Need for enforcement of ethicolegal education - an analysis of the survey of postgraduate clinical trainees.

Mayumi Mayeda,Kozo Takase

doi:10.1186/1472-6939-6-8

Abstract

BackgroundThe number of medical lawsuits in Japan was between 14 and 21 each year before 1998, but increased to 24 to 35 per year after 1999. There were 210 lawsuits during this 10-year period. There is a need for skills and knowledge related to ethics, which is as fundamental to the practice of medicine as basic sciences or clinical skills. in Japan education in ethics is relatively rare and its importance is not yet recognized. Establishing ethics education using legal precedents, which has already been achieved in Western countries, will be a very important issue in Japan. In the present study, a questionnaire survey was conducted among graduate intern doctors, in order to investigate whether ethics education using precedents might have a positive effect in Japan.MethodsIn 2002, a questionnaire survey entitled Physicians' Clinical Ethics was carried out in a compulsory orientation lecture given to trainees before they started clinical practice in our hospital. The attendees at this lecture were trainees who came from colleges in various districts of Japan. During the lecture, 102 questionnaires were distributed, completed by attendees and collected. The recovery rate was 100%. The questionnaire consisted of 22 questions (in three categories), of which 20 were answered by multiple choices, and the other two were answered by description. The time required to complete the questionnaire was about 10 minutes.ResultsThe recovered questionnaires were analyzed using statistical analysis software (SPSS for Windows, Release 10.07J-1/June/2000), in addition to simple statistical analysis. answers using multiple choices for the 20 questions in the questionnaire were input into SPSS. The principal component analysis was performed for each question. As a result, the item that came to the fore was "legal precedent". Since many intern doctors were interested in understanding laws and precedents, learning about ethical considerations through education using precedents might better meet with their needs and interests.ConclusionWe applied a new method in which the results of principal component analysis and frequencies of answers to other questions were combined. From this we deduced that the precedent education used in Western countries was useful to help doctors acquire ethical sensitivity and was not against their will. A relationship was found between reading precedents and the influence of lawsuits, and it was thought that student participation-type precedent education would be useful for doctors in order to acquire ethical sensitivity.

Highlights

The number of medical lawsuits in Japan was between 14 and 21 each year before 1998, but increased to 24 to 35 per year after 1999
To evaluate the relationship between components 1 and 2, they were placed in a 2 × 2 matrix, with attention paid to each component's strengths and weaknesses, and classified into (A), (B), (C) and (D). (A) indicated that "the disclosure was required since patients themselves had willingness to be cured or patients had distrust for doctors"; (B) indicated that "the disclosure was required only for patient's willingness to be cured"; (C) indicated that "the disclosure was required due to simple interests"; and (D) indicated that "the disclosure was required since patients had distrust for doctors"
This indicated that there was some relation between interns' reading legal precedents and their reason given for "Why do patients require the disclosure of medical records?" An arrow directed from "patients" to "doctors" in Figure 1 shows how doctors perceive patients' evaluations of doctors

Summary

Introduction

The number of medical lawsuits in Japan was between 14 and 21 each year before 1998, but increased to 24 to 35 per year after 1999. Establishing ethics education using legal precedents, which has already been achieved in Western countries, will be a very important issue in Japan. As the incidence of patient requests to physicians has increased following establishment of the selfdecision-making rights of patients [3], contradictions that cannot be addressed adequately by conventional medical education or clinical settings have arisen [4]. The amount of information learned by students has been increasing year by year, in line with scientific advances. The six-year study period for medical students is not adequate, and medical education that allows sufficient time for learning knowledge and techniques is needed. The importance of culture as a part of medical education has been raised [7] and physicians' ethical views have become an issue. There is a need for skills and knowledge related to ethics, which is as fundamental to the practice of medicine as basic sciences or clinical skills [8]

Methods

Results

Discussion

Conclusion