Matthias Katzer¹, Marcel Mertz¹, Sabine Salloch¹

¹ Institute for Ethics, History and Philosophy of Medicine, Hannover Medical School

It is widely assumed that medical training shapes students’ ethically relevant attitudes, such as empathy, communication and cooperation styles, and the acceptance of diversity. Such attitudes and the associated values and norms are addressed to some extent in courses on ethics and other subjects. However, it is often argued that the implicit ‘hidden curriculum’ of clinical practice exerts a stronger influence on the formation of these attitudes than explicit teaching. To shed more light on this issue, the study examines how the attitudes of medical students are shaped by their practical experiences.

Two qualitative methods were used in the study: participant observation during block placements in the 4th and 5th years of study, and focus group interviews with students in their clinical year. The focus was on three factors generally regarded as central to the formation of attitudes: role models, feedback and reflection.

The participants cited numerous examples of positive role models from clinical practice. They also reported on negative role models and reflected on how these experiences had shaped their understanding of professional conduct. When students received feedback, it generally concerned technical aspects. In some cases, the feedback touched on ethical issues, particularly when it concerned adherence to strict rules or the performance of specific actions. By contrast, students rarely received feedback on more general aspects of their ethical attitudes. Similarly, they were rarely encouraged to engage more deeply with ethically problematic situations they encountered in practice.

The results show that students actively engage with the ethical aspects of their clinical experiences and thereby develop ethical attitudes. However, they often lack opportunities for guided and systematic reflection on their experiences. This suggests that they would benefit from more opportunities for such reflection. New teaching formats designed with this in mind could contribute to the formation of ethical attitudes among students.