Time to tackle unethical attitudes and behaviour in medicine

March 22, 2001

Understanding the clinical dilemmas that shape medical students' ethics development: questionnaire survey and focus group study

Editorial: Closing the gap between professional teaching and practice

Personal View: Learning respect

Nearly half of medical students often feel under pressure to act unethically during training and almost two thirds regularly witness a clinical teacher behaving unethically, finds a study in this week's BMJ. These worrying findings highlight the need for a national policy to help protect the needs and rights of both patients and students in medical education.

Over 100 clinical students, who were about one year away from completing medical school at the University of Toronto, were surveyed about ethical dilemmas they had encountered during their clinical training. Nearly half (47%) reported that they had often been placed in a clinical situation in which they had felt pressure to act unethically, and 61% reported witnessing a clinical teacher acting unethically.

Three categories of ethical dilemma were identified, based on examples reported by 20 students during four focus groups. For example, reports of physical examination of patients for purely educational reasons without patients' prior consent indicated a conflict between medical education and patient care. Students also reported being given responsibility beyond their capacity, and involvement in patient care which they perceived to be substandard and unacceptable. The study also suggested that these dilemmas are seldom resolved during medical school.

The Toronto study's results are likely relevant to medical education in medical schools across the world. The need to enforce a national policy to help prevent abuses of both patients and students in medical education system is highlighted by Len Doyal, Professor of Medical Ethics at St Bartholomew's and the Royal London School of Medicine and Dentistry, in an accompanying editorial. This will ensure that the students of today will be proud rather than distressed that they have chosen to be the doctors of tomorrow, he writes.

The view that patient consent is needed for training procedures as well as treatment is reiterated in a personal view by Andrew West and colleagues. "The medical profession urgently needs to learn respect for the living and for the dead, and thereby earn the public respect that is its lifeblood," they conclude.

[Paper:] David W Robertson, Medical Student, University of Toronto, Faculty of Medicine, Toronto, Canada Email: davidw.robertson@utoronto.ca

[Editorial:] Len Doyal, Professor of Medical Ethics, St Bartholomew's and the Royal London School of Medicine and Dentistry, London, UK Email: l.doyal@mds.qmw.ac.uk

[Personal View:] Andrew West, Senior Registrar, Park Hospital for Children, Oxford, UK


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