Nearly half of all medical students often feel under
pressure to act unethically during training and almost two thirds regularly witness a
clinical teacher behaving unethically, according to a study in the British Medical
Journal.
The study has highlighted the need for a policy which would protect and rights of both
patients and students in medical education.
More than 100 clinical students, who were about one year away from completing medical
school at the University of Toronto, were surveyed about ethical dilemmas they had
encountered during their clinical training. Nearly half (47%) reported that they had often
been placed in a clinical situation in which they had felt pressure to act unethically,
and 61% reported witnessing a clinical teacher acting unethically.
Three categories of ethical dilemma were identified, based on examples reported by 20
students during four focus groups.
For example, reports of physical examination of patients for purely educational reasons
-- without patients' prior consent -- indicated a conflict between medical education and
patient care.
Students also reported being given responsibility beyond their capacity, and
involvement in patient care which they perceived to be substandard and unacceptable. The
study also suggested that these dilemmas are seldom resolved during medical school.
The Toronto study's results are likely relevant to medical education in medical schools
around the world. The need to enforce a policy to help prevent abuses of both patients and
students in medical education system was stressed by Len Doyal, professor of medical
ethics at St. Bartholomew's and the Royal London School of Medicine and Dentistry, in an
accompanying editorial.
Such a policy will ensure that the students of today will be proud -- rather than
distressed -- that they have chosen to be the doctors of tomorrow, he commented.
The view that patient consent is needed for training procedures as well as treatment is
reiterated in a personal view by Andrew West and colleagues.
"The medical profession urgently needs to learn respect for the living and for the
dead, and thereby earn the public respect that is its lifeblood," they concluded.
SOURCES: "Understanding the clinical dilemmas that shape medical
students' ethics development: questionnaire survey and focus group study," British
Medical Journal, March 24, 2001, No 7288 Volume 322.
