Changes in medical students’ perceptions of ethical climate during their medical training: a follow-up study of a student cohort

BACKGROUND: Ethical climate is an important component of professional development in medical education, yet little is known about how medical students' perceptions of ethical climate evolve during training or whether these perceptions are associated with career intentions. This study aimed to examine longitudinal changes in perceived and desired ethical climate among medical students and to explore potential associations with intended residency choice. METHODS: We conducted a follow-up study of a student cohort among medical students enrolled in the Croatian-language medical program at the University of Split School of Medicine. Ethical climate was assessed using the Ethical Climate Questionnaire (ECQ), which evaluates nine ethical climate domains. Data were collected during the third and the sixth year of study. Students completed both perceived and desired versions of the ECQ. Paired analyses were performed for students who participated at both time points, while independent-sample analyses compared third and sixth-year cohorts. Ethical climate domains were also examined in relation to students' desired residency choice. RESULTS: A total of 70 third year and 77 sixth-year students participated, with 57 students included in paired analyses. The two dominant climates were Company profit and Laws and professional codes. Perceived ethical climate scores decreased significantly from the third to the sixth year in the Company rules and procedures (p < 0.001), while other domains remained stable. No statistically significant differences were observed in desired ethical climate domains between the third and sixth study years after Bonferroni correction. No associations were found between ethical climate domains and intended residency choice. CONCLUSIONS: Medical students' perceptions of institutional ethical climate change during undergraduate training, particularly regarding organizational structure, while ethical ideals remain largely stable. Ethical climate perceptions do not appear associated with residency choice, suggesting that ethical development and career decision-making may follow distinct trajectories. These findings highlight the importance of addressing the hidden curriculum and supporting structured reflection on ethical tensions encountered during clinical training.