“It Is Challenging to Knowingly Cause Discomfort”: Medical Students' Experiences With Ethical Dilemmas and Professionalism During the Obstetrics and Gynecology Clerkship ID 2683534

INTRODUCTION: Medical students often encounter ethical dilemmas in obstetrics and gynecology clinical training, yet receive limited directed education to help them interpret and process these situations. We sought to explore students’ described experience with clinical ethical complexities to identify sources of conflict and inform training improvements. METHODS: From 2019 to 2022, medical students who submitted an essay assignment to describe an ethical dilemma encountered during their obstetrics and gynecology clerkship were invited to share their work with the study team. We performed thematic analysis of these essays. RESULTS: Thirty-nine essays were available for analysis. Prominent themes included patient autonomy, informed consent, approaches to counseling, power differentials, professionalism, and the learning environment and its effect on patient care. The following are sample quotes: “Each time a patient requested that a medical student not be involved in their care they often occupied positions of privilege by title, socioeconomic status, or race.”; “This was a difficult, uncomfortable experience. It is challenging to knowingly cause discomfort.”; “I wondered, and still wonder—should I have intervened? ... I did not have the courage to speak up, but I wish I did.” CONCLUSION: Students bear witness to and learn from ethical conflicts during obstetrics and gynecology training, which can prompt both self-reflection and cognitive dissonance. Topics such as informed consent and patient autonomy are commonly taught in medical schools; in practice, students also identified dilemmas related to their roles as learners navigating team-based health care. Medical students may need additional ethical training or support in processing the hierarchies of academic medicine.