Ethics teaching in a medical education environment: preferences for diversity of learning and assessment methods

Figures & data

Figure 1. Distribution of studied attitudes who reported being treated in an professional versus unprofessional manner. Among students who claimed being treated in less professional manner, attitudes toward ethics were less favorable (P = 0.001).

Table 1. Medical students’ attitudes toward ethics and its teaching.

	Gender
(Cronbach’s α 0.649)	Female (N = 84) Mean±SD	Male(N = 24) Mean±SD	Overall (N = 108) Mean±SD
1. Professionalism can be taught and learned.	6.94 ± 1.82	6.96 ± 1.52	6.94 ± 1.75
2. Ethics CANNOT be taught and learned.	3.58 ± 2.40*	2.63 ± 1.66	3.36 ± 2.28
3. Ethics should be formally taught in the medical school curriculum.	7.52 ± 1.48	6.75 ± 2.23	7.35 ± 1.70
4. Attitudes and values are set (fixed, established) by the time students reach residency.	6.27 ± 2.16	5.75 ± 2.40	6.15 ± 2.22
5. There are NO right and wrong answers to ethical issues questions.	6.37 ± 2.08	5.38 ± 2.39	6.15 ± 2.18
6. Ethics is a discipline with its own methods, literature, vocabulary, and content.	7.06 ± 1.68*	5.83 ± 2.65	6.79 ± 1.99
7. Attitudes and values are learned from family, culture, and religion.	7.95 ± 1.29	8.08 ± 0.93	7.98 ± 1.22
8. Attitudes and values are NOT an appropriate focus for undergraduate medical education.	2.71 ± 2.03	2.88 ± 2.25	2.75 ± 2.07
9. Physicians should possess professionalism.	8.31 ± .94	8.08 ± 2.00	8.26 ± 1.25
10. Selection of residents should NOT include assessment of professionalism.	2.96 ± 2.05	3.46 ± 2.21	3.07 ± 2.09
11. Evaluation of students should include assessment of professionalism.	7.36 ± 2.02	7.67 ± 2.20	7.43 ± 2.06
12. Ethical conflicts are common in the everyday practice of medicine.	7.69 ± 1.34*	8.29 ± 0.81	7.82 ± 1.27
13. Training in ethics does NOT help medical students deal with ethical conflicts	3.13 ± 1.94	2.92 ± 1.98	3.08 ± 1.94
14. Students face different ethical issues at different points in their training.	7.91 ± 1.18	7.50 ± 1.67	7.82 ± 1.31
15. Medical training fosters unethical behavior.	4.15 ± 2.25	4.67 ± 2.08	4.26 ± 2.21
16. Medical training fosters professionalism.	7.06 ± 1.75	6.58 ± 1.59	6.95 ± 1.72
17. Medical training fosters cynicism.	4.56 ± 2.22	4.42 ± 2.08	4.52 ± 2.18
18. Students receive adequate training to handle the ethical conflicts they may face.	5.23 ± 2.15	4.92 ± 1.93	5.16 ± 2.10
19. Attention to attitudes, values, and ethical issues helps to prevent cynicism in medical training.	7.01 ± 1.53	6.79 ± 1.96	6.96 ± 1.63
20. It is important that physicians-in-training take an oath or declaration to uphold the values of the profession.	6.98 ± 1.89	6.67 ± 2.46	6.91 ± 2.02
21. Psychiatrists must abide by a different set of ethical guidelines than other physicians.	5.61 ± 2.29	5.25 ± 2.33	5.53 ± 2.29
22. Psychiatrists must abide by a stricter set of ethical guidelines than other physicians.	5.58 ± 2.48	6.50 ± 1.77	5.79 ± 2.36
23. Physicians are more ethical than the general public.	5.59 ± 2.06	5.71 ± 2.22	5.62 ± 2.09
24. Most faculty physicians behave ethically towards students.	5.77 ± 2.03*	4.38 ± 2.55	5.46 ± 2.23
25. Most faculty physicians behave ethically towards patients.	6.62 ± 1.65	6.29 ± 1.99	6.55 ± 1.73
Group means	6.54 ± .65	6.45 ± .90	6.52 ± 0.72

1. Rated on a scale from 1 = ‘much less’ to 5 = ‘same’ to 9 = ‘much more’ attention needed compared to now.

*Statistically significant difference between male and female, P < 0.05

Table 2. Students’ ideas about the goal of education in professionalism and medical ethics.

