Ethical development in veterinary undergraduates : investigating the value of a novel reflective exercise

As veterinary graduates will take up an ethically challenging role, initiatives fostering reflective thinking and moral development are being increasingly promoted in the veterinary curriculum. The aim of this study was to develop and validate a structured, reflective learning tool to promote ethical awareness in pre-clinical veterinary students. The Animal Welfare Associated Reflective Exercise (AWARE) focused on the ethical content of animal welfare related issues witnessed by pre-clinical students during extra mural study (EMS) placements. The AWARE had five sections: demographic information, animal welfare related event, personal reflection, ethical reflection and round up. Students were invited to identify, and give details of, a relevant incident that had an animal welfare impact. The AWARE guided students to reflect on their emotional reaction to the event, and its ethical basis, with reference to three well established ethical frameworks. A computer based teaching package was created to accompany the AWARE. The AWARE was piloted with 25 first year veterinary undergraduate students. Most students reflected on an experience on a lambing placement and feedback from the pilot study was positive with the majority of students self-reporting that their awareness of animal welfare and ethical issues had improved. Validation of the AWARE was then completed with a full cohort of first year veterinary students using a mixed-methods approach. Qualitative analysis revealed that students exhibited higher levels of reflection in the AWAREs than they did in the unstructured reflections previously completed by students following EMS placements. Ethically relevant text was also significantly increased in the AWAREs than in the unstructured reflections. However, completion of the AWARE did not improve scores on standardised measures of ethical sensitivity or moral reasoning, two components of moral development. Following validation, the AWARE was adapted for use in clinical EMS contexts. Fourth year veterinary students completed either the AWARE using a clinical situation which impacted animal welfare or a modified version of the AWARE, the Reflection on Professional Ethics (ROPE) which focused on a professional ethical dilemma. Three different frameworks were utilised in the ROPE – RCVS’s ten guiding principles, the bioethical principles and virtue ethics. Engagement with the AWARE was similar in clinical and pre-clinical students but fewer clinical students left responses blank and more considered their future actions. Findings from analyses of the ROPEs indicated that veterinary surgeons struggled to meet all of their ethical obligations in difficult situations, that respect for client autonomy was met in the majority of cases, and that virtue ethics was poorly understood by students completing the exercise. Investigations into moral reasoning abilities of vet students at various points in the curriculum were also carried out, using a well-established measure, the Defining Issues Test (DIT). First year students were found to have a wide range of moral reasoning abilities but their mean scores were similar to that expected for students of their age and stage. The moral reasoning scores of clinical stage veterinary students were no higher than those of first year veterinary students. Application of the DIT to qualified veterinary surgeons also revealed a wide range of moral reasoning ability, with practising veterinarians scoring no higher than members of the public and over a quarter relying primarily on a basic form of moral reasoning, normally reserved for pre-adolescent children. These findings raise important questions regarding the impact of veterinary education on moral reasoning and concern for animal welfare and veterinary well-being. Ethical development is an area where both undergraduates and qualified veterinarians could benefit from improved training of ethical skills. Collectively, the findings show that the AWARE reliably elicits ethically relevant content, is viewed positively by students and has several learning benefits including improved ability to recognise and reflect on animal welfare and ethical issues. The AWARE now forms part of the veterinary curriculum at the University of Glasgow and is available to other UK vet schools.