Abstract
BackgroundAs the practice of medicine inevitably raises both ethical and legal issues, it had been recommended since 1999 that medical ethics and human rights be taught at every medical school. Most Nigerian medical schools still lack a formal undergraduate medical ethics curriculum. Medical education remains largely focused on traditional medical science components, leaving the medical students to develop medical ethical decision-making skills and moral attitudes passively within institutions noted for relatively strong paternalistic traditions.In conducting a needs assessment for developing a curriculum germane to the Nigerian society, and by extension most of Sub-Saharan Africa, this study determined the views of Nigerian medical students on medical ethics education, ethical issues related to the doctor-patient relationship and the ethical/professional dilemmas they are confronted with.MethodsUsing self-administered 63-item structured questionnaires, a cross-sectional survey of the final year medical students of the University of Nigeria was conducted in July 2015.Using the Statistical Package for the Social Sciences software (SPSS Version 17), frequency counts and percentages were generated.ResultsThe sample included 100 males (71.4%) and 40 females (28.6%), with the respective mean (SD) age being 24.6(5.61) and 21.8 (6.38) years. Only 35.7% were satisfied with their medical ethics knowledge, and 97.9% indicated that medical ethics should be taught formally. Only 8.6% had never witnessed a medical teacher act unethically. The dilemmas of poor communication between physicians and patients, and the provision of sub-standard care were reported highest for being encountered ‘often’. A majority (60.7%) indicated that “a doctor should do his best always, irrespective of the patient’s wishes”. No significant difference in responses across gender was noted.ConclusionThere is a strong desire by the contemporary Nigerian medical student for medical ethics education. Their lack of exposure in medical ethics in an ethically challenging environment suggest a dire need for the development of an appropriate medical ethics curriculum for them and the provision of an ethically conducive learning environment.
Highlights
As the practice of medicine inevitably raises both ethical and legal issues, it had been recommended since 1999 that medical ethics and human rights be taught at every medical school
Though the University does not run a formal training program in medical ethics, a majority of the students stated that they had been formally exposed in variable degrees to medical ethics within their undergraduate education; with a sizeable proportion of these students not being able to specify the type of formal exposure obtained and none being capable of specifying clearly the title of any medical ethics textbook read or didactic lecture ever received in school (Table 1).Among the 83 who stated that they had been formally taught medical ethics, a greater segment referred to the traditional onetime pre-clinical orientation talk for new clinical students as the main type of formal medical ethics teaching received (Table 1)
Our study had a high response rate whereas, several related studies conducted in various parts of the world had recorded response rates ranging from 46.5% to 96% [7, 13, 15, 17, 20,21,22,23]; which may merely be a reflection of the levels of interest displayed by the various study populations or the types of study procedures adopted.Our study demonstrates a strong desire by these students for formal medical ethics education against the backdrop of the observed low level of their medical ethics education (Tables 1 and 2)
Summary
As the practice of medicine inevitably raises both ethical and legal issues, it had been recommended since 1999 that medical ethics and human rights be taught at every medical school. It is becoming imperative that the policies and processes being put in place to address this and other issues should guarantee a climate that is favourable and conducive to the ethical development of future medical practitioners [2] With this changing role of medicine and the growing expectations by patients, the content and delivery of medical curricula have to change [3].As part of this drive, it was recognised that medical ethics education should be accorded a greater formal presence in the medical curriculum [4]. In Nigeria, medical education remains largely focused on traditional clinical and basic medical science components, leaving students to develop moral attitudes passively through observation and intuition [7]; a situation that may not be too far from what it is obtainable in most of Sub-Saharan Africa [8,9,10]. There is evidence that the ‘hidden’ curriculum confers a powerful influence on the ethical and professional development of the students as they observe the norms, behaviours and interactions in their learning environments [4]; with the doctor-patient relationship being the predominant interaction
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