Investigating the Moral Sensitivity of Medical Students in the Preclinical and Late Clinical Courses

Background

Paying attention to moral issues is one of the essential requirements of medical practice, and moral aspects must be considered in making decisions to achieve the desired results and ensure the patient's satisfaction. Moral sensitivity is one of the components that enable physicians to act ethically in their decisions. Since medical students must acquire the necessary skills to deal with patients properly in clinical courses, the current paper examines the moral sensitivity of medical students in both preclinical and late clinical courses.

Methods

This is a cross-sectional study performed on 180 medical students in the preclinical and late clinical course. The study tool is an adapted version of the Kim-Lutzen ethical sensitivity questionnaire with 25 items and Likert scoring 0-4. The obtained score can be between 0-100. Data was analyzed using SPSS25. Statistical t-test or its non-parametric equivalent (Mann-Whitney) was used for quantitative variables and Chi-square or Fisher exact tests were used for qualitative variables. Pearson's correlation coefficient was used to measure the correlation of the variables.

Results

The mean age of stagers and interns was 22.7 + 0.85, and 26.5 + 1.11. 41 (51.2%) of stagers and 51 (63.7%) of interns had a history of participating in workshops related to medical ethics, and 4 (5%) of the former and 3 (3.8%) of the latter had previously conducted research in the field of medical ethics. there was a significant relationship between the stagers' history of conducting research in the field of ethics and their moral sensitivity. Concerning moral sensitivity components, the highest scores belonged to "altruism and trustworthiness", "the use of moral concepts in moral decisions", and "respect for the patient's autonomy" in both groups., 95% of stagers and 98.8% of interns had medium level (51-75) of moral sensitivity.

Conclusion

Medical students' moral sensitivity did not increase significantly during the clinical course. It is necessary to review and reconsider medical ethics educational methods, the time allocated to relevant courses, and the practical need for clinical education in addition to theory. Directing research projects and student dissertations toward topics related to medical ethics can also contribute significantly to enhancing moral sensitivity.

Assessment of surgery residents' knowledge of medical ethics and law. Implications for training and education

Medical ethics and law are essential topics that should be included in medical residency programs. However, surgery training programs in Iran lack a specific course in medical ethics and law, which can lead to patient dissatisfaction with surgical outcomes. This study aimed to assess surgery residents' knowledge of medical ethics and law and suggest improvements for future residency programs. This descriptive cross-sectional study involved 112 surgery residents from six teaching hospitals. A valid and reliable questionnaire comprising 15 items on medical ethics and 12 items on medical law was used to assess participants' knowledge. Most participants were female (31-40 years old), and their mean knowledge score for medical ethics was 3.26±0.53 out of 5, with the lowest score in "futile treatment and DNR orders." The mean knowledge score for medical law was 3.69±0.69, with the lowest score in "surrogate decision-maker." Age did not affect residents' knowledge, but gender did, with female residents demonstrating significantly better knowledge of medical ethics (3.344/5 vs. 3.112/5) and law (3.789/5 vs. 3.519/5). Surgery residents had a relatively favorable knowledge of medical ethics and law, but they require further training in some areas to improve their knowledge. Training should include journal clubs, role-play programs, standardized patient programs, and debates to achieve better results, as purely didactic lectures appear inadequate.

Ethical challenges of cord blood banks: a scoping review

Cord blood is a rich source of hematopoietic stem cells used to treat many diseases of blood origin. Thus, storage banks were created to store and provide umbilical cord cells. With the development of diagnostic and therapeutic technologies and techniques in medicine, ethical issues have also become more widespread and complex. After the creation of the cord blood banks, efforts were made to address the ethical issues associated with such banks. The present study attempts to identify the ethical challenges in these banks in the published studies. Databases including PubMed, Scopus, Web of Science (WOS), Embase, Proquest, and Google Scholar were searched from January 1996 to January 2021. Then, the ethical challenges of the cord blood bank were extracted from the results section using thematic content analysis. 22 studies were selected based on inclusion and exclusion criteria. The ethical challenges raised in the studies included private or public ownership of the bank, fair access to banking services, informed and voluntary consent, failure to provide sufficient information to individuals about the process, confidentiality of user's information, conflict of interest of bank founders (who are commonly doctors). The findings of this study indicated that there are serious ethical concerns regarding umbilical cord blood banks. Responding clearly to these ethical challenges calls for the attention of policymakers and medical ethics professionals; this will require a clear statement of the various aspects of these banks for society.

