Bioethical-Communicative Judgments Across Training Years
Cross-Year Evidence from Uzbek Medical Education
DOI:
https://doi.org/10.7160/eriesj.2026.190301Keywords:
bioethical norms, Central Asian medical education, hidden curriculum, pragmatic socialization, professional responsibility, situational judgment testAbstract
Whether bioethical-communicative judgments vary across stages of medical education remains underexplored in Central Asian contexts. This pilot cross-sectional study examined scenario-based judgments among 100 undergraduate medical students from six year groups and seven universities in Uzbekistan using a purpose-designed six-scenario Situational Judgment Test (SJT). Five Likert-format scenarios were analysed separately, with S4 and S5 reverse-coded only for directional consistency, while S6 used a forced-choice format. After Holm correction, significant year-group differences remained for patient autonomy and consent (S3: H(5) = 28.89, p < .001, ε² = .254), comprehension verification (S4: H(5) = 14.52, p = .038, ε² = .101), and emotional responsiveness (S5: H(5) = 18.72, p = .009, ε² = .146), but not for prognosis disclosure or hierarchical challenge. In Year 1 versus Years 2–6 comparisons, Year 1 students rated S2 and S3 higher, whereas Years 2–6 rated S4 and S5 higher; S1 did not differ significantly. S6 responses were divided among refusal, acceptance, and compromise. Overall, cross-year variation was domain-specific and bidirectional. Given the cross-sectional design, unequal group sizes, and exploratory instrument, the findings should be interpreted as hypothesis-generating rather than causal. They identify domains warranting further longitudinal, qualitative, and behaviourally validated investigation within Uzbek medical education settings.
References
Ahmedov, M., Azimov, R., Mutalova, Z., Huseynov, S., Tsoyi, E. and Rechel, B. (2014) ‘Uzbekistan: Health system review’, Health Systems in Transition, Vol. 16, No. 5, pp. 1–137.
Salimova, G. (2026) ‘Sociopragmatic Competence in Medical Higher Education: Structure, Criteria, and Measurement Methods’, Journal of Applied Linguistics and Applied Literature: Dynamics and Advances, Iss. 1, article accepted and in press. https://doi.org/10.22049/jalda.2026.31530.1982
Bardovi-Harlig, K. (1999) ‘Exploring the interlanguage of interlanguage pragmatics: A research agenda for acquisitional pragmatics’, Language Learning, Vol. 49, No. 4, pp. 677–713. http://dx.doi.org/10.1111/0023-8333.00105
British Psychological Society (2021) BPS Code of Human Research Ethics, Leicester: British Psychological Society. https://doi.org/10.53841/bpsrep.2021.inf180
Brodahl, K. Ø., Finset, A., Storøy, H.-L. E. and Pedersen, R. (2021) ‘Medical students’ expressions of empathy: A qualitative study of verbal interactions with patients expressing emotional issues in a medical interview’, Patient Education and Counseling, Vol. 104, No. 12, pp. 2936–2943. http://dx.doi.org/10.1016/j.pec.2021.03.042
Brown, P. and Levinson, S. C. (1987) Politeness: Some universals in language usage, Cambridge: Cambridge University Press.
Carrillo, I., Serpa, P., Landa-Ramírez, E., Guilabert, M., Gómez-Ayala, Y., López-Pineda, A. and Mira, J. J. (2024) ‘Speaking up about patient safety, withholding voice and safety climate in clinical settings: A cross-sectional study among Ibero-American healthcare students’, International Journal of Public Health, Vol. 69, p. 1607406. http://dx.doi.org/10.3389/ijph.2024.1607406
Conaboy, K. A., Nugmanova, Z., Yeguebaeva, S., Jaeger, F. and Daugherty, R. M. (2005) ‘Central Asian republics: A case study for medical education reform’, Journal of Continuing Education in the Health Professions, Vol. 25, No. 1, pp. 52–64. http://dx.doi.org/10.1002/chp.9
Duff, P. A. (2010) ‘Language socialization into academic discourse communities’, Annual Review of Applied Linguistics, Vol. 30, pp. 169–192. http://dx.doi.org/10.1017/S0267190510000048
Duff, P. A. and Talmy, S. (2011) ‘Language socialization approaches to second language acquisition: Social, cultural, and linguistic development in additional languages’, in: Atkinson, D. (ed.), Alternative approaches to second language acquisition, London: Routledge, pp. 95–116. https://doi.org/10.4324/9780203830932-5
Ha, J. F. and Longnecker, N. (2010) ‘Doctor-patient communication: A review’, Ochsner Journal, Vol. 10, No. 1, pp. 38–43.
