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Ashwini K.Shetty, Ravi Vaswani. Knowledge, attitude and practice of healthcare ethics among final year medical and nursing students at a college in South India. Biomedicine (Taipei) 2022. [DOI: 10.51248/.v42i3.1276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Introduction and Aim: The basic knowledge about health care ethics is very much necessary for both medical and nursing students before they start dealing with patients. The aim of the study is to assess the knowledge of, attitude and practice of health care ethics among final year medical and nursing students and to compare the same among these students.
Methodology: The cross sectional study was done using a validated questionnaire on 75 students each from final year MBBS and nursing. The collected data was interpreted using appropriate statistical methods like percentages, proportions. Chi square test was used for comparison, p<0.05 was considered statistically significant.
Results: The medical and nursing students included in our study had significant knowledge about medical ethics like autonomy where there is respect to patient and his decisions regarding treatment plans. The students lacked sensitivity on issues of paternalism. Majority of respondents also felt that any wrong doing by health care professional should be conveyed to the patient. Respondents had inclination towards learning ethics and wanted it in their respective curriculum.
Conclusion: This study demonstrates the paucity in knowledge of health care ethics among medical and nursing students. Respondents had an inclination to study ethics of health care.
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Yeshineh G, Feleke A, Tadie C, Hagos A, Debebe W, Teshale G, Yazachew L. Practice of code of ethics and associated factors among health professionals in Central Gondar Zone public hospitals, Northwest Ethiopia, 2021: a mixed-method study design. BMC Med Ethics 2022; 23:68. [PMID: 35778713 PMCID: PMC9250232 DOI: 10.1186/s12910-022-00807-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 06/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ethics is the science of moral and ethical rules recognised in human life and attempts to verify what is morally right and wrong. Healthcare ethics is seen as an integrated part of the daily activities of health facilities. Healthcare professionals' standardisation and uniformity in healthcare ethics are urgent and basic requirements. Therefore, this study aimed to assess the practice of the code of ethics and associated factors among health professionals in Central Gondar Zone public hospitals, Northwest Ethiopia, 2021. METHODS A facility-based cross-sectional study design with a mixed method was conducted on 631 health professionals from Central Gondar Zone public hospitals. For the quantitative part, pre-tested self-administered questionnaires were used, and for the qualitative part, key informant interviews with a semi-structured questionnaire were used. Variables with a p value of < 0.2 in binary logistic regression entered into a multivariable logistic regression, then p value < 0.05 and AOR were used to declare statistically significant variables in quantitative data. A thematic content analysis was used for qualitative data analysis. RESULTS This study revealed that only 286 (46.7%) health professionals had good practice of the code of ethics. Good ethical knowledge (AOR = 1.95, 95% CI 1.37, 2.77), favourable attitude (AOR = 1.55, 95% CI 1.11, 2.16), and satisfaction of health professionals with their jobs (AOR = 1.45, 95% CI (1.04, 2.04) were significantly associated with the practice of health care ethics. CONCLUSIONS Health professionals' overall level of practice of health care ethics in the Central Gondar Zone public hospitals was poor. This necessitates practical training, ongoing follow-up, availing of necessary medical equipment, a smooth working environment, and modification of the recognition system for health professionals.
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Affiliation(s)
| | - Amsalu Feleke
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
| | - Chalie Tadie
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
| | - Asebe Hagos
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
| | - Wubshet Debebe
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
| | - Getachew Teshale
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia.
| | - Lake Yazachew
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
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Al-Busaidi AS, Ganesh A, Al-Adawi S, Al-Farsi YM, Al-Rawahi MK, Al-Mawali NA, Al-Kharousi NS, Al-Alawi M, Al-Mujaini AS. Development and validation of an instrument to measure physician awareness of bioethics and medical law in Oman. BMC Med Ethics 2021; 22:65. [PMID: 34022852 PMCID: PMC8140473 DOI: 10.1186/s12910-021-00619-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 04/19/2021] [Indexed: 11/27/2022] Open
Abstract
Background A different ethos with respect to the perception of medical ethics prevails in societies in transition such as those in the Arabian Peninsula, which makes it difficult to apply international principles of bioethics in medical practice. This study aimed to develop and psychometrically test an instrument that measures physicians’ awareness of bioethics and medical law and their attitudes towards the practice of medical ethics. Additionally, it examined physician correlates influencing the awareness of bioethics. Methods Following a rigorous review of relevant literature by a panel of experts, a 13-item instrument, the Omani physicians’ bioethics and medical law awareness (OBMLA) questionnaire was developed with the aim of assessing physicians’ awareness of bioethics and medical law. The study tool’s construct validity and internal consistency reliability were examined by exploratory factor analysis (EFA) and Cronbach’s alpha. In a cross-sectional study, the questionnaire was distributed among a random sample of 200 physicians at a tertiary hospital in Muscat, Oman. Participant characteristics that may influence awareness of bioethics and medical law were explored. Results The EFA of the OBMLA questionnaire resulted in three well-loading factors: (1) Physicians’ bioethics practice subscale (2) incentive related bioethics subscale and (3) medical law awareness subscale. Internal consistency reliability ranged between Cronbach’s α: 0.73–0.8. Of the total 200 participants, 52% reported that teaching medical ethics during medical school was inadequate. The overall mean (standard deviation, SD) of the bioethics awareness score and Omani medical law awareness were 27.6 (3.5) and 10.1 (2.1) respectively. The majority of physicians (73%) reported that they frequently encountered ethical dilemmas in their practice and 24.5% endorsed the view that unethical decisions tended to occur in their practice. Conclusion The study provides an insight into the practice of bioethics, and the awareness of bioethics and medical law among physicians in a teaching hospital in Oman. The OBMLA questionnaire appears to be a valid and reliable tool to assess a physician’s awareness of bioethics and medical law. In this preliminary study, it appears that participants have suboptimal scores on the indices which measure practice and awareness of bioethics and medical law. Supplementary Information The online version contains supplementary material available at 10.1186/s12910-021-00619-1.