Patient’s Rights in Iran and Iraq

Background: The aim of this study was to compare, review, and evaluate the studies on patients right in Iran and Iraq. Methods: This is a review study conducted by searching the Iranian and Iraqi databanks, such as Scientific Information Database (SID), Iranian Research Institute for Information Science and Technology, Iran Medex, Iraqi Academic scientific journals, and Google Scholar for both Iranian and Iraqi articles from 2002 to 2017 using the keywords, such as “Patient Rights”, “Patient Rights Charter”, “Patient Rights Observance”, “Iraq”, “Iran”, and “Patient Awareness and Rights”. Results: Of a total of 32 Iranian and Iraqi articles, only 25 articles met the aim of our study. Conclusion: The growing number of articles published indicates that from 1999 forwards, this topic began to attract the attention of Iranian researchers in a gradual manner, as for the Iraqi researchers, their attention has been attracted from 2013 onwards. Also, despite the poor knowledge of physicians about the patients’ rights in Iran, they have shown acceptable awareness and attitude regarding some patients’ rights. The same is true for Iraqi doctors and health care providers, but they have shown unsatisfactory consequences for some of the rights of Iraqi patients. Patient education through media and careful observation of the patient rights charter, and educating healthcare professionals, and developing professional training on patients’ legal rights by engaging them in educational sessions and lectures on patient rights is necessary. Adequate monitoring of practice according to the patient charter is strongly suggested.

Ethical Considerations in Conducting Clinical Trials

Background: Clinical trials are the golden key in medical science research with human participants. They have always been considered interesting topics by researchers and scientists working in this field. However, the samples are “human participants,” so the research should be carefully conducted. Methods: In the present study, the published articles on the ethical challenges of conducting clinical trials were evaluated between 2010 and 2019 in Google Scholar, PubMed, and Scopus. The English search keywords were “clinical trial,” with at least one of the phrases of “ethical consideration” or “standard”. Results: In this article, we examined the ethical requirements and considerations in these research studies in four stages: research design and question, proposal review and approval, supervision and implementation, and publication of the results. We have examined them using relevant articles published between 2010 and 2019 and identified important and prominent issues or neglected ones. Conclusion: During this study, it was found that the “research design and question” stage was the most discussed and challenging stage, and the authors’ sensitivity about it has been more than the other three stages. On the other hand, the “results publishing” stage has been considered less sensitive with the least number of references in articles.

Knowledge and Attitude of Midwives and Obstetricians Towards Therapeutic Abortion Law and its Ethical Pitfalls

Background: Despite the implementation of a safe motherhood program in many countries, unsafe abortion continues to be a matter of reproductive health. Thus, urgent efforts to make abortion legal and safe have been recommended in developing countries. The present study was done to determine the knowledge of midwives and obstetricians about the therapeutic abortion law as well as their attitude about the ethical pitfalls. Methods: In this descriptive knowledge and attitude study, a researcher-made questionnaire was used to gather data, after estimating the appropriate Cronbach’s Alpha coefficient. A total of 162 midwives and obstetricians working in public and private medical centers affiliated to Shahid Beheshti University of Medical Sciences in 2018 were included in the study by convenience sampling method. Results: According to the results, 9.3% of participants had a low level, 72.8% had a moderate level, and only 17.9% had a good level of knowledge. The total mean score of knowledge was 7.17±1.7. The mean score of knowledge in the group of obstetricians (7.60±1.74) was significantly higher than midwives (6.94±1.54), (t=2.29, p=0.024). There was a significant correlation between participants’ age and their knowledge (r=0.912, p=0.001). Also, 47.53% of the participants believed that the therapeutic abortion law has some pitfalls. The most frequent attitude was about the restriction of the therapeutic law up to 19 weeks for fetal indications. Conclusion: The level of participants’ knowledge was low to moderate. The findings indicated the need for training the professional standards related to prenatal genetic screening and therapeutic abortion.

