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Cover page of the Journal of Health Sciences


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 15  |  Issue : 2  |  Page : 131-136

Knowledge and attitude about medical ethics among undergraduate medical students - A cross sectional comparative study


Department of Pharmacology, Malla Reddy Medical College for Women, Suraram, Hyderabad, India

Date of Submission18-Jan-2021
Date of Acceptance29-Jul-2021
Date of Web Publication24-May-2022

Correspondence Address:
Assoc. Prof. Vibha Rani
Flat 408, Udaya Balaji Residency, 1-1-17 A/B, Opp. Sudarshan theatre, Jawahar Nagar, RTC X Road, Hyderabad - 500 020, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kleuhsj.kleuhsj_13_21

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  Abstract 


Background: Knowledge of ethics has a significant influence on the professionalism and moral qualities of doctors and also helps them to face ethical issues. The first step in incorporating ethics on a bigger scale in our curriculum will be to determine the level of the basic knowledge and attitude among medical students on ethics. Hence, this study was planned at a medical college among students to evaluate the level of knowledge and attitude about medical ethics.
Objectives: The objective of the study was to assess and to compare the level of knowledge and attitude about medical ethics among students and interns.
Materials and Methods: A cross-sectional questionnaire study was conducted among 147 second-year students, 104 interns, and the questionnaire consisted of 14 questions, five questions on knowledge and nine on attitude domain. The data were analyzed using Statistical Package for the Social Sciences (SPSS) version 10, and knowledge comparison between students was done using Chi-square test, while the attitude was compared using Mann–Whitney U-test and P < 0.05 was considered statistically significant.
Results: Nearly 77.9% of interns and 39% of students knew about the basic principles of ethics and 82.9% of students and 60.6% of interns told that doctors should maintain patient's confidentiality and there was a significant statistical difference in knowledge and attitude between the students and interns.
Conclusion: The knowledge and attitude of undergraduate students on medical ethics was found to be satisfactory, and the results of this study can be used to further strengthen the medical curriculum and such initiatives will help in developing ethically competent doctors.

Keywords: Attitude ethics and communication, consent, curriculum, ethics, medical students


How to cite this article:
Rani V. Knowledge and attitude about medical ethics among undergraduate medical students - A cross sectional comparative study. Indian J Health Sci Biomed Res 2022;15:131-6

How to cite this URL:
Rani V. Knowledge and attitude about medical ethics among undergraduate medical students - A cross sectional comparative study. Indian J Health Sci Biomed Res [serial online] 2022 [cited 2022 Jun 25];15:131-6. Available from: https://www.ijournalhs.org/text.asp?2022/15/2/131/345820




  Introduction Top


Medical ethics is a system of moral principles that gives values for health professionals to practice medicine and also guides in the field of scientific research. It is composed of set of four principles which includes, respect for autonomy, nonmaleficence, beneficence, and justice which forms a basic foundation for all health-care professionals.[1] It also helps in professional conduct of behavior and guide them when they have to face ethical dilemmas.[2] In many instances, conflicts arise between patients and doctors which require doctors to be well versed with the ethical principles.[3] Medical ethics is an essential part of medical curriculum and every student should have adequate knowledge regarding the same. Our medical education system does not train undergraduate medical students in ethical aspects during their undergraduate course so, as a result in the recent times very frequently we have seen an increase in number of assaults among doctors and also there is gradual decline in confidence on doctors among the general public.[4] The main aim of medical education is to ensure that every student acquires adequate knowledge, skills in medical subjects but are also trained in ethical and communication aspects to treat patients effectively.[5] In 2018, Medical Council of India (MCI) had released (Attitude Ethics and Communication [AETCOM]) module, which is a useful guide to train undergraduate medical students.[6] This landmark step will eventually guide medical colleges in training medical students in various aspects of ethics and professionalism. Many studies done in the past signify the lack of adequate knowledge about medical ethics among medical students[7],[8] and doctors.[9],[10],[11] Hence, teaching ethics in both theoretical and practical aspects for students during their undergraduate training course will have a significant influence on the moral qualities of medical professionals. The first step in incorporating ethics in our medical curriculum will be to determine the level of the basic knowledge and attitudes among medical students. Hence, this study was planned to evaluate the level of knowledge and attitude about medical ethics among undergraduate medical students who are the future doctors of our society.