	Gender		Overall (N = 108)
(Cronbach’s α 0.922)	Female (N = 84) Mean±SD (range)	Male(N = 24) Mean±SD (range)	Male and female Mean±SD (range)
1. To become better people	7.60 ± 1.42	7.50 ± 1.38	7.58 ± 1.41
2. To better recognize ethical issues	7.69 ± 1.27	7.58 ± 1.32	7.66 ± 1.27
3. To develop interpersonal skills useful in resolving ethical conflicts	7.76 ± 1.25	7.50 ± 1.25	7.70 ± 1.25
4. To acquire a working knowledge of social science, philosophy, religion, and law as they apply to clinical care	7.63 ± 1.26*	6.71 ± 1.71	7.42 ± 1.41
5. To improve patient care and clinical decision making	7.93 ± 1.18	7.50 ± 1.45	7.83 ± 1.25
6. To prevent cynicism (negativity) and detachment in interactions with patients	7.57 ± 1.56	7.67 ± 1.27	7.59 ± 1.50
7. To better clarify values-laden (not objective; with personal bias) choices	7.54 ± 1.32*	6.88 ± 1.51	7.39 ± 1.39
8. To reduce the likelihood a physician may make a legal error in the future	7.88 ± 1.14*	6.79 ± 2.36	7.64 ± 1.56
9. To reduce the likelihood that a clinician will face a medical liability suit at some point during practice	7.80 ± 1.03*	6.71 ± 2.27	7.55 ± 1.47
10. To reduce the likelihood that a physician may make an ethical error in the future	7.77 ± 1.12	7.71 ± 1.43	7.76 ± 1.19
11. To learn how to heal our patients in addition to treating them	7.88 ± 1.24	7.63 ± 1.53	7.82 ± 1.31
Group means	7.73 ± .99	7.29 ± 1.11	7.63 ± 1.03

1. Rated on a scale from 1 = ‘much less’ to 5 = ‘same’ to 9 = ‘much more’ attention needed compared to now.

*Statistically significant difference between male and female, P < 0.05

Table 3. Medical students’ preferred methods for learning about professional attitudes, values, and ethics (Mean±SD).

	Gender		Overall (N = 108)
(Cronbach’s α 0.907)	Female (N = 84) Mean±SD (range)	Male(N = 24) Mean±SD (range)	Male and female Mean±SD (range)
1. Case conferences (presentations)	6.98 ± 1.75*	6.08 ± 1.98	6.78 ± 1.83
2. Grand round presentations	7.19 ± 1.49*	6.08 ± 1.67	6.94 ± 1.59
3. Lectures	6.52 ± 1.78	6.00 ± 2.06	6.41 ± 1.85
4. Clinical rounds	7.54 ± 1.35*	6.37 ± 1.789	7.28 ± 1.53
5. Discussion groups of peers led by a knowledgeable clinician	7.88 ± 1.17	7.54 ± 1.32	7.81 ± 1.20
6. Discussion groups of peers without leadership by a clinician	5.49 ± 2.07	5.83 ± 1.71	5.56 ± 2.00
7. Watching videotapes on ethics topics followed by discussion led by a knowledgeable clinician	6.43 ± 1.85	6.33 ± 2.30	6.41 ± 1.95
8. Incorporation of ethical issues into lectures and teaching rounds	7.62 ± 1.24*	6.79 ± 1.62	7.44 ± 1.37
9. Role modeling of ethical reasoning and behavior by faculty	7.48 ± 1.34	7.37 ± 2.06	7.45 ± 1.52
10. Interactions with standardized (e.g., simulated) patients	6.96 ± 1.48	6.62 ± 1.69	6.89 ± 1.52
11. Interactions with patients in routine training situations	7.76 ± 1.16	7.17 ± 1.69	7.63 ± 1.28
12. Independent reading	5.76 ± 2.13	5.87 ± 1.78	5.79 ± 2.05
13. Web-based educational approaches	5.79 ± 2.100	6.17 ± 1.373	5.87 ± 1.96
14. Directed (assigned) reading with tutorial discussions	6.27 ± 1.835	5.71 ± 2.293	6.14 ± 1.95
15. Directed ethics research with a mentor	6.32 ± 1.977	5.67 ± 2.200	6.18 ± 2.04
16. Discussion of clinical ethics with ethics consultants	7.19 ± 1.596	6.83 ± 2.078	7.11 ± 1.71
17. Discussion of the legal aspects of patient care with attorneys (lawyers, legal experts)	7.16 ± 1.604	6.42 ± 1.692	6.99 ± 1.65
18. Discussion of the spiritual (religious) aspects of patient care with religious leaders	7.31 ± 1.448*	6.04 ± 1.922	7.03 ± 1.64
19. Discussion of the cultural aspects of patient care with cultural experts	7.15 ± 1.477*	6.29 ± 1.829	6.96 ± 1.59
Group means	6.88 ± .99	6.38 ± 1.19	6.77 ± 1.06