Neonatal end-of-life decisions and ethical perspectives

End-of-life decisions are usually required when a neonate is at high risk of disability or death, and such decisions involve many legal and ethical challenges. This article reviewed the processes of ethical decision-making for severely ill or terminal neonates, considering controversial issues including the followings: (i) identifying primary decision makers, (ii) the role of law and guidelines, and (iii) changes in treatment controversy, law and regulations over twenty years in several European countries such as Switzerland, Germany, Italy, United Kingdom, France, the Netherlands, Sweden, and Spain. This review study conducted on accessible articles from PubMed, Google Scholar, Web of Science and Scopus databases. Based on two studies in 2016 and 1996, neonatologists reported that withholding intensive care, withdrawing mechanical ventilation or life-saving drugs, and involvement of parents in decision-makings have become more acceptable as time passes, indicative of trend change. Trend of physicians on how end the life of neonates, at risk of death, varies in different countries, and cultural factors, parents’ involvement in decisions and gestational age are factors considered in end-of-life decision-making. Future investigations continuously need to identify upcoming ethical aspects of proper decision-making.

Investigating Ethical Skills in Dentists and Dental Students: A Comparative Study

Background: Commitment to professional ethics is important for all medical practitioners, including dentists. This skill should be taught to students during their studies. The purpose of this study was to investigate the moral skills of dentistry students and dentists. Methods: This cross-sectional study was performed on 160 dentistry students and dentists. The Moral skills Inventory (MSI) Questionnaire was cross-culturally adapted and used in this study. The MSI was developed by Chamber’s and has 40 items covering four domains including: moral sensitivity, moral reasoning, moral integrity, and moral courage. Each domain’s scores ranged from zero to 20. The results were analyzed using SPSS software version 21. Results: comparing with dentists, dentistry students got higher score in moral sensitivity domain (5.5 ± 3.64 vs. 3.87 ± 2.22) and moral integrity (6.4 ± 3.2 vs. 5.78 ± 2.72). However, in moral reasoning, dentists got higher score than students (15.40 ± 2.11 vs. 13.92 ± 2.35). In the moral courage domain, students’ score was 13.47 ± 3.10 and dentists’ was 13.62 ± 2.96. The mean±SD of total score of moral skills in all domains was 39.3± 4.50 for dental students, 38.68 ± 4.48 for dentists, and 38.99 ± 4.49 for all participants. Conclusion: The professional ethics skills are relatively low in all four domains among dentistry students and dentists. Workshops, reviewing the syllables of medical ethics course, and practicing moral skills during training courses and monitoring professional performance can help to improve moral skill.

Reviewing the Status of Professional Commitment Principles in the Physician-Patient Communication Models

Much attention is paid to the importance of the relationship between patients and physicians and the ethical issues that have been considered from different perspectives. Moreover, different models have been developed to establish such a relationship. In one of the most advanced methods, Emanuel EJ categorized 4 paternalistic -informative-interpretive models that have been agreed upon by many medical professionals. Each model has its characteristics and in the relationship between a patient and a practitioner, and to some extent, the professional commitment values (professionalism). In other words, the observance of the values of professionalism in each of these models has been based on the definitions of these principles; each is of particular importance, and individual attention has been paid to these values in different models. The present work aimed to evaluate each communication model according to the values of medical resource planning. Analyzing and adapting these models in terms of professional ethics could finally lead to analyzing the comparative approaches to professional commitment values.

Changes in ethical attitudes of clinical laboratory professionals after teaching them ethics using three different methods

Background: Ethical attitudes and personal values play a significant role in clinical decision-making; however, they have been given limited attention by professionals in laboratory medicine. Studies suggest that individual attitudes are not static and that professionals learn ethical attitudes through a variety of formal and informal learning methods. This study was conducted to investigate changes in the attitudes of clinical laboratory professionals after teaching them ethics and to compare the results among the 3 groups. Methods: Four topics were selected in the field of medical laboratory ethics as teaching materials. A questionnaire including 22 items was designed and validated. Teaching sessions for the 3 study groups were held. All 65 clinical laboratory participants completed the questionnaire before and after the classes. Paired t test and ANOVA were used to assess differences among groups. Results: Significant differences were found in the mean scores of ethical attitudes before and after the educational intervention among the lecture-based teaching group (p=0.016), problem-based learning group (p=0.001), and all participants (p=0.004). However, no significant difference was found between the mean scores before and after the intervention in role-playing group (p=0.623). Conclusion: Teaching by lecturing and problem-based learning was more effective to change ethical attitude of the laboratory professionals than the role-playing method. Thus, we suggest the implementation of teaching ethics using these methods to improve the ethical attitude of clinical laboratory professionals.

