Document Type : Original Article
Authors
- Morteza Rastgar 1
- Ramin Haghighi 2
- Mohammadreza Safdari 3
- Mohammadreza Taghavi 4
- Amir Saberi 5
- Hasan Namdar Ahmadabad 6
1 Assistant Professor, Department of General Courses and Islamic Studies, School of Medicine, North Khorasan University of Medical Sciences, Bjonur, Iran
2 Department of Urology, School of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
3 Department of Surgery, School of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
4 Department of Infectious Diseases, School of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
5 Student research committee, School of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
6 Department of Pathobiology and Laboratory Sciences, School of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
Abstract
Introduction: In the present study, we investigated the viewpoint of clinical internship students about respecting the codes of ethics among clinical medicine educators in North Khorasan University of Medical Sciences (NKUMS).
Methods: In this descriptive cross-sectional study, 90 clinical internship students who were training in educational hospitals of NKUMS selected using simple random sampling. The data were collected using a valid, reliable researcher-made questionnaire, which consisted of three parts: 1) demographic information 2) evaluating the ethical codes for clinical medicine educators (9 components with 54 items), and 3) evaluation of ethical codes in different clinical departments based on a 5-point Likert scale.
Results: The overall compliance with ethical codes for clinical medicine educators was 3.50 ± 1.08 at a semi-desirable or average level. The highest scores were respectively related to work conscience (3.85 ± 1.00) and secrecy (3.76 ± 0.98) and the lowest scores were respectively related to attention to the student (3.09 ± 1.14) and patience and good manners (3.19 ± 1.13). Our results also showed that departments of emergency medicine and pediatrics have the highest and the lowest ethics compliance levels. We observed significant differences between clinical departments in level of compliance with ethical codes (P˂ 0.05).
Conclusion: Taken together, these results suggest that, although respecting the codes of ethics among clinical medicine educators in NKUMS are at a semi-desirable level, clinical medicine educators pay more attention to students and deal with them patiently and with good manners.
Extended abstract:
Introduction: The implementation of professional ethics training programs within the curriculum of medical schools is crucial in establishing and reinforcing ethical principles among medical students. However, it is widely acknowledged that solely relying on formal professional ethics education may not be sufficient to effectively shape the attitudes, behaviors, and performance of future healthcare professionals. Research indicates that a substantial portion of ethical values are internalized through the "hidden curriculum," which is influenced by the conduct of clinical lecturers and peers at advanced educational stages. Therefore, the failure of clinical lecturers to uphold ethical standards can inadvertently impact the ethical development of medical students. Clinical medicine educators have dual ethical obligations. On the one hand, society expects them to adhere to the principles of professional ethics when providing healthcare services. On the other hand, the education system aims to cultivate exceptional students. Students observe and emulate their professors, who serve as their clinical lecturers, at the bedside. This modeling process acts as a gateway to molding the student's future professional persona. Given the pivotal role of role modeling in clinical education, it is imperative for clinical internship students to be exposed to exemplary and ethical role models in addition to formal instruction on medical ethics. This study marks the first attempt to investigate the level of adherence to ethical standards among clinical lecturers, as perceived by clinical intern students at North Khorasan University of Medical Sciences. The findings of this study are anticipated to have a positive impact on promoting ethical behavior among clinical educators.
methods: This study employed a cross-sectional descriptive design conducted between 2019 and 2021 at the teaching hospitals affiliated with North Khorasan University of Medical Sciences, Bojnourd city. The study focused on clinical internship students selected through simple random sampling, with the sample size calculated using Cochran's formula. Data was collected using a researcher-developed questionnaire, crafted based on previous studies outlining ethical standards for medical clinical educators, with minimal adjustments made. The questionnaire consisted of three sections: the first part gathered demographic information, the second part comprised 54 items aligned with ethical codes categorized into nine components—conscientiousness in work (6 items), responsibility (8 items), respect for others (5 items), justice (5 items), integrity and collegiality (5 items), academic excellence (6 items), confidentiality (5 items), student support (9 items), and patient care (5 items). The third section evaluated the status of each component of professional ethics as perceived by clinical training groups using a five-point Likert scale. To ensure the tool's validity, both face and content validity assessments were conducted. Graphpad Prism version 5 software was used for statistical analysis of data.
Results: In this study, a total of 90 clinical internship students completed the designated questionnaire. According to the students' perspectives, the overall adherence to ethical codes by clinical lecturers was rated at 3.50 ± 1.08, indicating a moderate to favorable level. Among the nine components assessed, work ethics, respect for others, confidentiality, and patient care were deemed to be in a strong or favorable condition. The remaining components were rated at an average or relatively favorable level. Notably, conscientiousness and confidentiality stood out with the highest average scores of 3.85 ± 1.00 and 3.76 ± 0.98, respectively, while attention to students and positivity exhibited the lowest averages at 3.09 ± 1.14 and 3.19 ± 1.13, respectively. Further analysis revealed significant discrepancies between male and female students' perceptions regarding respect for others, collegiality, and academic excellence (P<0.05). When comparing different educational groups within the medical school concerning clinical lecturers' adherence to professional ethics from the viewpoint of clinical internship students, the pediatric educational group scored an average of 3.39 ± 1.18, whereas the emergency medicine group obtained the highest compliance level with an average of 4.16 ± 0.87.
Conclusion: This study has revealed that the level of adherence to ethical principles among clinical medicine educators is moderately satisfactory, although particular components such as student attention and interpersonal demeanor received lower ratings from the students' perspective. Given the importance of fostering relationships based on trust and respect between educators and students in clinical settings, it is essential to create conducive conditions for the establishment of such effective connections within teaching hospitals. Previous study has underscored the challenges faced in maintaining effective communication in hospital settings due to overcrowded outpatient departments and healthcare providers' time constraints and resource limitations.
This study suggests that the relatively limited number of hospitals and inpatient beds in North Khorasan province, in relation to the population size, may have contributed to the observed difficulties in fostering trust-based relationships between clinical educators and students. Despite the existing constraints and heavy workloads, clinical medicine educators are encouraged to prioritize student engagement, demonstrating patience and a positive attitude in their interactions. Efforts to enhance student-educator relationships within the clinical setting are crucial for promoting a supportive and constructive learning environment.
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