Aims and objectives

  1. To assess the level of knowledge about medical ethics among undergraduate medical students
  2. To assess attitude about medical ethics among undergraduate medical students
  3. To compare difference in knowledge and attitude about medical ethics between students and interns.



  Materials and Methods Top


A cross sectional study was conducted among second-year MBBS students (no. 146) and interns (no. 104) at a medical college in Hyderabad. Ethical Clearance was obtained from Malla Reddy Medical College for Women, Hyderabad with Ref no MRMCWIEC/AP/09/2018 dated 22-12-2018. Institutional Ethics Committee permission was taken before conducting the study. Oral consent was taken from those who are willing to participate in the study, and the objectives of the study were briefly explained to the students before administering the questionnaire. A questionnaire[12] with knowledge and attitude items was used in this study, and it was validated by pilot testing among seven students. The questionnaire has three sections. The first section of the questionnaire covered demographic information such as age and year of study of study participants. The second part of the questionnaire contains questions about their knowledge on medical ethics and its importance and the third part is about their attitudes on various issues such as core values for guidance of doctors and importance of medical ethics in their curriculum which was assessed by 5-point Likerts scale. The data were analyzed using IBM SPSS Statistics for Windows, Version 25.0. (Armonk, NY: IBM Corp). and interpretation of data was done using percentage and proportion. For comparing the knowledge among the two groups, Chi-square test was used, Mann–Whitney U-test was used to compare attitude, and P < 0.05 was considered statistically significant.


  Results Top


Out of 150 interns, 104 (69.3%) took part in the study and all 146 (100%) second MBBS students participated in the study and the mean age group of interns and second MBBS students was 23.1 years and 19.8 years [Graph 1], and all the participants in this study were females as it is a women's medical college. [Table 1] describes students and interns knowledge on medical ethics. Various sources of acquisition of knowledge on medical ethics among the students and interns are shown in [Graph 2]. Importance of consent taking is shown in [Graph 3]. There is a significant statistical difference in knowledge between second MBBS students and interns (P < 0.05). [Table 2] depicts attitude of students and interns toward medical ethics. Attitude of students and interns on maintain patients' confidentiality is shown in [Graph 4]. There is a significant statistical difference in attitude among second MBBS students and interns (P < 0.05) except for the questions relating to the physicians respect for human life and their duty regarding updating their knowledge and skills.

Table 1: Knowledge on medical ethics among students and interns

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Table 2: Attitude of undergraduate students towards medical ethics