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Affiliation(s)
- Ahmed S Al-Busaidi
- Directorate General of Primary Health Care, Ministry of Health, Muscat, Sultanate of Oman
| | - Anuradha Ganesh
- Department of Ophthalmology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman.
| | - Samir Al-Adawi
- Department of Behavioral Medicine, College of Medicine and Health Sciences, Muscat, Sultanate of Oman
| | - Yahya M Al-Farsi
- Department of Family Medicine and Public Health, Sultan Qaboos University, Muscat, Sultanate of Oman
| | - Maryam K Al-Rawahi
- Medical Student, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman
| | - Nusaiba A Al-Mawali
- Medical Student, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman
| | - Nadiya S Al-Kharousi
- Department of Ophthalmology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman
| | - Mohammed Al-Alawi
- Department of Behavioral Medicine, College of Medicine and Health Sciences, Muscat, Sultanate of Oman
| | - Abdullah S Al-Mujaini
- Department of Ophthalmology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman
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Almoallem AM, Almudayfir MA, Al-Jahdail YH, Ahmed AE, Al-Shaikh A, Baharoon S, AlHarbi A, Al-Jahdali H. Top Ethical Issues Concerning Healthcare Providers Working in Saudi Arabia. J Epidemiol Glob Health 2020; 10:143-152. [PMID: 32538030 PMCID: PMC7310778 DOI: 10.2991/jegh.k.191211.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 10/20/2019] [Indexed: 11/26/2022] Open
Abstract
Background: Healthcare providers working in Saudi Arabia come from various nationalities, cultures, and training backgrounds. This study aimed to assess the perceptions of healthcare providers working in Riyadh hospitals about ethical dilemmas and solutions. Methods: This is a cross-sectional study among physicians working in Riyadh’s private and governmental hospitals between June and December 2017. The study collected information on demographics, knowledge about medical ethics, the sources of such knowledge, and common ethical issues in general and the top ethical issues and dilemmas encountered in their daily practice. Results: A total of 455 physicians from government and private hospitals were enrolled in the study. The mean age of the participants was 34.29 ± 10.5 years, females were 29.7% and mean years of practice was 13.0 ± 11.5. The top ethical issues identified by the participants were “disagreement with the patients’ relatives about treatment” (91%), patient disagreement with decisions made by professionals (84%), treating the incompetent patient (79%), conflict with administration policy and procedures (77%), scarcity of resources (72%), and making decision about do-not-resuscitate or life-sustaining treatment (68%). There were significant differences in dealing with ethical issues in relation to gender, confidence about ethical knowledge, nationality, seniority, training site, and private or government hospitals academic and nonacademic. Conclusion: Healthcare providers in Riyadh hospitals face multiple ethical challenges. In addition to improvement in ethics knowledge through educational program among healthcare professional, there is a valid need for healthcare professionals and other sectors within society to engage in serious and continuous dialogue to address these issues and propose recommendations.
