The impact of medical students' values on their clinical decision-making

Abstract

Introduction Clinical decision-making involves choosing which treatments are best for patients. Often there is no consensus among practitioners on the best alternatives, and values of individual practitioners may guide their decisions. This thesis investigates how the values of medical students may impact on their clinical decisions. Methods A systematic literature review was undertaken to identify personal and professional values of healthcare practitioners. The values were arranged within Schwartz’s values model and a framework for healthcare practitioners’ values, which formed the basis for a new instrument, the Healthcare Practitioner Values Scale (HPVS), was derived. Content and construct validity of the HPVS was explored using the Schwartz Values Survey (SVS) as a reference for the HPVS’ content and structure in a sample of healthcare students and professionals. The impact of medical students’ values on their decision-making was investigated using the HPVS to measure their values, and content analysis to measure their decision-making in four clinical scenarios. Results The systematic review identified eleven healthcare practitioners’ values (authority, capability, pleasure, intellectual-stimulation, critical thinking, equality, altruism, morality, professionalism, safety and spirituality) and defined a structure of relations among them. Schwartz’s structure of value relations was replicated in the sample of students and professionals studied. HPVS and SVS value correlations ranged from -0.39 to 0.64. The correlation between the structure of the HPVS and SVS was 0.43 (CI - 0.29 - 0.57). Spirituality and critical thinking were the prominent values that influenced students’ decision-making. Students who prioritised spirituality were more likely to consider patient-centred factors in their decisions, and less likely to consider clinical factors than other students. Students who prioritised critical thinking were less likely to consider patient-centred factors in their decisions than other students. Conclusion This thesis developed and demonstrated evidence of validity for the HPVS, which measures key values across healthcare professions, and embeds a theory on relations among them. It can be a valuable tool to identify value-related issues in decision-making in clinical practice. This thesis concludes that students’ values may influence their clinical decision-making. Helping students and professionals become aware of their values may improve their decision-making and quality of patient care.