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  Discussion Top


The study shows that undergraduate medical students and interns involved in the study had some basic knowledge and good attitude about medical ethics. The main source of students' knowledge on medical ethics was through lectures, when compared to similar to study done by Chatterjee and Sarkar et al.[12] and Purushothaman et al.[13] where it was 46.3% and 50% for newspapers. In this study, none of the 2nd-year students and only 9.6% of interns quoted medical journals as their source of information on ethics which is very less in comparing to a similar study[13] where it was 17.5% even among the students. Majority of interns (93.3%) knew about the presence of ethics committee at our college when compared to second MBBS students because these interns have undertaking various research projects, for which they had taken ethics committee clearance, the result of which in higher in comparison to a similar study by Jatana et al.,[14] where the response was 57.7% and similarly most of the interns also knew about the basic principles of medical ethics indicating these future doctors have a basic foundation in ethics which will eventually enable them to tackle ethical issues in the near future. It was good to note that 84.2% of students, 97.1% interns agreed that taking consent is a must before examining patients the results of which are less when comparing to a study done by Chetan et al.[15] where it was 92.8% for students and 100% for interns. Maintaining patient's confidentiality is very important, which was strongly agreed by 82.6% of students, 60.6% interns, while comparing to a study done by Adhikari et al.[5] where it was 92.4% among doctors and this difference in attitude might be due to the fact that attitude improves with practice and age. Teaching ethics to students as a part of the curriculum is very essential, which was strongly agreed by 78.8% of interns as these students were taught only few ethical aspects as a part of forensic medicine during their second professional year. In a study done by Chin et al.[16] students recommended formal ethics teaching and assessment as an important requirement of medical education and also in a similar study by Goldie et al.[17] showed preliminary ethical training has a positive impact on students potential behavior on facing ethical problems. Furthermore, another study done by Burling et al.,[18] Kesselheim et al.[19] and Sharma et al.[20] highlighted the importance of incorporating medical ethics and professionalism in medical curriculum. All these studies show that medical ethics must be given a major share in the curriculum for undergraduate medical students. The training module developed by the World Health Organization in 2009 in ethics and the AETCOM module by MCI can be used as a referral by the medical colleges in training their students.[6],[21] Therefore it is very necessary to reemphasize the importance of ethics by adopting new teaching learning methods, interactive workshops, case studies, seminar, role plays, simulated patients, and cinemeducation which will help in implementing longitudinal programs that will help students acquire necessary competency in ethics and followed by frequent assessment methods which will facilitate students to improvise themselves. Furthermore, certain crucial topics such as informed consent, publication ethics, research misconduct, and confidentiality need to give special importance.

Patients trust on physician is the major contributing factor for successful prevention, diagnosis, management of diseases, and also for a fruitful doctor–patient relationship.[22] Integrating good ethical behavior among medical students will help in reinforcing public trust in medical professionals and will eventually make medicine a sacred and valuable profession.[23] These efforts will help in scrupting a competent Indian Medical Graduate who will be able to carter the health care needs of the society.


  Conclusion Top


Today's medical students are tomorrow's health-care professionals. This study highlights that there is an improvement in knowledge and attitude among medical students as they progress through their years in medical college. The process of imparting ethical knowledge must be started from the grass root level and continued throughout their medical course and this needs to be imparted as a multidisciplinary approach. Furthermore, teaching ethics needs to be reviewed by appropriate assessment strategy which will further strengthen our medical curriculum.

Acknowledgments

I would like to thank all the interns and second-year MBBS students for their active participation in the study. This study was done as a project for Advanced Course in Medical Education by Jawaharlal Nehru Medical College, Belgaum, Belgavi, Karnataka.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Page K. The four principles: Can they be measured and do they predict ethical decision making? BMC Med Ethics 2012;13:10.  Back to cited text no. 1
    
2.
Limentani AE. The role of ethical principles in health care and the implications for ethical codes. J Med Ethics 1999;25:394-8.  Back to cited text no. 2
    
3.
Thakre SB, Thakre SS, Ughade SN, Niswade AK. Dealing with conflict in the doctor-patient relationship: An administrator's perspective at tertiary health care teaching institution of central India. Case Stud J 2015;4:1-6.  Back to cited text no. 3
    
4.
5.
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.  Back to cited text no. 5
    
6.
Available from: https://old.mciindia.org/UG-Curriculum/UG-Curriculum-Vol-I.pdf. [Last assessed on 2021 Jan 01].  Back to cited text no. 6
    
7.
Arun Babu T, Venkatesh C, Sharmila V. Are tomorrow's doctors aware of the code of medical ethics? Indian J Med Ethics 2013;10:192-4.  Back to cited text no. 7
    
8.
Dutt R, Yadav AK, Chakraborty S, Siva A, Mondal M. Awareness of medical ethics among undergraduate students of medical college in South Kolkata. Indian J Public Health Res Dev 2019:10:726-9.  Back to cited text no. 8
    