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Affiliation(s)
| | | | - Yassar H Al-Jahdail
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh
| | - Anwar E Ahmed
- College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh.,College of Medicine, King Abdullah International Medical Research Center (KAIMRC), Riyadh
| | - Adnan Al-Shaikh
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh.,Department of Pediatrics, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah.,College of Medicine, King Abdullah International Medical Research Center (KAIMRC), Riyadh
| | - Salim Baharoon
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh.,Department of Medicine, King Abulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Riyadh.,College of Medicine, King Abdullah International Medical Research Center (KAIMRC), Riyadh
| | - Abdullah AlHarbi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh.,Department of Medicine, King Abulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Riyadh.,College of Medicine, King Abdullah International Medical Research Center (KAIMRC), Riyadh
| | - Hamdan Al-Jahdali
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh.,Department of Medicine, King Abulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Riyadh.,College of Medicine, King Abdullah International Medical Research Center (KAIMRC), Riyadh
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Barman B, Srivastava TK, Sarma A, Nath CK. Effectiveness of formal training in bioethics of 3 rd semester undergraduate medical students in recognizing bioethical issues and principles in patient care. J Family Med Prim Care 2020; 9:2871-2876. [PMID: 32984141 PMCID: PMC7491772 DOI: 10.4103/jfmpc.jfmpc_405_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/25/2020] [Accepted: 05/11/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Despite well-described code of conduct for physician the recent increase in litigation against doctors is an issue of concern which says that doctors and health professionals are confronted with many ethical problems regularly. The aim of the present study was to see the ability to recognize different bioethical issues in relation to patient care among 3rd semester undergraduate students and also the change in the pattern of recognition of bioethical issues after formal training. METHODS This cross-sectional study was carried out using self-administered questionnaire among the fifty 3rd semester undergraduate MBBS students. Each question was designed in a "Likert scale" pattern carrying a minimum score of 1 (1 = strongly disagree) and maximum score of 5 (5 = strongly agree). After 6 months of training and bedside clinical exposure, students were assessed again with same set of questionnaire. The statistical analyses were performed using SPSS 17.0. RESULTS All of the respondents in the study group were of the opinion that medical ethics is very important but only 24% aware about existence of ethics committee in the institute. Changes has been observed after clinical exposure in response like disclosure of patient's condition to close relatives (agreed 54% versus 84% pre and postexposure, respectively) and discussion of related ethical issues with clinical case discussion (agreed 74% versus 94% pre and postexposure, respectively). Some of the issues needs further clarification even after clinical exposure like doctors must not refuse to do abortion (56% disagreed and 38% agreed), consent regarding treatment in children (60% disagreed and 32% agreed), and uses of branded versus generic drugs (76% generic and 26% branded). CONCLUSION There is a need to stress the importance of ethical practice in the undergraduate curriculum to make the doctors confident enough to deal the ethical dilemma for themselves and better professional efficiency.
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Affiliation(s)
- Bhupen Barman
- Department of General Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, Meghalaya, India
| | - Tripti K. Srivastava
- Department of Physiology, Convener, MCI Nodal Center for Faculty Development, JNMC, Sawangi (Meghe), Wardha, Maharashtra, India
| | - Amitav Sarma
- Department of Anatomy, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, Meghalaya, India
| | - Chandan K. Nath
- Department of Biochemistry, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, Meghalaya, India
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Al Qadrah BH, Al-Saleh AM, Al-Sayyari A. Saudi pediatric residents' confidence in handling ethical situations and factors influencing it. Int J Pediatr Adolesc Med 2020; 8:160-164. [PMID: 34350328 PMCID: PMC8319651 DOI: 10.1016/j.ijpam.2020.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 03/29/2020] [Indexed: 11/27/2022]
Abstract
Background During their residency program, pediatric residents frequently face ethical challenges. The aim of the study is to evaluate the pediatric residents’ knowledge and confidence to handle common ethical dilemmas during their training. Methods This is a survey-based cross-sectional study on all pediatric residents in the largest pediatric training center in Saudi Arabia. The survey had six sections: a) Demographics and self-assessment of religiosity, b) Sources of ethics education, c) Degree of confidence in dealing with ethical challenges in clinical practice, d) Rating of the quality of ethics education during residency, e) Agreement or disagreement regarding ten ethical scenarios, and f) Confidence level in handling 21 different ethical situations. The response to the survey questions was based on a Likert scale; the survey was electronically distributed to all pediatrics residents. Mean knowledge scores and 95% confidence intervals (CI) were calculated for each independent variable to test for associations. Comparisons were made using an independent t-test or an ANOVA test when there were more than two groups. Result Eighty residents responded to the study (85.1% response rate). Over 60% reported that the best source of ethical education for them was through discussions with a senior physician and it was through formal lecturers in 13.8%. One-fifth felt confident in dealing with ethical challenges. Only 2.5% rated the ethics education as “very good/excellent” and 12.5% rated the “support from residency program for ethics education” as being “very good/excellent.” Agreement of more than 80% was only noted for 4 of 10 of the ethical scenarios. Overall, only 16.4% felt “confident/extremely confident” in handling different ethical situations while 38.5% felt “not confident/a little confident” with more confidence among male residents (35.3% versus 18.7% p = 0.01). Marital status, year of residency, religiosity, and source of ethics knowledge had no impact on the level of confidence. Conclusion Overall, the ethics education was considered inadequate. Only one fifth had the confidence in dealing with ethical situations. Gender but not marital status, year of residency, religiosity, or source of ethics knowledge had an impact on the level of confidence in handling ethical situations.
