'I found myself a despicable being!':Medical students face disturbing moral dilemmas

CONTEXT: The psychological realm of medical students` moral experiences is explored tangentially in medical education literature, often in the context of ethics or professionalism education. This study deepens our understanding by (1) investigating the nature of moral dilemmas experienced at the onset of clinical practice, (2) exploring students` emotional response to these dilemmas, and (3) examining how students perceive the influence of these dilemmas on their professional development. METHODS: This is a cross-sectional qualitative study carried out in 2017 that applied Thematic Template Analysis to individual interviews performed with last-year medical students. The interviews followed the drawing of a Rich Picture representing moral dilemmas experienced by medical students at the onset of clinical practice. RESULTS: Moral dilemmas have four intertwined dimensions. The first relates to students` struggle to prioritize, balance and apply conflicting moral values; the second comprises the clash between students` inner motivation and the external constraints that limit the moral action; the third refers to the conflict between students' current attitudes with the desired/idealized attitudes of the doctor they intend to become; the forth corresponds to weighting conflicting ethical principles during the moral decision. Students` emotional responses are intense, long-lasting, and with a remarkable residue effect, particularly when the moral decision does not align with their moral beliefs. Moral dilemmas are impactful experiences that affect the professional development of medical students and can culminate in both detachment or growth in moral courage. CONCLUSION: Moral dilemmas are memorable, complex, and emotionally intense experiences that impact the professional development of medical students. Understanding students` moral dilemmas can help educators to devise pedagogical activities to anticipate and reflect on these experiences. These activities should happen under the guidance of a non-judgmental facilitator, capable of listening and legitimating students' thoughts and feelings while providing insights to nurture their professional development

The adaptive reuse of industrial structures

Purpose: The purpose of this paper is to investigate the feasibility of the adaptive reuse of a particular case study, and the evaluation of it within the context of international research done on similar projects. It aims to highlight the reuse potential of industrial structures by private developers, and the financial, environmental and social advantages that they could hold. Design/methodology/approach: A literature review that explores these themes is followed by the post-occupancy analysis of the case study. Data were gathered primarily through interviews with key role players in the project, site visits and an analysis of the relevant project documentation. Findings: While there are a number of international examples of the reuse of power stations in particular, these are mostly on a large scale, dependent mostly on government funding, lottery funding and donations and generally stripped of most of their machinery. The case study is a smaller-scale example which demonstrates that a project of this nature can be entirely funded by a private developer, that it can be sustainable and that it can be done while keeping most of the original machinery in place. The case study confirms a number of findings that are revealed in current research in the field, and it also shows the relative advantages of adaptive reuse when compared to new-build projects. Research limitations/implications: There is fairly limited information and published research about adaptive reuse, especially in South Africa, so the paper builds on international knowledge on the subject while exposing a suitable local example. It is hoped that the study will not only lead to further research and post-occupancy analysis of similar projects in South Africa in particular, but also support international research that indicates the feasibility of adaptive reuse. Originality/value: The Thesen Islands power station (or the Turbine Hotel as it is now known) could potentially be used as a precedent for similar redevelopments, and it could shed some light on the opportunities and constraints related to the management of fixed engineering assets.</p