9.
Varghese AM, Vaswani VR, Kumar BK, Shenoy V. Awareness and attitude of medical negligence and medical ethics among interns and resident doctors. Int J Curr Microbiol App Sci 2016;5:532-5.  Back to cited text no. 9
    
10.
Jalal SS, Imran M, Mashood A, Younis M. Awareness about knowledge, attitude and practice of medical ethics pertaining to patient care, among male and female physicians working in a public sector hospital of Karachi, Pakistan – A cross-sectional. Eur J Environ Public Health 2018;2:1-8.  Back to cited text no. 10
    
11.
Singh S, Sharma PK, Bhandari B, Kaur R. Knowledge, awareness and practice of ethics among doctors in tertiary care hospital. Indian J Pharmacol 2016;48:S89-93.  Back to cited text no. 11
    
12.
Chatterjee B, Sarkar J. Awareness of medical ethics among undergraduates in a West Bengal medical college. Indian J Med Ethics 2012;9:93-100.  Back to cited text no. 12
    
13.
Purushothaman S, Salmani D, Somashekhar S, King KI, Reghunath S, Pushkar B. Knowledge and attitude of health care ethics among MBBS students. Indian J Clin Anat Physiol 2017;4:97-9.  Back to cited text no. 13
    
14.
Jatana SK, Soe HH, Phyu KL, Lwin H, Than NN. A Survey on Knowledge and Attitudes towards Medical Ethics among Undergraduate Medical Students. Education 2018;8:48-53.  Back to cited text no. 14
    
15.
Chetan L. Rajput, Swati H. Shah, Arun N. Kowale. Knowledge and awareness about medical ethics in medical students, interns and resident doctors. Paripex- Indian J Res 2017;6:63-5.  Back to cited text no. 15
    
16.
Chin JJ, Voo TC, Karim SA, Chan YH, Campbell AV. Evaluating the effects of an integrated medical ethics curriculum on first-year students. Ann Acad Med Singap 2011;40:4-18.  Back to cited text no. 16
    
17.
Goldie J, Schwartz L, McConnachie A, Morrison J. The impact of three years' ethics teaching, in an integrated medical curriculum, on students' proposed behaviour on meeting ethical dilemmas. Med Educ 2002;36:489-97.  Back to cited text no. 17
    
18.
Burling SJ, Lumley JS, McCarthy LS, Mytton JA, Nolan JA, Sissou P, et al. Review of the teaching of medical ethics in London medical schools. J Med Ethics 1990;16:206-9.  Back to cited text no. 18
    
19.
Kesselheim JC, Najita J, Morley D, Bair E, Joffe S. Ethics knowledge of recent paediatric residency graduates: The role of residency ethics curricula. J Med Ethics 2016;42:809-14.  Back to cited text no. 19
    
20.
Sharma S, Satija M, Sagar M, Chaudhary A, Sharma S, Sharma P. A mixed methods study to introduce bioethics training in undergraduate medical teaching of community medicine. Natl J Community Med 2018;9:415-19.  Back to cited text no. 20
    
21.
Module for Teaching of Medical Ethics to Undergraduates. Available from: http://www.searo.who.int/entity/human_resources/documents/Module_Medical_Ethics/en/. [Last accessed on 2021 Feb 02].  Back to cited text no. 21
    
22.
Seif-Farshad M, Bazmi S, Amiri F, Fattahi F, Kiani M. Knowledge of medical professionalism in medical students and physicians at Shahid Beheshti University of Medical Sciences and affiliated hospitals-Iran. Medicine (Baltimore) 2016;95:e5380.  Back to cited text no. 22
    
23.
Berger R, Bulmash B, Drori N, Ben-Assuli O, Herstein R. The patient–physician relationship: An account of the physician's perspective. Isr J Health Policy Res 2020;9:1-16.  Back to cited text no. 23
    



 
 
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