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Affiliation(s)
- Bedoor H Al Qadrah
- Department of Pediatrics, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdullah M Al-Saleh
- Department of Pediatrics, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdulla Al-Sayyari
- Department of Medicine, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Common medical ethical issues faced by healthcare professionals in KSA. J Taibah Univ Med Sci 2019; 14:412-417. [PMID: 31728138 PMCID: PMC6838996 DOI: 10.1016/j.jtumed.2019.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 09/09/2019] [Accepted: 09/10/2019] [Indexed: 01/26/2023] Open
Abstract
Objective There are growing concerns about ethical issues in the healthcare system. This study was conducted to determine the nature of common ethical issues faced by healthcare providers in a tertiary-care hospital in KSA. Method This cross-sectional study comprised a self-administered questionnaire given to the physicians working at King Abdulaziz Medical City Hospital-Riyadh, Ministry of National Guard Health Affairs (KAMC-RD, MNGHA). We used a convenience sampling technique during symposia and conferences. Results We distributed 240 questionnaires amongst the physicians and recorded a response rate of 80%; 68% (136) of the respondents were men, while 82.5% were Saudis. The mean age of the group was 34.08 ± 10.43 years. Only 69% (138) of the physicians had ever received any formal teaching in bioethics. Most physicians (77.5%) demanded clear guidelines to help them to take appropriate ethical decisions on therapeutic futility, whereas 54% felt that they sometimes overtreat their patients. Conclusion This study reported a lack of knowledge in certain healthcare-related ethical issues in a significant proportion of the physicians. There is a need for a standard educational agenda for medical ethics for healthcare providers, not only during medical school but also after graduation and during clinical rounds.
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Abstract
INTRODUCTION: Clinical trials are integral to innovation in the treatment modalities and are conducted to assess the safety and efficacy of novel drugs. Clinical trials of modern era have evolved through stern consequences and tragedies in the past. This study was designed to know knowledge on ethics, adverse drug reactions (ADRs), and tragedies in clinical trials among interns and postgraduates (PGs). METHODOLOGY: A cross-sectional study was carried out on graduates undergoing internship (interns) and PG residents of a medical college and a dental college from Punjab. This descriptive cross-sectional study was conducted on 151 professionals of medical college and 100 professionals of dental colleges in Punjab with the help of a prevalidated questionnaire. The data were then analyzed using descriptive statistics. RESULTS: There was no significant difference between dental and medical doctors regarding ethics and ADRs, but a significant difference was observed among interns and PG residents, with interns having higher awareness regarding ethics and ADRs. There was no significant difference (P = 0.941) in knowledge among dental and medical doctors as well as among interns and PG residents, with P = 0.264 about tragedies in clinical trials. CONCLUSION: From the study, it can be concluded that interns and PGs do not get enough exposure to basics in clinic research such as research ethics, ADRs, and tragedies in clinical trials. It is suggested that there is a requirement for suitable modifications in the teaching curriculum at undergraduate level and regular training must be provided to professionals.
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Affiliation(s)
- Sonu Gupta
- Department of Clinical Research, Dasmesh Institute of Research and Dental Sciences, Faridkot, Punjab, India
| | - Ravinder Nath Bansal
- Department of Hospital Management, Guru Gobind Singh Medical Hospital, Faridkot, Punjab, India
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Tiruneh MA, Ayele BT. Practice of code of ethics and associated factors among medical doctors in Addis Ababa, Ethiopia. PLoS One 2018; 13:e0201020. [PMID: 30089133 PMCID: PMC6082517 DOI: 10.1371/journal.pone.0201020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 07/06/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION In the health sector, questions are being raised about the possible threats to the accepted principles of ethics such as autonomy, beneficence, non malfeasance and justice in the delivery of health care. There is limited information in Ethiopia regarding to practice of code of ethics among medical doctors. Hence, this study aimed to assess practice of code of ethics and associated factors among medical doctors working in governmental and private hospitals in Addis Ababa, Ethiopia. METHODS Institution based cross sectional quantitative study triangulated with qualitative study was conducted among 500 medical doctors working in governmental and private hospitals and three key informants from Federal Ministry of Health, Ethiopian Food, Medicine and Healthcare Administration and Control Authority and Ethiopian Medical Association in Addis Ababa from May 8, 2017 to June 30, 2017. Data were collected using pretested self-administered structured questionnaire and semi-structured questionnaire. Binary Logistic Regression and Content Analysis methods were used for the quantitative and qualitative data analysis respectively. RESULTS The study showed that only 152 (30.4%) of medical doctors had good practice of code of ethics. The odds of having good practice of code of ethics among medical doctors in the age group of 25-29 years were 2.749 times the odds of those in the age group of 30-34 years (AOR = 2.749, 95% CI: 1.483, 5.096), medical doctors working in governmental hospitals were 65.4% less likely to have good practice of code of ethics compared to those working in private hospitals (AOR = 0.346, 95% CI: 0.184, 0.652), knowledgeable medical doctors were 83.5% more likely to have good practice of code of ethics compared to those who were not knowledgeable about code of ethics (AOR = 1.835, 95% CI: 0.999, 3.368), and