Background: In the past, teachers used to ask medical students to reflect on their clinical experience through free-form writing. In this study, a structured form called “Critical Incident Report” was implemented. Through systematic and multi-dimensional writing, better understanding of students’ psychological and cognitive reactions toward clinical ethical problems could be expected.

Methods: Twenty-six medical school students who were taking the compulsory course “Medical Ethics” participated in the current study. Seventeen of them were males and 9 of them were females. Participants were asked to each complete a Critical Incident Report (CIR) (Griffin, 2003) on an ethically sensitive event they had found unforgettable during their practicum in their 5th year of medical school. The CIR contained eight columns: what, emotions, why, classification, general meaning, professional standards, position, and actions. The data obtained from the CIR written by these 26 students with consent was subjected to a qualitative analysis. Both the experts’ and the students’ classification of the events on their CIRs were compared to ethical principles listed by medical ethics experts according to each student’s event report.

Results: 1. There was a significant difference between the medical students and the experts in the ethical principles they categorized the events into. 2. The most remarkable ethically sensitive events and conflicts experienced by the students were most frequently related to “non-maleficence” and “autonomy”. 3. Beliefs that students held toward ethically sensitive events included patient-centered practice, professionalism, and holistic health care. 4. Students’ emotions about the events included confusion and sympathy toward patients, and negative feelings such as anger, disapproval or disappointment toward clinical physicians. 5. When faced with ethical dilemmas, students usually adopted “communication” as the primary strategy.

Conclusion: Medical students’ experience with medical ethics in the clinical setting involved a broad range of issues including cognition, personal beliefs, emotions, and intentional actions. The CIR helped students record and present these experiences, which could also serve as a reference for future improvement of medical ethics education and research.