The underlying factors affecting the ethical performance of health service providers when faced with disasters: a qualitative study

Disasters are sudden catastrophic events leading to decisions in health service provision that are not in compliance with the principles and frameworks used in normal circumstances. It is essential to develop guidelines in order to ensure the ethical performance of health service providers and to prevent and manage the adverse consequences. As the first step in guideline development, the present study investigated the underlying factors affecting the ethical performance of health service providers in disasters. This was a qualitative research based on grounded theory, and was conducted through unstructured in-depth interviews with various health service providers including paramedics, physicians and crisis zone managers who had some experiences in a number of domestic and foreign disasters. The collected data were analyzed using conventional content analysis. The underlying factors extracted from the 24 interviews were divided into structural and mediatory factors. The structural factors covered the nature of the disaster, the type of social interactions, and lack of a unity management; the mediatory factors were connected to the emotional atmosphere governing the field, the behavior of the local people, the locals' economic status, the locals' trust in the authorities, and the safety of the crisis zone. We can look into more effective, continuous and dynamic relationships between the components of the process of ethical performance. It is evident, however, that the underlying factors have more effective roles than the other components. According to our findings, the role of the underlying, structural and mediatory factors are more of a threat than an opportunity in disasters.

End of Life Issues in Cancer Cases: Ethical Aspects

This article investigates ethical challenges cancer patients face in the end stages of life including doctors' responsibilities, patients' rights, unexpected desires of patients and their relatives, futile treatments, and communication with patients in end stages of life. These patients are taken care of through palliative rather than curative measures. In many cases, patients in the last days of life ask their physician to terminate their illness via euthanasia which has many ethical considerations. Proponents of such mercy killing (euthanasia) believe that if the patient desires, the physician must end the life, while opponents of this issue, consider it as an act of murder incompatible with the spirit of medical sciences. The related arguments presented in this paper and other ethical issues these patients face and possible solutions for dealing with them have been proposed. It should be mentioned that this paper is more human rational and empirical and the views of the legislator are not included, though in many cases human intellectual and empirical comments are compatible with those of the legislator.

Knowledge of medical professionalism in medical students and physicians at Shahid Beheshti University of Medical Sciences and affiliated hospitals-Iran

Although medical professionalism is a fundamental aspect of competence in medicine and a distinct facet of physicians' competence, evidence suggests that the subject of professionalism is not taught or assessed as part of medical students' curricula in Iran and many other countries. Assessing the knowledge of medical students and physicians about medical professionalism seems to be helpful in identifying the weaknesses of training in the field of professionalism and devise plans for future training on the subject.The present cross-sectional, quantitative, observational, and prevalence study recruited 149 medical interns, clinical residents, physicians, and professors working in hospitals selected through stratified random sampling using a questionnaire designed by the researchers and confirmed for its validity and reliability. The results were analyzed by Stata at a significance level of 0.05.Out of 149 cases, 61.64% were male with the mean age of 30.81 years. A total of 66 participants (44.29%) (95% confidence interval [CI]: 36.44%-52.44%) had heard and 83 (55.70%) (95% CI: 47.55%-63.55%) had not heard the term "medical professionalism" before the study. After adjusting for potential confounders, age and degree did not have statistically significant difference in assessed knowledge of medical professionalism, but sex had (mean difference: 5.88, P = 0.045), and the mean of the female was significantly higher than that of the male participants. The mean percentage of correct answers was 47.67.The present study demonstrated that the medical professionals working in the national healthcare system have an unfavorable theoretical knowledge about medical professionalism in Iran; although this does not indicate that their practices are unethical, it should be noted that one of the prerequisites of possessing a high level of medical professionalism and for establishing a proper relationship between the medical community and the patients is to have a proper knowledge of this concept. Improving behaviors and performances in medical professions requires adequate training on the concepts of medical professionalism and consequently the assessment of the levels of professionalism achieved in medical professionals.

