Informed Consent for Surgical Care in East Africa

In the developed world one of the pillars of ethical conduct in surgical practise is informed surgical consent. In low income developing countries only a few researchers have explored the practise of surgical consent pre-operatively. During the informed consent process, the patient has a right to make an autonomous and independent decision about his/her surgical treatment after having been provided the necessary information by the surgeon caring for the patient. Patient autonomy and independent decision-making is recommended by the World Medical Association (WMA) Declaration of Lisbon. Family and cultural background, education, religion and socioeconomic status may all influence informed consent in surgical practise. In East Africa, few studies have reviewed consent practises among surgeons to document best surgical practise and identify areas that need improvement in the East African setting. This review reports the author’s personal experience of the practise of surgical consent among surgeons in Uganda and reviews the specific challenges faced in East Africa. In Uganda, the administration and documentation of informed consent is still inadequate. Better medical ethics education and proper communication skills training in medical schools needs to be addressed. Refresher courses on medical ethics and communication skills may also be necessary for fully trained surgeons.

STUDENTS’ VIEWS ON THE ROLE OF ETHICS EDUCATION FOR THEIR FUTURE MEDICAL PRACTICE

INTRODUCTION: Worldwide, in different ways, ethical dilemmas arise in medicine and life sciences. It is critical for medical professionals to respond with confidence when ethical challenges are addressed in their clinical practice. Medical ethics and bioethics education is recognized as an essential course of the medical curriculum. The course aims to provide students with knowledge and competencies on dealing with moral problems. OBJECTIVES: In this article, we aim to explore students’ views about the importance and role of medical ethics education for their future practice. Their suggestions on specific medical ethics and bioethics topics were also considered, as well as previous knowledge on ethics before they enrolled in university. METHODS: A paper questionnaire was developed and distributed among first-year foreign medical students from the Faculty of Medicine in the Medical University-Sofia in Bulgaria. All students participated in the study anonymously and voluntarily. The study was conducted during January and February 2020. RESULTS: Completed questionnaires were received from 366 medical students. Data collected demonstrates that only 19% of the students were taught ethics before enrolling in university and covered topics on philosophy and ethics, civil and human rights. The majority (92%) of the responders believe that the study of medical ethics and bioethics helps medical professionals to improve their skills in identifying ethical problems in their everyday practice. Interesting were the suggestions for topics in medical ethics and bioethics that needed further study during lectures and seminars and included principles of medical ethics and bioethics, ethical behavior in medicine and health care, ethical dimensions of new technologies in health care, ethical dimensions of clinical decisions and patients’ quality of life, ethics and health management. CONCLUSIONS: Medical ethics education is significant for future physicians, helping them to improve their skills in identifying ethical issues, and base their decisions on fundamental ethical principals in their everyday practice. Attention should be given to topics related to principles of medical ethics, models of patient-physician relationships, new technologies in health care, ethics and health policy.

Medical Ethics: Uncommon Morality and the Implications for Medical Ethics Education

"Common morality has been the touchstone for addressing issues of medical ethics since the publication of Beauchamp and Childress’s Principles of Biomedical Ethics in 1979. In my presentation, I will challenge that reigning view by presenting two arguments. The negative argument shows why common morality cannot be the ethics of medicine. The positive argument explains why medical professions require their own ethics. I will then explain medicine’s distinctive ethics in terms of the trust that society allows to the profession. By distinguishing roles from professions, I will explicate sixteen specific duties that medical professionals undertake when they join the profession. My derivation of medicine’s distinctive ethics begins with a thought experiment demonstrating that trust is at the core of medical practice. Society allows doctors to develop special knowledge and skills and allows them to employ special powers, privileges, and immunities that could be particularly dangerous to members of society. Society, therefore, has to be assured that professional’s use of their remarkable powers and privileges will be constrained to their intended use. Professions’ publically declared codes and oaths go a long way to engender public confidence in medical professionals. Medical education must complete the job by helping our trainees understand their professional obligations and become clinicians who uphold their profession’s ethics. Medical educators therefor have to help our students comprehend and internalize their duty to “seek trust and be deserving of it,” and uphold their fiduciary responsibility to “use medical knowledge, skills, powers and privileges for the benefit of patients and society.” "

Paediatric Residents and Fellows Ethics (PERFEct) survey: perceptions of European trainees regarding ethical dilemmas

