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The goal of values clarification is to promote students’ knowledge of their own values (Miles et al., 1989). Goldie (2004) comments on the sources and impact of these values:


“Students enter medical school with pre-existing perspectives, through which they will view their experiences and from which meaning will emerge. These meaning perspectives consist of specific values, assumptions and beliefs, often acquired uncritically in the course of childhood through socialisation and acculturation. This occurs most frequently during significant experiences with parents, teachers and mentors. These processes have the potential to continue during students’ medical education. Students’ meaning perspectives provide them with the criteria for judging or evaluating right and wrong and what is appropriate or inappropriate.”


A corollary of this is the importance of engaging with the perceptions of students from the time they arrive at medical school, and to continue doing so throughout the curriculum (Goldie, 2004).


With regard to learning in clinical contexts, Hundert et al. (1996) underline its significance for “understanding ethics less as academic material and more as part of professional development and routine professional life”. Goldie (2004) highlights the essential modelling that also takes place in clinical settings:


“As ethical decision making is integral to clinical decision making… The ethical aspects of clinical decision making should be made explicit during clinical teaching… clinical teachers have the potential to act as powerful positive role models for their students. Empirical evidence has shown students to be more profoundly affected by role models than by formal coursework.”


In line with this, Cruess & Cruess (2006) correlate clinical learning with the acquisition of tacit knowledge, which is “best learned not in the lecture hall, but by situated learning”.


Citing the work by Snyder (1971) on the hidden curriculum, Coles & Grant (1985) comment on the learning that can be “highly desirable” or alternatively “rather more sinister”. Depicting this informal zone of learning as part of the curriculum that students actually experience (lying exterior to its intersections with the curriculum as planned and the curriculum as delivered), Coles (1998) explains:


“It is part of the curriculum which was never intended nor became the curriculum in action yet nevertheless it forms a large part of the students’ experience… It can be much more powerful in determining what students actually do than many teachers or curriculum planners imagine.”


As Hafferty & Franks (1994) explain, this learning can in certain circumstances lead to “a progressive decline of moral reasoning during undergraduate medical school training”, and an essential counterbalance is the formative role of the community of practice in all educational settings, both through campus-based professional studies and clinical learning in workplace settings.


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Guide 53: Ethics and Law in the Medical Curriculum


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