Abstract
Previous studies show that medical students in clinical training face ethical problems that are not often discussed in the literature. In order to make teaching timely and relevant for them, it is important to understand what medical students perceive as ethical problems, as various factors may influence their perception, including cultural differences and working environment. The purpose of this qualitative study was to explore students’ perceptions of what an ethical problem is, during their clinical training in the hospital, and compare the results from two different countries. We observed a total of eighteen ethics group discussions and interviewed fifteen medical students at two medical schools, in Indonesia and the Netherlands. Data were interpreted and analyzed using content analysis. We found that students in both settings encounter problems which are closer to their daily work and responsibilities as medical students and perceive these problems as ethical problems. Indonesian students perceived substandard care and inequity in healthcare as ethical problems, while Dutch students perceived that cases which are not matters of life and death are less worthy to discuss. Our study suggests that there might be a gap between ethical problems that are discussed in class with teachers, and problems that students actually encounter in practice. Teachers should be aware of the everyday situations in clinical training which may be perceived by students as ethically problematic and should acknowledge and discuss these ethical problems with students as part of the learning processes in ethics education.
Highlights
Twenty years ago, a third-year Canadian medical student addressed the importance of acknowledging student-specific ethical dilemmas in the curricula, and stated that most contemporary ethics curricula in medical schools have failed to address these specific issues (St. Onge 1997)
More recent studies showed that general practitioners have different perceptions on how terms like ethical problem and ethical dilemma apply in everyday practice (Braunack-Mayer 2001), while a study in Germany shows that teachers in medical schools were unable to identify ethical issues encountered by students in medical training, they were familiar with ethical issues in healthcare (Chiapponi et al 2016)
There is a persisting question on what medical students perceive as ethical problems and what they need from ethics education (Eckles et al 2005)
Summary
The concept and definition have developed since the old days of medical ethics and Hippocratic Oath, to the modern days of Bioethics (Kuhse and Singer 2009), while other literatures introduce the more narrowed definition of ethical problems as ethical dilemmas, implying that problems of conflicting moral principles and choices are essential (Beauchamp and Childress 2008; Jonsen et al 2006; Lo 2013). The varying “conceptual starting points” of students are at the same time crucial for the effectiveness of teaching and have not been explored. For this reason, we were interested in exploring what medical students perceive as ethical problems and compare students’ perceptions from two different countries
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