|Ahead of print publication
Teaching ethics to medical faculties: An E-learning intervention
Manushi Srivastava1, Sandeep Shrivastava2, Pradyumn Srivastava3, Ratan K Srivastava1, Shweta Jaiswal1
1 Department of Community Medicine, Institute of Medical Sciences, BHU, Varanasi, Uttar Pradesh, India
2 Department of Orthopedics, Institute of Medical Sciences, Wardha, Maharashtra, India
3 Epley Center for Health Professions, University of Arkansas, Fayetteville, AR, USA
|Date of Submission||15-Sep-2020|
|Date of Decision||29-Oct-2020|
|Date of Acceptance||13-Dec-2020|
|Date of Web Publication||21-Sep-2021|
Department of Community Medicine, Institute of Medical Sciences, BHU, Varanasi - 221 005, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Introduction: Ethics is defined as a system of moral principles or standards governing conduct; a system of principles by which human actions and proposals may be judged good or bad, right, or wrong. However, ethics for medical teachers with respect to their students has been largely unnoted. Therefore, it seems necessary to know the status of teaching ethics practiced by medical educators which are the major assets in good quality medical education. Objectives: The objectives were to study the changes in the understanding and practices of teaching ethics and principles of medical professionals. Methodology: A prospective interventional study had conducted with 30 medical faculties. Results: Only one-third of the medical educators (33.33%) had reported that they have ever read any literature in “Teaching Ethics,” but after e-intervention, this purport increased to 90.48% as indicated by the posttest results. Conclusion: It could be concluded that faculties were quite aware of the basic philosophy of teaching ethics, but they also agreed with the fact that still, medical teaching is not up to the mark as per the norms of teaching ethics, although most of them were not in agreement of those unethical teaching practices.
Keywords: e-intervention, medical faculties, teaching ethics
| Introduction|| |
Health is the most indispensable part of human life, as all human activities are influenced by the state of one's healthy body and mind. Practice of medicine can render great services to the society provided due care, sincerity, efficiency, and skill are observed by doctors. Since time immemorial doctor has been looked upon as god in the form of human being. Particularly, in India, the doctor is god himself.
However, the respect, status, and recognition enjoyed by doctors have declined giving way to suspicion and mistrust. Even the quality of medical colleges has deteriorated, today, medical service is seen as a commercial venture with money as a deciding factor. Hence, the cordial relationship that existed between doctors and students is under strain.,
Medical teachers play a vital role in the medical education system. In medical teaching, it is well recognized that ethical knowledge is not separate from professional knowledge., Ethics is the rule of right conduct or practice by which each person should be guided in their private and professional life. Beneficence, justice, and autonomy are the basic principles of ethics., However, teaching ethically involves making an analytical decision about what is to be done to maximize learning. The quality of student–faculty relationship is the critical factor in determining a good outcome in education. Teaching medical ethics is not intended to make righteous doctors. Teachers cannot re-bring students again while they are already more than 18 years' old. Medical teachers need to make students like what we think the doctors should be. It is crucial to know that teachers do influence their students in different ways because teachers are as role models for their students who, consciously or subconsciously, emulate their behavior whether good or bad.,,,,,
Therefore, the Medical Council of India prescribes the code of conduct for doctors as encoded in the “CodeofMedical Ethics” in which duties and standards of their professional conduct and etiquette that must be practiced by doctors have been described. Hence, proper implementation of ethical standards in medical practice plays an important role in protecting human rights.
Although many studies discussed professional ethics, code, and conduct in the doctor–patient relationship, only a few articles have investigated the medical teacher–student relationship. There is dearth in studies addressing ethical practices in medical education discussing professional and ethical principles governing the student–faculty relationship, code of professional behavior of medical faculty, and underlying ethical issues. Therefore, this study aimed at assessing the change in understanding and practices of teaching ethics by medical faculties who are involved in regular teaching of undergraduate medical students in Institute of Medical Sciences, BHU.
By imparting intervention through online modes by sharing literature and educational documents, we tried to find the power of online educational intervention, knowledge gap regarding teaching ethics among medical faculties, and the changing attitude regarding the issue under the study.
| Methodology|| |
The prospective interventional study was carried out in the Institute of Medical Sciences, Banaras Hindu University, during April–September 2019. A random number (generated by MS Excel) was used for selecting the participants. Thirty medical faculties were enrolled from 15 departments involved in UG teaching (two faculties from each department). However, 24 complied in the pretest and 21 during the posttest period. Google Form was used as a tool for collecting data (E-Survey). E-learning materials were used to impart the training based on self-directed learning (SDL). Applied Delphi Method (The Delphi method is a process used to arrive at a group opinion or decision by a panel of experts.) was used to validate the Google Form (data collection tool).
After obtaining consent (telephonically followed by e-mail) from the participants, a Google Form with 10 questions was mailed to all study participants to conduct pretest. On getting the responses through Google Form, e-learning materials including two PDF documents and one video were mailed to all study participants as a part of e-learning intervention. They were asked to study the e-learning materials carefully SDL and then for conduction of posttest, again a Google Form with 10 questions was mailed to participants to complete and return within stipulated time. Thus, data collection including intervention took approximately 45 working days despite all efforts to complete early.
