Medical students want more ethics training

By Sarah Guy, medwireNews Reporter

Almost two-thirds of medical students and residents feel that there is a need for more ethics training during their curricula and training programs, respectively, show results of a survey undertaken at a US medical school.

Less than half of respondents felt that medical school training was adequate, and those who had received ethics training at least once per month during school were significantly more likely to agree that the training helped prepare them for handling clinical ethical dilemmas.

Only eight of 35 scenarios covered in the survey, including breaking bad news, resulted in more than 70% of participants saying they felt comfortable, report the researchers in the Journal of Medical Ethics.

"The optimal medical ethics training may very well depend on direct clinical exposure of trainees to ethics dilemmas, the so-called 'experimental' curriculum, whereby, experience gained by actually confronting these clinical ethics issues while on the wards can impart a sense of comfort with everyday ward issues," suggests the team.

Henry Silverman (University of Maryland, Baltimore, USA) and co-investigators surveyed a total of 129 medical students and 207 residents between September 2009 and February 2010.

Overall, just 13.4% of respondents reported receiving a formal course in ethics during medical school training, and 44.0% agreed that it had been helpful in preparing them for ethical dilemmas. The majority (63.4%) believed there should be more ethics taught in medical school.

Indeed, receiving ethics training at least once per month during medical school was associated with a significant 5.2-fold increase in the odds for agreeing that the training had helped prepare the respondents adequately for difficult ethical situations, report Silverman and colleagues.

Situations the respondents felt most comfortable handling included: talking to patients who refuse recommended treatment, at 74.9%; discussing advance directives in case of future incapacity to make decisions, at 74.5%; discussing 'Do Not Resuscitate' orders, at 74.0%; breaking bad news, at 73.5%; and understanding disparities in healthcare among different ethnic or racial groups, at 76.7%.

Conversely, survey respondents felt least comfortable when dealing with an attending physician they perceived to be acting unethically (22.4%), when reporting other colleagues' behavior (33.0%), and when dealing with a colleague abusing prescription drugs (33.2%).

"What is needed then, is a curriculum that situates these clinical ethics experiences to trainees in a more systematic fashion and within a structured format," conclude Silverman et al.

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