Year: 2008
Type: article
Abstract: Context and setting The principles of medical ethics can be taught through didactic lectures in formal classroom teaching. However, students would appreciate the principles better if they were exposed to real-life clinical scenarios where issues related to medical ethics in clinical practice could be encountered. The Department of Family Medicine at the International Medical University, Malaysia has developed a structured and organised ethics learning programme for clinical students during the family medicine posting. Why the idea was necessary The UK General Medical Council and other professional bodies worldwide have now recognised that medical ethics need to be explicitly taught, rather than remaining a ‘hidden’ subject in medical education. During the family medicine rotation, Year 3 medical students are required to be attached to community primary care clinics. This presents a good opportunity for students to identify and appreciate common ethical issues in day-to-day practice. This approach makes the teaching and learning of ethics more effective. What was done Year 3 medical students posted to a community clinic on the family medicine rotation were required to identify one ethical issue during their 1-week posting to enable them to complete their case write-up. At the end of this period, they participated in a debriefing session with their lecturer. They were asked to discuss the principles of the ethics involved and to suggest ways to handle the issues identified. They were also required to give their opinions as to whether the consulting doctor had handled these ethical issues appropriately. After the joint discussion, they were asked to submit a report of their findings reflecting on the ethical issues identified. Evaluation of results and impact This learning activity was initiated in March 2007. To date, 140 students have completed the primary care attachment. The medical ethics issues commonly encountered include: questions of honesty in issuing medical sick leave; doctor decisions to order investigation and treatment (doctor autonomy); patient refusal of treatment and admission (patient autonomy); appropriate prescription of treatment (beneficence and justice), and discussion of a patient’s diagnosis in the presence of a third party (confidentiality). The students also managed to identify issues related to professionalism such as: attitudes of health care workers towards patients; ignoring of patient requests for treatment, and poor communication (because of language and social status). Students identified eight in 30 patients (26.6%) for whom they considered the granting of medical sick leave to have been inappropriate and in breach of honesty. Inappropriate prescribing (such as for antibiotics) was reported in 20 of 100 patients (18%). Confidentiality was breached in 35 of 140 patients (25%) because more than two doctors were consulting patients in the same consultation room due to lack of space. Student attachments to community primary care clinics allowed them to identify ethical issues in real clinical scenarios. This helped students to achieve a deeper understanding of the principles of medical ethics. Further discussion and reflection through case write-up induced a deeper cognitive understanding in clinical practice. This exercise appears to cultivate a value system in medical students and should continue throughout their medical education.
Source: Medical Education
Authors: Keng Yin Loh, Sivalingam Nalliah
Institution: IMU University
Language: English
Subfield: Education
Field: Social Sciences
Domain: Social Sciences
Open Access status: bronze
OpenAlex ID: W2008407107