the odds of having good practice of code of ethics among medical doctors with favourable attitude were 7.404 times the odds of those with unfavourable attitude towards code of ethics (AOR = 7.404, 95% CI: 4.254, 12.887). Furthermore lack of motivation, unfavorable working environment, working at various health facilities simultaneously, public awareness, taking courses on medical ethics, lack of unethical conduct reporting and complaint handling system, incompetence of medical doctors, and weak collaboration among key stakeholders were identified as determinants of practice of code of ethics. CONCLUSIONS Only 30.4% of medical doctors had good practice of code of ethics. This indicates that practice of code of ethics among medical doctors in Addis Ababa is poor. The factors associated with practice of code of ethics were age, type of hospital, knowledge, attitude, lack of motivation, unfavorable working environment, working at various health facilities simultaneously, public awareness, medical ethics course, lack of unethical conduct reporting and compliant handling system, incompetence of medical doctors and weak collaboration among key stakeholders. Hence, awareness creation and attitudinal change on code of ethics by continuous training, implementation of integrated medical ethics course, enforcement of code of ethics and continuing professional development (CPD) implementation are important.
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Affiliation(s)
- Mesafint Abeje Tiruneh
- Ethiopian Food, Medicine and Healthcare Administration and Control Authority, Addis Ababa, Ethiopia
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Okoye O, Nwachukwu D, Maduka-Okafor FC. Must we remain blind to undergraduate medical ethics education in Africa? A cross-sectional study of Nigerian medical students. BMC Med Ethics 2017; 18:73. [PMID: 29221454 PMCID: PMC5723059 DOI: 10.1186/s12910-017-0229-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 11/22/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As the practice of medicine inevitably raises both ethical and legal issues, it had been recommended since 1999 that medical ethics and human rights be taught at every medical school. Most Nigerian medical schools still lack a formal undergraduate medical ethics curriculum. Medical education remains largely focused on traditional medical science components, leaving the medical students to develop medical ethical decision-making skills and moral attitudes passively within institutions noted for relatively strong paternalistic traditions. In conducting a needs assessment for developing a curriculum germane to the Nigerian society, and by extension most of Sub-Saharan Africa, this study determined the views of Nigerian medical students on medical ethics education, ethical issues related to the doctor-patient relationship and the ethical/professional dilemmas they are confronted with. METHODS Using self-administered 63-item structured questionnaires, a cross-sectional survey of the final year medical students of the University of Nigeria was conducted in July 2015.Using the Statistical Package for the Social Sciences software (SPSS Version 17), frequency counts and percentages were generated. RESULTS The sample included 100 males (71.4%) and 40 females (28.6%), with the respective mean (SD) age being 24.6(5.61) and 21.8 (6.38) years. Only 35.7% were satisfied with their medical ethics knowledge, and 97.9% indicated that medical ethics should be taught formally. Only 8.6% had never witnessed a medical teacher act unethically. The dilemmas of poor communication between physicians and patients, and the provision of sub-standard care were reported highest for being encountered 'often'. A majority (60.7%) indicated that "a doctor should do his best always, irrespective of the patient's wishes". No significant difference in responses across gender was noted. CONCLUSION There is a strong desire by the contemporary Nigerian medical student for medical ethics education. Their lack of exposure in medical ethics in an ethically challenging environment suggest a dire need for the development of an appropriate medical ethics curriculum for them and the provision of an ethically conducive learning environment.
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Affiliation(s)
- Onochie Okoye
- Department of Ophthalmology, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Enugu State, Nigeria.
| | - Daniel Nwachukwu
- Department of Physiology, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Ferdinand C Maduka-Okafor
- Department of Ophthalmology, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Enugu State, Nigeria
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Kennedy KM, Wilkinson A. A Student Selected Component (or Special Study Module) in Forensic and Legal Medicine: Design, delivery, assessment and evaluation of an optional module as an addition to the medical undergraduate core curriculum. J Forensic Leg Med 2017; 53:62-67. [PMID: 29182913 DOI: 10.1016/j.jflm.2017.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 08/28/2017] [Accepted: 11/19/2017] [Indexed: 10/18/2022]
Abstract
The General Medical Council (United Kingdom) advocates development of non-core curriculum Student Selected Components and their inclusion in all undergraduate medical school curricula. This article describes a rationale for the design, delivery, assessment and evaluation of Student Selected Components in Forensic and Legal Medicine. Reference is made to the available evidence based literature pertinent to the delivery of undergraduate medical education in the subject area. A Student Selected Component represents an opportunity to highlight the importance of the legal aspects of medical practice, to raise the profile of the discipline of Forensic and Legal Medicine amongst undergraduate medical students and to introduce students to the possibility of a future career in the area. The authors refer to their experiences of design, delivery, assessment and evaluation of Student Selected Components in Forensic and Legal Medicine at their respective Universities in the Republic of Ireland (Galway) and in the United Kingdom (Oxford).