Hafferty, F. W. (1998) ‘Beyond curriculum reform: Confronting medicine’s hidden curriculum’, Academic Medicine, Vol. 73, No. 4, pp. 403–407. http://dx.doi.org/10.1097/00001888-199804000-00013
Hosseinpour, A. and Keshmiri, F. (2024) ‘Professionalism assessment of students in clinical education through Situational Judgment Test (SJT)’, BMC Medical Education, Vol. 24, No. 1, p. 1291. http://dx.doi.org/10.1186/s12909-024-06205-4
Kasper, G. and Rose, K. R. (2002) Pragmatic development in a second language, Malden, MA: Blackwell Publishers.
LaNoue, M. D. and Roter, D. L. (2018) ‘Exploring patient-centeredness: The relationship between self-reported empathy and patient-centered communication in medical trainees’, Patient Education and Counseling, Vol. 101, No. 6, pp. 1143–1146. http://dx.doi.org/10.1016/j.pec.2018.01.016
Lave, J. and Wenger, E. (1991) Situated learning: Legitimate peripheral participation, Cambridge: Cambridge University Press.
Martinez, W., Lehmann, L. S., Thomas, E. J., Etchegaray, J. M., Shelburne, J. T., Hickson, G. B., Brady, D. W., Schleyer, A. M., Best, J. A., May, N. B. and Bell, S. K. (2017) ‘Speaking up about traditional and professionalism-related patient safety threats: A national survey of interns and residents’, BMJ Quality & Safety, Vol. 26, No. 11, pp. 869–880. http://dx.doi.org/10.1136/bmjqs-2016-006284
Matsumura, S. (2003) ‘Modelling the relationships among interlanguage pragmatic development, L2 proficiency, and exposure to L2’, Applied Linguistics, Vol. 24, No. 4, pp. 465–491. http://dx.doi.org/10.1093/applin/24.4.465
Neumann, M., Edelhäuser, F., Tauschel, D., Fischer, M. R., Wirtz, M., Woopen, C., Haramati, A. and Scheffer, C. (2011) ‘Empathy decline and its reasons: A systematic review of studies with medical students and residents’, Academic Medicine, Vol. 86, No. 8, pp. 996–1009. http://dx.doi.org/10.1097/ACM.0b013e318221e615
Patterson, F., Rowett, E., Hale, R., Grant, M., Roberts, C., Cousans, F. and Martin, S. (2016) ‘The predictive validity of a situational judgement test and multiple-mini interview for entry into postgraduate training in Australia’, BMC Medical Education, Vol. 16, No. 1, p. 87. http://dx.doi.org/10.1186/s12909-016-0606-4
Plonsky, L. and Gass, S. (2011) ‘Quantitative research methods, study quality, and outcomes: The case of interaction research’, Language Learning, Vol. 61, No. 2, pp. 325–366. http://dx.doi.org/10.1111/j.1467-9922.2011.00640.x
Pun, J. K. H., Chan, E. A., Wang, S. and Slade, D. (2018) ‘Health professional-patient communication practices in East Asia: An integrative review of an emerging field of research and practice in Hong Kong, South Korea, Japan, Taiwan, and Mainland China’, Patient Education and Counseling, Vol. 101, No. 7, pp. 1193–1206. http://dx.doi.org/10.1016/j.pec.2018.01.018
Rechel, B., Richardson, E. and McKee, M. (eds.) (2014) Trends in health systems in the former Soviet countries, Observatory Studies Series, No. 35, Copenhagen: European Observatory on Health Systems and Policies.