With an increasingly complex healthcare environment, ethics is becoming a more critical part of medical education. We aimed to explore European paediatric trainees’ experiences of facing ethical dilemmas and their medical ethics education whilst assessing their perceptions of ethical dilemmas in current and future practice. The Young Sections of the European Academy of Paediatrics and European Society of Paediatric and Neonatal Intensive Care developed an explorative online survey covering demographics, ethical dilemmas faced and ethics training. The survey was made available in nine languages from November 2019 to January 2020 via newsletters and social media. Participants (n = 253) from 22 countries, predominantly female (82%) and residents (70%), with a median age of 29-years, completed the survey. The majority (58%) faced ethical dilemmas monthly or more frequently. Most ethics training was received by ethics lectures in medical school (81%) and on the job (60%). A disagreement between the healthcare team and patient/family was the most frequently faced moral dilemma (45%); the second was withholding/withdrawing life-prolonging measures (33%). The latter was considered the most challenging dilemma to resolve (50%). Respondents reported that ethical issues are not sufficiently addressed during their training and wished for more case-based teaching. Many have been personally affected by moral dilemmas, especially regarding withholding/withdrawing life-prolonging measures, and often felt inadequately supported.Conclusion: Paediatric trainees face many moral issues in daily practice and consider that training about managing current and future ethical dilemmas should be improved, such as by the provision of a core European paediatric ethics curriculum. What is Known:• Paediatric services are becoming more complex with an increase in ethical dilemmas asking for rigorous training in ethics.• Ethics training is often lacking or covered poorly in both pre- and postgraduate medical education curricula.• Existing ethics training for European paediatric trainees is haphazard and lacks standardisation. What is New:• The PaEdiatric Residents and Fellows Ethics (PERFEct) survey provides insight into the European paediatric trainees’ views regarding ethical dilemmas in their current and future practice.• European paediatric trainees report a lack of ethics training during paediatric residency and fellowship.• This study provides content suggestions for standardised medical ethics training for paediatric trainees in Europe.

Impact of a Novel Approach for Undergraduate Medical Ethics Education in The Middle East and South Asia

Background Complexities of ethics education, combined with socio-cultural issues specific to the medical curricula of the developing country context, have created resource constraints that impact medical ethics education delivery in countries like Pakistan and Saudi Arabia. These constraints include the dearth of contextually relevant texts, shortage of trained teachers and confines in institutional regulations in the regions. Focused strategies are required to address these constraints. Workbook-based ethics learning (WBEL) is one such strategy based on a contextually relevant ethics education model. Purpose This study aimed to evaluate the effectiveness of ethics education, delivered through the WBEL strategy, on students’ learning and satisfaction in medical colleges of Pakistan and Saudi Arabia. Methods A pre-post-test intervention study was conducted in two medical colleges, Jinnah Sindh Medical University, Pakistan and King Abdulaziz University, Saudi Arabia. An ethics course was structured using the WBEL strategy and delivered to early clinical years medical students. The impact on student learning was measured by pre-and-post administration of a set of Key Feature Questions (KFQ) and a Script Concordance Test (SCT). A twenty-eight-item course feedback questionnaire was developed to collect students’ perceptions regarding the WBEL strategy. Results Of the total 125 students who consented, 90 (72%) completed the pre-and post-test measures, and 103 returned the feedback forms at the two sites. The post-test scores in KFQs were significantly higher than pretest scores in both Pakistani and Saudi students (p-value < 0.001). There was no significant pre-to-post difference in overall SCT scores (p = 0.057). The majority of participants considered the overall course to be valuable. They provided positive feedback on the Workbook’s usefulness and the enhancement of critical thinking within the course. Ethics case discussions, classroom quizzes, and reflective writing were considered most effective for learning during the course. Conclusion The findings suggest that the WBEL is a promising way forward in medical ethics education as it resulted in a notable increase in participants’ knowledge and ethical decision-making skills. The study also provides evidence of feasibility for using the WBEL strategy for teaching ethics in resource-limited regions.

Does teaching medical ethics ensure good knowledge, attitude, and reported practice? An ethical vignette-based cross-sectional survey among doctors in a tertiary teaching hospital in Nepal