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Affiliation(s)
- Kieran M Kennedy
- SAOLTA University Healthcare Group, Health Service Executive West, Galway, Ireland; School of Medicine, National University of Ireland, Galway, Ireland.
| | - Andrew Wilkinson
- Oxford Medico-Legal, Headington, Oxford, OX3 0BU, United Kingdom; The Faculty of Forensic and Legal Medicine of the Royal College of Physicians of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom; School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland.
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Adhikari S, Paudel K, Aro AR, Adhikari TB, Adhikari B, Mishra SR. Knowledge, attitude and practice of healthcare ethics among resident doctors and ward nurses from a resource poor setting, Nepal. BMC Med Ethics 2016; 17:68. [PMID: 27821141 PMCID: PMC5100232 DOI: 10.1186/s12910-016-0154-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 11/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Healthcare ethics is neglected in clinical practice in LMICs (Low and Middle Income Countries) such as Nepal. The main objective of this study was to assess the current status of knowledge, attitude and practice of healthcare ethics among resident doctors and ward nurses in a tertiary teaching hospital in Nepal. METHODS This was a cross sectional study conducted among resident doctors (n = 118) and ward nurses (n = 86) in the largest tertiary care teaching hospital of Nepal during January- February 2016 with a self-administered questionnaire. A Cramer's V value was assessed to ascertain the strength of the differences in the variables between doctors and nurses. Association of variables were determined by Chi square and statistical significance was considered if p value was less than 0.05. RESULTS Our study demonstrated that a significant proportion of the doctors and nurses were unaware of major documents of healthcare ethics: Hippocratic Oath (33 % of doctors and 51 % of nurses were unaware), Nuremberg code (90 % of both groups were unaware) and Helsinki Declaration (85 % of doctors and 88 % of nurses were unaware). A high percentage of respondents said that their major source of information on healthcare ethics were lectures (67.5 % doctors versus 56.6 % nurses), books (62.4 % doctors versus 89.2 % nurses), and journals (59 % doctors versus 89.2 % nurses). Attitude of doctors and nurses were significantly different (p < 0.05) in 9 out of 22 questions pertaining to different aspects of healthcare ethics. More nurses had agreement than doctors on the tested statements pertaining to different aspects of healthcare ethics except for need of integration of medical ethics in ungraduate curricula (97.4 % doctors versus 81.3 % nurses),paternalistic attitude of doctor was disagreed more by doctors (20.3 % doctors versus 9.3 % nurses). Notably, only few (9.3 % doctors versus 14.0 % nurses) doctors stood in support of physician-assisted dying. CONCLUSIONS Significant proportion of doctors and nurses were unaware of three major documents on healthcare ethics which are the core principles in clinical practice. Provided that a high percentage of respondents had motivation for learning medical ethics and asked for inclusion of medical ethics in the curriculum, it is imperative to avail information on medical ethics through subscription of journals and books on ethics in medical libraries in addition to lectures and training at workplace on medical ethics which can significantly improve the current paucity of knowledge on medical ethics.
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Affiliation(s)
- Samaj Adhikari
- Institute of Medicine, Maharajgunj Medical Campus, Tribhuvan University, Kathmandu, Nepal.
| | - Kumar Paudel
- Institute of Medicine, Maharajgunj Medical Campus, Tribhuvan University, Kathmandu, Nepal
| | - Arja R Aro
- Unit for Health Promotion Research, Institute of Public Health, University of Southern Denmark, Niels Bohrsvej 9, Esbjerg, 6700, Denmark
| | - Tara Ballav Adhikari
- Faculty of Health Sciences, Unit for Health Promotion Research, University of Southern Denmark, Esbjerg, Denmark
| | - Bipin Adhikari
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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Monsudi KF, Oladele TO, Nasir AA, Ayanniyi AA. Medical ethics in sub-Sahara Africa: closing the gaps. Afr Health Sci 2015; 15:673-81. [PMID: 26124819 DOI: 10.4314/ahs.v15i2.47] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Health care providers are expected to have the skills and knowledge relevant to their field and should also be familiar with the ethical and legal expectations that arise out of the standard practices. OBJECTIVES To elucidate the practice of the health care providers in relation to healthcare ethics in Nigeria. METHODS A self-administered structured questionnaire was devised and distributed to staff of two tertiary health care facilities in Northern Nigeria. The questionnaire comprised of detailed questions regarding day-to-day aspects of Medical ethical issues. RESULTS A total of 307(76.2%) out of 403 health care providers responded to the questionnaire. The median age of the respondents was 34 years. More than half 168(54.7%) of the respondents disagreed as to whether "Ethical conduct is important only to avoid legal action. Many respondents 135 (44.0%) agreed to adhering to "patient's wishes", on the other hand over two-third of the respondents 211 (68.7%) agreed that "doctor should do what is best" irrespective of the patient's opinion. There were significant differences (p<0.05) between the perception of physicians and non-physicians on many ethical issues. CONCLUSION This study has shown gap in knowledge and practice of healthcare ethics among health care providers. There is a need for periodic education on clinical ethics in our hospitals.
