Influence of cognitive dissonance on clinical judgment of a medical student playing the role of a doctor in an educational program combining ambulatory clerkship and peer role-play: A qualitative study

Problem

In some clinical training programs, medical students play patients or doctors in peer role-play, providing opportunities for clinical judgment. Cognitive dissonance is considered to have important effects on clinical judgment. However, the situations in which cognitive dissonance occurs, and how it influences students’ clinical judgment, are currently unclear. At Nagoya University, an educational program combining ambulatory clerkship and peer role-play using narratives from outpatients is used for training medical students. The current study was conducted to identify the factors influencing the impact of cognitive dissonance on students’ clinical judgment while playing the role of the doctor.

Approach

The participant was a male student playing the role of the doctor. In April 2016, the participant was interviewed about what he thought about the training program, and the problem that patient was played by a student. The participant was recruited through purposive sampling. Transcripts of the interview were analyzed using a qualitative data analysis method called “Steps for Coding and Theorization”. We used the theory of cognitive dissonance as a framework for analysis. The ethical Committee of Nagoya University approved the study (2015-0043).

Findings

We found that one of the influential factors was cognitive dissonance between A : a scenario involving a female patient, which was a recognization he wanted to adopt, and B : the visual recognition of a male student, which inhibited adopting A. Thus, two forms of dissonance were identified, that caused by sex and that caused by gender. These dissonances affected the student’s clinical judgment by less “presence” and less “particularization” of the patient’s information. Less “presence” meant, for example, the lack of visual recognition of a female patient. Less “particularization” meant, for example, that the student playing the role of the patient possessed little information about menstruation. Efforts to reduce cognitive dissonance led to a reduction in the dissonance caused by gender, but dissonance caused by sex could not be reduced. Clinical judgment was partially aided by reducing the cognitive dissonance associated with gender. But asking about sexual background and exhibiting an empathetic attitude were inhibited by the dissonance related to sex.

Consequences

The current findings suggested that a medical student recognized two kinds of cognitive dissonance caused by gender and sex. The student attempted to overcome both forms of cognitive dissonance; one was overcome, and the other was not. These findings suggested that the biological gap between the patient actor and the scenario could present an important difficulty for students playing the doctor role, particularly during training in clinical judgment for issues related to sexual background, and showing empathy. Because the results suggested that cognitive dissonance caused by gender could be overcome, conducting clinical judgment in consideration of gender may facilitate training in this educational program.