Assessment of patients' awareness of their rights in teaching hospitals in Iran

INTRODUCTION

Respecting patients' rights is an essential component in health care. Passing a regulation is not a guarantee for the protection of patients' rights. This article aimed to assess patients' awareness of the contents of the Patient's Bill of Rights in Iran and to determine if they had received a service compatible with their rights charter.

METHODS

This is a descriptive study in 202 hospitalised patients. A questionnaire was used, and associations between variables were examined using Pearson's correlation test. The significance level was p < .05.

RESULTS

The patients' ages ranged from 18 to 87 years of age, 33% were male and 79% were married. Patients' knowledge was lowest regarding the need for consent for the treatment process and was highest regarding the patient's right to know the expertise of the treatment team. The mean of patients' knowledge was 77.56%. As for patients' exercising their rights, the highest score belonged to the patient's right for attending doctors and treatment team's confidentiality; the lowest score belonged to the right to receive necessary information about probable complications, other treatment options and participation in the final selection of treatment method. The mean score of patient satisfaction was 8.06 (out of 11). There was no significant relationship with their education level or the number of admissions.

CONCLUSION

Health-care professionals can provide care based on patients' rights, and their knowledge of patients' rights needs to be evaluated. Educational programmes, leaflets, booklets and posters can be helpful in this regard. In addition, professional organisations and the Ministry of Health need to be more sensitive to this issue.

Relationship of Moral Sensitivity and Distress Among Physicians

BACKGROUND

Providing health services is described as an important moral measure, since its major aim is to ensure the welfare of the people who need treatment and care. Moral sensitivity is the ability to identify the existing moral problem and understand the moral consequences of the decisions made on the patient's part. Physicians are always exposed to moral distress due to various circumstances.

OBJECTIVES

In this survey, we evaluated moral sensitivity and moral distress among physicians and the relationship of these ethical factors on them. Hence, we assessed y relationship between moral sensitivity and moral distress in physicians will facilitate their sound management so as to provide high-quality and safe health services. Moreover it will confirm proposed theories regarding this subject.

MATERIALS AND METHODS

This cross-sectional descriptive-analytic study aimed at investigating the relationship between moral sensitivity and moral distress among 321 specialist physicians working in hospitals affiliated to Tehran Medical Universities in Tehran. The samples were selected through two-stage random cluster sampling method. A three-partite questionnaire comprising of demographic characteristics, moral distress, and moral sensitivity was used for collecting data which then were analyzed using SPSS-20.

RESULTS

There was a negative significant relationship between moral sensitivity and moral distress frequency; there was a positive significant relationship between moral sensitivity and moral distress intensity. Participating in medical ethics courses increased moral sensitivity and decreased the frequency of moral distress.

CONCLUSIONS

Participating in medical ethics courses increased moral sensitivity and decreased the frequency of moral distress.

Moral distress in physicians practicing in hospitals affiliated to medical sciences universities

BACKGROUND

Researchers have regarded moral distress as a major concern in the health care system. Symptoms associated with moral distress may manifest as frustration, dissatisfaction, and anxiety and may lead to burnout, job leaving, and finally, failure to provide safe and competent care to patients. Proper management of this phenomenon can be fulfilled through study of its causes at different levels of health services and taking necessary measures to solve them.

OBJECTIVES

This study aimed to determine the status of moral distress in physicians practicing in hospitals affiliated to Medical Sciences Universities in Tehran.

MATERIALS AND METHODS

This cross-sectional study was carried out using the Standard Hamric Scale to collect data after modification and evaluation of its reliability and validity. A total of 399 physicians responded to the scale. Data analysis was performed using descriptive and correlation statistics with respect to the variables.

RESULTS

Results showed that the frequency of moral distress of physicians was 1.24 ± 0.63 and the intensity of moral distress and composite score of moral distress were 2.14 ± 0.80 and 2.94 ± 2.38, respectively. A significant negative correlation existed between age and frequency and composite score (r = -0.15, P < 0.01 and r = -0.16, P < 0.01, respectively) as well as years of experience and composite score (r = -0.11, P = 0.04). Moral distress composite score in adults specialists was higher than pediatricians (P = 0.002), but lower in physicians participated in medical ethics training courses compared to those not participated.

CONCLUSIONS

Physicians may encounter moral distress during their practice; therefore, the common causes of distress should be identified in order to prevent its occurrence.