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Affiliation(s)
- Kehinde F Monsudi
- Department of Ophthalmology, Federal Medical Center, Birnin Kebbi, Nigeria
| | - Tajudeen O Oladele
- Department of Psychiatric, Federal Neuropsychiatric Hospital, Kware, Nigeria
| | - Abdulrasheed A Nasir
- Department of Surgery, University of Ilorin / University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Abdulkabir A Ayanniyi
- Department of Ophthalmology, University of Abuja/ University of Abuja Teaching Hospital, Abuja Nigeria
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Dhanappa KB, Mn P, Ravi R, Mg J, Deshpande P, Biradar SM. Knowledge, attitudes and practice of healthcare ethics and law among dental graduates at the RV dental college, Bengaluru. J Contemp Dent Pract 2014; 15:223-8. [PMID: 25095848 DOI: 10.5005/jp-journals-10024-1519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess knowledge, attitudes and practices among the dental graduate in relation to healthcare ethics and law. MATERIALS AND METHODS A cross-sectional study design was employed using a self-administered questionnaire. A 15 item questionnaire about law and ethics was devised; tested and made available to all levels of graduates including teaching staff, postgraduates and intern at dental college in Bengaluru. A total of 116 graduates participated, with a response rate of 96.5% (n = 112). RESULTS Seventy-six percent of the participants said that they are legally bound to treat all the patients who approach them for the treatment. Nearly 32% of the participants have mentioned the various other reasons for the rejection apart from the reason like HIV+, poor patients and patients with the contagious disease. CONCLUSION The study points to the need for appropriate training among graduates including the professional staffs and other graduates, and to devise means to sensitize them to issues of law and ethics in the workplace.
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Affiliation(s)
- Kirankumar B Dhanappa
- Reader, Department of Public Health Dentistry, Navodaya Dental College and Hospital, Raichur, Karnataka, India
| | - Praveen Mn
- Senior Lecturer, Department of Orthodontics, KLE Institute of Dental Sciences Bengaluru, Karnataka, India
| | - Ramakrishna Ravi
- Professor and Head, Department of Conservative Dentistry and Endodontics SB Patil Dental College and Hospital, Bidar, Karnataka, India
| | - Jayachandra Mg
- Reader, Department of Public Health Dentistry, Rungta College of Dental Sciences and Research, Bhilai, Chhattisgarh, India
| | - Prashanth Deshpande
- Reader, Department of Conservative Dentistry and Endodontics SB Patil Dental College and Hospital, Bidar, Karnataka, India
| | - Sharaschandra M Biradar
- Reader, Department of Periodontics, SB Patil Dental College and Hospital, Bidar, Karnataka, India
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Fadare JO, Desalu OO, Jemilohun AC, Babatunde OA. Knowledge of medical ethics among Nigerian medical doctors. Niger Med J 2013; 53:226-30. [PMID: 23661883 PMCID: PMC3640244 DOI: 10.4103/0300-1652.107600] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The knowledge of medical ethics is essential for health care practitioners worldwide. The main objective of this study was to evaluate the knowledge of medical doctors in a tertiary care hospital in Nigeria in the area of medical ethics. MATERIALS AND METHODS A cross-sectional questionnaire-based study involving 250 medical doctors of different levels was carried out. The questionnaire, apart from the bio-data, also sought information on undergraduate and postgraduate training in medical ethics, knowledge about the principles of biomedical ethics and the ethical dilemmas encountered in daily medical practice. RESULTS One hundred and ninety (190) respondents returned the filled questionnaire representing a response rate of 76%. One hundred and fifty-two respondents (80%) have had some sort of medical ethics education during their undergraduate level in the medical education. The median duration of formal training or exposure to medical ethics education was 3.00 hours (range: 0-15). One hundred and twenty-nine respondents have read at least once the code of medical ethics of the Medical and Dental Council of Nigeria while 127 (66.8%) have some general knowledge of the principles of biomedical ethics. The breakdown of the identified ethical dilemmas shows that discharge against medical advice was the most identified by the respondents (69.3%) followed by religious/cultural issues (56.6%) while confidentiality was recognized by 53.4%. CONCLUSION The knowledge of medical ethics by Nigerian medical doctors is grossly inadequate. There is an urgent need for enhancement of the teaching of the discipline at both undergraduate and postgraduate levels in Nigeria.
