a group feedback session vs. individual student instructor feedback session in a gross anatomy course. Pre- (weeks 1-3) and post-intervention (weeks 4-6) Total Professionalism Scores (TPS) were derived. A paired T-test demonstrated that peer-peer feedback improved overall TPS (p= 0.032)
Cohn F,Lie D, (2002) Medical student construction of their own codes of ethics with identification of primary values within their code design. “Small groups” of first year medical students 1) To report connections between values expressed in the medical school oath and those expressed in the ethics and professionalism curriculum of first year medical students. 2) For students to identify important values and differentiate between personal and professional values. Student evaluation, narrative feedback and faculty observation indicate that the intervention was educationally helpful and enjoyed by participants.
Edelstein SF, (1992) Investigation of link between increased moral judgment development, and longer exposure to patient care/more peer discussion opportunities on ethical issues/more availability to trained ethics instructors 171 dietetics students To compare moral judgement (asset out in Kohlberg’s theory of Moral Development) of students before and after training from internships (n=96),coordinated undergraduate programs (n=61) and pre-professional practice programs (n=14) Rest’s Defining Issues Test (DIT) was used to measure the level of cognitive moral development pre- and post- intervention. A separate questionnaire was used to determine mode of ethics teaching, the ethics training of instructors and the importance of ethics training in their programs curriculum. Programs that foster peer discussion of moral dilemmas were found to facilitate moral growth more than programs that do not emphasise this aspect.
Elliott D,et al., (2009) A medical school curriculum branch entitled Professionalism and the Practice of Medicine (PPM) involving 40 two-hour sessions over the first 2 years of medical school. The curriculum incorporates a specific emphasis on ethical judgment and includes student led sessions, formal peer assessment and peer feedback. First and second year medical student cohorts over 7 years To develop and evaluate a longitudinal course in professionalism spanning the first two years of medical school. Five administrations of university educational objective feedback forms revealed that 81.2% of students attributed gains in skill related to ethical judgment to the PPM curriculum. There was additional positive anecdotal feedback.
Frish ND, (1987) Control and experimental populations (n=24 and 28) were either not given or given ethical decision making instruction and then evaluated via questionnaire at the beginning and end of the semester. 52 nursing students To establish whether a value analysis teaching strategy of nursing ethics impacted students’ cognitive moral development (as set out in Kohlberg’s theory of moral development). Rest’s Defining Issues Test (DIT) was used to measure the level of cognitive moral development. A strong correlation was found between DIT score gains and self-report of peer discussion of ethical issues. Chi square test analysis showed that students who discussed their ethical problem outside of class were more likely to advance on the DIT P-score (a measure of the level of principled thinking) than those who did not (p<0.05).
Fryer-Edwards K, et al., (2006) “Ward Ethics” – A program of peer discussions guided by clinical faculty mentors trained in ethics facilitation. A total of 24 ninety-minute sessions were held across 4 hospitals, during the first week of six-week medical and surgical rotations. 89 third-year medical students estimated across all the sessions To develop and evaluate a ward based ethics educational program designed to facilitate the professional development of clinical medical students. 102 student-written evaluations were obtained after 24 sessions. 94% student responses rated the sessions as valuable, useful or successful. 98% saw the sessions as the most successful way to facilitate discussions of challenging experiences amongst peers. 83% felt the sessions helped them to outline how to manage risks, mistakes, or failures.
Lin C, et al., (2010) Senior nursing students were randomly assigned to lecture based teaching (control) (n=70) and problem based learning (experimental) (n=72) intervention groups over an 8-week period. 142 senior nursing students To compare lecture-type conventional styles teaching medical ethics with problem based learning (PBL) methods. Ethical Discrimination and Learning Satisfaction scales were devised and administered. Ethical discrimination was measured pre- and post- intervention. Both interventions produced and improvement in nursing ethical discrimination ability scores (p<0.05) Students who received PBL performed better than those who received conventional teaching (p<0.001).
Nofziger AC, et al., (2010) Online peer assessments are completed during the second and third year of the course as part of the university curriculum. Students then completed an online questionnaire regarding their experiences of peer-assessment. Narratives were coded into themes by two members of the research team. 101 second-year medical students and 83 fourth-year medical students To investigate which types of peer feedback are the most memorable for students and the transformations students experience as a result of peer assessment. The authors analysed responses using mixed and qualitative-quantitative methods. There were 138 responses in total. 68 from fourth-year class, and 70 from second-year class. 65% reported important transformations in awareness, attitude of behaviour as a result of peer assessment.
Parker L,et al., (2012) A modified teaching ward round model with students supplying de-identified cases of ethical interest for round-table discussion in 4 one-hour sessions. Sessions were evaluated using a questionnaire after the first and last ward round. 60 fifth year medical students across four campuses To assess the efficacy of clinical ethics ward rounds as an ethics education intervention. Sessions were evaluated using a questionnaire after the first and last ward round. Data from 47 students who attended three or more ward rounds were used. Statistically significant improvements were observed in students’ willingness to ‘contribute to ethics discussions’ and their ‘confidence to raise concerns with supervisors’ (P<0.05). Anecdotal comments suggest students enjoyed the methodology and relevance of the educational intervention.
Varga- Atkins T,et al., (2010) An online wiki was made available to 4 problem-based (PBL) groups. Students used this to share resources or ask questions relating to the objectives on professional development. Qualitative feedback was collected through a small-scale student survey, and four focus group sessions. 32 first-year undergraduate medical students To establish whether use of wikis (collaborative websites) and whether they could enhance medical students’ development of professionalism. Only 25% (8 students) gave feedback via the questionnaire regarding the use of wikis for developing professionalism. However, 75% (24 students) participated in focus group feedback. Students identified the benefits of wikis: ease of sharing information/resources, enhancement of face-face PBL meetings and improved confidence with regard to achieving learning objectives.
Int J Med Educ. 2015; 6:184-190; doi: 10.5116/ijme.5650.54ad