It is an educational intervention with pre- and postassessment. UG teaching faculties who had minimum 5 years or more of teaching experience were included in the study.
Medical faculties from superspecialty (i.e., cardiothoracic surgery, orthopedics, surgical oncology, etc.) branches and unwilling to participate were excluded from the study.
Epi Info Software was used for data entry as well as analysis. Statistical significance was calculated by applying “Standard error of difference between two Proportions.” Ethical approval from the institute ethical committee was obtained before convening the study.
| Results|| |
Based on the analysis of prepost test after imparting e-intervention through the information on “teaching ethics,” the following results were revealed. At the beginning of the study during pretest, around one-third of the faculty members (33.33%) reported that they have ever read any information on “Teaching Ethics,” but after imparting e-intervention, this proportion increased to 90.48% in the posttest and this finding was statistically significant.
However, all the participating faculties could correctly describe ethics for medical educators since the beginning. “Teachers code of Ethics” was known to 70.83% of faculties in the pretest which increased after intervention up to 100% and this change was found significant.
Faculties were asked about their views on different teaching ethics practiced by medical teachers. Initially, less than two-third of the faculties (62.5%) did not agree that “Exposing students to embarrassment or ridicule helps them to remember subject very well” is ethical, but after intervention, 90.41% showed their disagreement with the statement [Table 1].
|Table 1: Changes in teaching ethics practiced by medical teachers after e-intervention|
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Many times, faculties display their temper on medical students, and they believe that it helps in maintaining discipline in the class and helps in learning as well. Disagreement to this view increased from 45.8% to 57.1%; however, this change was not statistically significant. On the other hand, around 40% of faculties expressed their partial agreement. Shouting and insulting students is often practised during teaching in medical institutions which is against teaching ethics. View of medical teachers regarding this was also obtained and analyzed and it was found that in pretest, 70.8% did not agree with the statement, and after intervention, disagreement increased up to 85.7%, though it was not statistically significant. Then again, invading student's privacy is an unethical behavior of medical educator, irrespective of the situation. When this issue was asked from medical teachers to share their opinion, it was observed that during the pretest, 33.3% of faculty members justified invading students' privacy if necessary, they further expressed that it is based on the situations. However, after the e-intervention, 47.62% of the faculty members accepted that invading students' privacy is an unethical practice without any doubt and cannot be justified in any situation.
There are many ethical boundaries between teachers and students, such as communication-related boundaries, cultural boundaries, social boundaries, and emotional boundaries. To access the knowledge of medical teachers about these ethical boundaries, they were asked “to enlist four ethical boundaries between teachers and students.” After imparting e-intervention three-fourth of respondents (76.19%) could answer correctly about all the four ethical boundaries, as the same was only 4.17% before intervention [Figure 1]. The value of student's feedback was considered as important to ascertain teacher's ethical behavior by 75% of medical faculties during pretest and was raised to 85.7% after intervention.
In medical training, many faculties often allow their residents to perform surgery or any medical procedure [Figure 2] without obtaining the patient's consent. Such practices are called as “Ghost surgery.” The analysis of this knowledge of the respondents revealed that 12.5% of respondents were aware of this terminology, and after intervention, the knowledge increased up to 90.60% and it was found statistically significant. This is not only a breach of patient's privacy and confidentiality; it also violates teaching training and ethical practices.
|Figure 2: Allowing residents to perform surgery without consent “Ghost Surgery”|
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| Discussion|| |
Most of the studies agreed,,,, with the fact that in medical profession, from the time of Hippocrates, more focus has been given to patient care ethics, but ethics for medical teachers with respect to their students has been largely overlooked. Participants of our study accepted that they have attended a session on ethical teaching practices and principles in their professional tenure till date. As an output of this study, the posttest results do indicate that the participants became more aware that medical educators must know about the basics of teaching ethics and principles.
Interaction and repetitions are the fundamentals for learning any skill. E-learning involves technology, which can be repeated any number of times to improve the levels of learning. Although medical educators are more aware of the teaching ethics and principles, response rate was still very low for e-learning techniques due to lack of motivation, heavy work load and clinical duties, and less competency with technology. Even in our study, most of the faculties willingly consented to be the part of the study, but due to their professional and administrative responsibilities, some of them could not manage time to participate. That is why the nonresponse rate was high in this study. The dropout rate was 20% in the pretest, which increased to 30% in posttest. Which showed that noninteractive interventions lack interest and involvement of the participation leading to high dropout rate? However, the e-intervention method proved as cost-effective and time saving.
| Conclusion|| |
This study aimed to assess the general understanding of teaching ethics of medical faculties and informed the faculties regarding the concept and practices of teaching ethics. Most of the faculties had good understanding about teaching ethics, but majority of them were of the opinion that practicing ethical teaching largely depends on situation. The results revealed that the ethics for medical educators with respect to students has been largely overlooked. Hence, we recommend including this component of “Policies and Practices on Teaching Ethics” in the Basic and Advance Courses for Faculty Development Programs.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]