Background Importance of awareness of medical ethics and its integration into medical curriculum has been frequently highlighted. Study 1 aimed to assess the knowledge, attitude, and reported practices of medical ethics among clinicians at Patan Academy of Health Sciences, a tertiary care teaching hospital in Nepal. Study 2 was conducted to assess whether there was a difference in knowledge, attitude, and reported practices of medical ethics among doctors who received formal medical ethics education during undergraduate studies and those who did not. Methods Two cross-sectional surveys using self-administered questionnaires were conducted. Study 1 included 72 participants; interns, medical officers, and consultants working at Patan Academy of Health Sciences. Study 2 was a comparative study conducted among 54 medical officers who had received formal medical ethics education (Group 1) and 60 medical officers who did not (Group 2). Results Participants who had completed post-graduate education had higher knowledge (p = 0.050), practice (p < 0.001), and overall combined scores (p = 0.011). Participants with ethics education had higher knowledge (p < 0.001), attitude (p = 0.001), practice (p < 0.001), and overall score (p < 0.001). Most participants preferred consulting colleagues if an ethical dilemma arose. Fewer participants had heard of the Declaration of Helsinki. Most participants thought doctors to be most capable of judging what is best for the patient (Study 1: 70.42%, Study 2 Group 1: 42.59%, Group 2: 80%). Case scenarios in which participants demonstrated poor practice were ethical issues concerning truth-telling, end-of-life decisions, treating HIV/AIDS patients, treating a minor, and reporting colleague’s errors. Conclusions This study found that participants who have received medical ethics education have higher knowledge, attitude, and practice scores. The results further justify the need for medical ethics education to be a part of the core medical curriculum. A blame-free environment where seniors can be approached for advice should be created. Research ethics should also be given attention. During medical ethics training, ethical issues where doctors perform poorly should be given more priority and should be discussed in a country-specific context.

Virtue and medical ethics education

The traditional structure of medical school curriculum in the United States consists of 2 years of pre-clinical study followed by 2 years of clinical rotations. In this essay, I propose that this curricular approach stems from the understanding that medicine is both a science, or a body of knowledge, as well as an art, or a craft that is practiced. I then argue that this distinction between science and art is also relevant to the field of medical ethics, and that this should be reflected in ethics curriculum in medical education. I introduce and argue for virtue ethics as the best opportunity for introducing practical ethical knowledge to medical trainees.

TEACHING MEDICAL ETHICS IN LEADING UNIVERSITIES OF CHINA

The article examines the issue of teaching medical ethics in leading Chinese universities in the training of medical professionals and found that medical ethics courses for physicians are an innovation for Chinese medical high schools. Due to different cultural traditions, researchers of Chinese medical ethics hold conflicting views on the scientific importance and practical necessity of medical ethics and bioethics. The study found that medical ethics education in China has gradually adapted the experience of leading countries such as the United States and the United Kingdom in teaching ethics. China is now in the process of discussing how to develop its own traditional ethics in the context of globalization. It is established that in the program of masters in medicine the formation of ethical knowledge is a mandatory subject. The teaching of medical ethics takes place not only while studying in Chinese universities, but is a long-term lifelong process in which the student summarizes the results of their efforts, combining moral reflection, learning and leadership. The article analyzes the methods and content of teaching medical ethics, which include relevant cultural, social and personal development, and the education of masters in medicine at Chinese universities.Teaching ethics in medical universities is a relatively new area of medical education in China, ethics curricula have different levels of development. In order to determine the peculiarities in the contents of curricula, teaching and learning methods, forms of evaluation and quality of teaching ethics in China, it was analyzed ethical education in several leading medical universities in China: Wuhan University School of Medicine, Guangzhou Medical University and Peking University School of Medicine. In the process of scientific research on the teaching of ethics in universities, it was found that medical ethics for some time was part of the mandatory course of disciplines, with a strong tendency to emphasize the correct ideological thinking of future physicians.Key words: specialist in medicine, medical ethics, master’s degree, higher medical education in China, professional competence of doctor.

Systematic development and refinement of a contextually relevant strategy for undergraduate medical ethics education: a qualitative study

Background Delivery of medical ethics education is complex due to various reasons, compounded by the context-dependent nature of the content. The scarcity of relevant resources in the contexts of some developing countries adds a further layer of difficulty to ethics education in these contexts. We used a consultative approach with students, teachers and external experts to develop a practical approach to medical ethics education. This study aimed to develop and refine a contextually relevant approach to ethics education in the region of Saudi Arabia. Methods The study utilised an explorative qualitative methodology to seek views of students and faculty of Rabigh Faculty of Medicine, Saudi Arabia, and international experts in the field of ethics and education to review and enhance a new ethics learning strategy which included a workbook-based tool. Three focus groups with 12 students, in-depth interviews with four faculty members and qualitative feedback from eleven external experts enabled the study participants to objectively critique the WBEL and provide feedback to enhance its quality. Thematic content analysis of the data was done to draw inferences which were used to refine the educational strategy. Results The analysis generated twenty-one sub-themes within four main themes: design features, content, teaching methods and assessment. These findings helped to design the educational strategy to improve its effectiveness in the given context. Conclusion The study drew on the views of students, faculty and external experts to systematically develop a novel approach to ethics education for countries like Saudi Arabia. It also demonstrated the use of the consultative approach for informing a culturally relevant educational strategy in the Middle East context.