1. Rated on a scale from 1 = ‘much less’ to 5 = ‘same’ to 9 = ‘much more’ attention needed compared to now.

*Statistically significant difference between male and female, P < 0.05

Table 4. Students’ views of appropriate needed methods for assessing knowledge of professional attitudes, values, and ethics.

	Gender
(Cronbach’s α 0.837)	Female (N = 84) Mean±SD (range)	Male(N = 24) Mean±SD (range)	Overall (N = 108) Mean±SD (range)
1. Multiple choice examinations	5.19 ± 2.66	5.17 ± 2.22	5.19 ± 2.56
2. Short answer questions	5.35 ± 2.68	5.50 ± 2.28	5.38 ± 2.59
3. Essays	5.11 ± 2.53	5.08 ± 2.47	5.10 ± 2.50
4. Oral examinations	6.43 ± 2.42	5.50 ± 2.55	6.22 ± 2.47
5. Standardized (e.g., simulated) patient interactions	6.96 ± 1.98	6.33 ± 2.55	6.82 ± 2.12
6. Clinical supervision	7.67 ± 1.50	7.46 ± 1.25	7.63 ± 1.44
Group means	6.11 ± 1.71	5.84 ± 1.73	6.05 ± 1.71

1. Rated on a scale from 1 = ‘much less’ to 5 = ‘same’ to 9 = ‘much more’ attention needed compared to now.

Table 5. Students’ views of appropriate needed methods for assessing skills of professional attitudes, values, and ethics.

	Gender		Overall (N = 108)
(Cronbach’s α 0.845)	Female (N = 84)	Male (N = 24)	Male and female
1. Standardized (e.g. simulated) patients’ assessment of their interactions with students	6.84 ± 1.70	7.04 ± 1.68	6.89 ± 1.69
2. Faculty direct observation of students’ interactions with actual patients	7.60 ± 1.31	7.67 ± 1.13	7.62 ± 1.26
3. Faculty observation of videotaped interactions of students with actual patients	6.45 ± 2.04	6.46 ± 2.13	6.45 ± 2.05
4. Faculty observation of students’ interactions with clinical team members	7.31 ± 1.51	7.29 ± 1.33	7.31 ± 1.46
5. Students’ written and observational skills in analyzing ‘trigger’ videotapes	5.77 ± 2.14	5.92 ± 1.56	5.80 ± 2.02
6. Written exercises as follow-ups to standardized (e.g., simulated) patient interactions	5.73 ± 1.95	6.00 ± 2.00	5.79 ± 1.95
7. Evaluation of students by non-faculty staff	6.54 ± 1.98	6.33 ± 2.60	6.50 ± 2.12
8. Evaluation of students by patients	7.20 ± 1.99	7.13 ± 2.86	7.19 ± 2.20
Group means	6.68 ± 1.31	6.73 ± 1.28	6.69 ± 1.30

1. Rated on a scale from 1 = ‘much less’ to 5 = ‘same’ to 9 = ‘much more’ attention needed compared to now.