Sahota, G. S. and Taggar, J. S. (2020) ‘The association between Situational Judgement Test (SJT) scores and professionalism concerns in undergraduate medical education’, Medical Teacher, Vol. 42, No. 8, pp. 937–943. http://dx.doi.org/10.1080/0142159X.2020.1772466
Sahota, G. S., Fisher, V., Patel, B., Ju, J. K. and Taggar, J. S. (2023) ‘The educational value of situational judgement tests (SJTs) when used during undergraduate medical training: A systematic review and narrative synthesis’, Medical Teacher, Vol. 45, No. 9, pp. 997–1004. http://dx.doi.org/10.1080/0142159X.2023.2168183
Salehi, P. P., Jacobs, D., Suhail-Sindhu, T., Judson, B. L., Azizzadeh, B. and Lee, Y. H. (2020) ‘Consequences of medical hierarchy on medical students, residents, and medical education in otolaryngology’, Otolaryngology-Head and Neck Surgery, Vol. 163, No. 5, pp. 906–914. http://dx.doi.org/10.1177/0194599820926105
Singh, P. K., Singh, S., Ahmad, S., Singh, V. K. and Kumar, R. (2025) ‘Navigating power dynamics and hierarchies in medical education: Enhancing faculty experiences and institutional culture’, Journal of Postgraduate Medicine, Vol. 71, No. 2, pp. 82–90. http://dx.doi.org/10.4103/jpgm.jpgm_728_24
Surbone, A. (2006) ‘Telling the truth to patients with cancer: What is the truth?’, The Lancet Oncology, Vol. 7, No. 11, pp. 944–950. http://dx.doi.org/10.1016/S1470-2045(06)70941-X
Trillo, J. R. (2002) ‘The pragmatic fossilization of discourse markers in non-native speakers of English’, Journal of Pragmatics, Vol. 34, No. 6, pp. 769–784. http://dx.doi.org/10.1016/S0378-2166(02)00022-X
Ullah, H., Huma, S., Tahir, N., Yasin, G., Ashraf, M., Shabana, H., Gabr, B. M., Yunus, M. and Khan, J. S. (2025) ‘Effects of hidden curriculum on medical education and strategies to reshape hidden curriculum as a curriculum promotor: A systematic review’, Advances in Medical Education and Practice, Vol. 16, pp. 2087–2098. http://dx.doi.org/10.2147/AMEP.S561248
Vanstone, M. and Grierson, L. (2022) ‘Thinking about social power and hierarchy in medical education’, Medical Education, Vol. 56, No. 1, pp. 91–97. http://dx.doi.org/10.1111/medu.14659
Wang, D.-C., Peng, X., Guo, C.-B. and Su, Y.-J. (2013) ‘When clinicians telling the truth is de facto discouraged, what is the family’s attitude towards disclosing to a relative their cancer diagnosis?’, Supportive Care in Cancer, Vol. 21, No. 4, pp. 1089–1095. http://dx.doi.org/10.1007/s00520-012-1629-y
World Medical Association (2013) Declaration of Helsinki: Ethical principles for medical research involving human subjects, [Online], Available at: https://www.wma.net/wp-content/uploads/2024/10/DoH-Oct2013.pdf [7 August 2026].
Wu, J., Wang, Y., Jiao, X., Wang, J., Ye, X. and Wang, B. (2021) ‘Differences in practice and preferences associated with truth-telling to cancer patients’, Nursing Ethics, Vol. 28, No. 2, pp. 272–281. http://dx.doi.org/10.1177/0969733020945754
Zolkefli, Y. (2021) ‘Healthcare dilemma towards gift giving by patients’, Malaysian Journal of Medical Sciences, Vol. 28, No. 5, pp. 137–141. http://dx.doi.org/10.21315/mjms2021.28.5.14
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