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Affiliation(s)
- Joseph O Fadare
- Department of Medical Pharmacology and Therapeutics, Obafemi Awolowo University, Ile-Ife, Nigeria
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Schulz S, Woestmann B, Huenges B, Schweikardt C, Schäfer T. How important is medical ethics and history of medicine teaching in the medical curriculum? An empirical approach towards students' views. GMS ZEITSCHRIFT FUR MEDIZINISCHE AUSBILDUNG 2012; 29:Doc08. [PMID: 22403593 PMCID: PMC3296096 DOI: 10.3205/zma000778] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 09/20/2011] [Accepted: 12/01/2011] [Indexed: 11/30/2022]
Abstract
Objectives: It was investigated how students judge the teaching of medical ethics and the history of medicine at the start and during their studies, and the influence which subject-specific teaching of the history, theory and ethics of medicine (GTE) - or the lack thereof - has on the judgement of these subjects. Methods: From a total of 533 students who were in their first and 5th semester of the Bochum Model curriculum (GTE teaching from the first semester onwards) or followed the traditional curriculum (GTE teaching in the 5th/6th semester), questionnaires were requested in the winter semester 2005/06 and in the summer semester 2006. They were asked both before and after the 1st and 5th (model curriculum) or 6th semester (traditional curriculum). We asked students to judge the importance of teaching medical ethics and the history of medicine, the significance of these subjects for physicians and about teachability and testability (Likert scale from -2 (do not agree at all) to +2 (agree completely)). Results: 331 questionnaire pairs were included in the study. There were no significant differences between the students of the two curricula at the start of the 1st semester. The views on medical ethics and the history of medicine, in contrast, were significantly different at the start of undergraduate studies: The importance of medical ethics for the individual and the physician was considered very high but their teachability and testability were rated considerably worse. For the history of medicine, the results were exactly opposite. GTE teaching led to a more positive assessment of items previously ranked less favourably in both curricula. A lack of teaching led to a drop in the assessment of both subjects which had previously been rated well. Conclusion: Consistent with the literature, our results support the hypothesis that the teaching of GTE has a positive impact on the views towards the history and ethics of medicine, with a lack of teaching having a negative impact. Therefore the teaching of GTE should already begin in the 1st semester. The teaching of GTE must take into account that even right at the start of their studies, students judge medical ethics and the history of medicine differently.
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Affiliation(s)
- Stefan Schulz
- Ruhr-University Bochum, Institute of Medical Ethics and the History of Medicine, Department of General Medicine, Bochum, Germany.
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Preston-Shoot M, McKimm J. Towards effective outcomes in teaching, learning and assessment of law in medical education. MEDICAL EDUCATION 2011; 45:339-346. [PMID: 21401681 DOI: 10.1111/j.1365-2923.2010.03882.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
CONTEXT Law is slowly emerging as a core subject area in medical education, alongside content on the ethical responsibilities of doctors to protect and promote patient health and well-being. Curriculum statements have begun to advise on core content and methods for organising teaching and assessment. However, no comprehensive overview of approaches to the delivery of this law curriculum has been undertaken. OBJECTIVES This paper reports an assessment of the nature and strength of the published evidence base for the teaching, learning and assessment of law in medical education. It also provides a thematic content overview from the best available literature on the teaching of law to medical students and on the assessment of their legal knowledge and skills. METHODS A systematic review of the evidence base was completed. Detailed scrutiny resulted in the inclusion of 31 empirical sources and 11 conceptual papers. The quality of the included material was assessed. RESULTS Significant gaps exist in the evidence base. Empirical studies of the teaching of law are characterised by insufficient sample sizes and a focus on individual study programmes. They rely on measures of student satisfaction and on evaluating short-term outcomes rather than assessing whether knowledge is retained and whether learning impacts on patient outcomes. Studies reveal a lack of coordination between pre- or non-clinical and clinical medico-legal education. Although evidence on the development of students' knowledge is available, much learning is distant from the practice in which its application would be tested. Law learning in clinical placements appears to be opportunistic rather than structured. CONCLUSIONS The place of law in the curriculum remains uncertain and should be more clearly identified. A more robust knowledge base is needed to realise the aspirations behind curriculum statements on law and to enable medical students to develop sufficient legal literacy to manage challenging practice encounters. Further research is needed into effective methods of teaching, learning and assessing legal knowledge and skills during and following initial medical education.
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