When should students learn about ethics, professionalism and patient safety?

Abstract

Medical education curricula are required to teach ethics, professionalism and patient safety, but there is no clear evidence as to when these topics should be introduced. The Personal and Professional Development (PPD) theme incorporates these topics, and is integrated throughout our postgraduate medical programme, but we were particularly interested in knowing when and how to introduce them to year-1 students. We describe an intensive PPD programme in the context of broader issues associated with the appropriate timing of PPD curricula in a medical programme. The PPD Intensive was held over 2 days (267 students in 2008 and 299 in 2009). Attendance was mandatory. Teaching included a mixture of didactic, small group and interactive sessions. Students completed a formative case-based assessment and evaluation questionnaire. In response to questions about a patient narrative, many students focused on the health provider perspective, even when asked specifically to put themselves in the patient's position when answering questions about the case. Students showed a superficial understanding of patient safety factors, even those who were previous health professionals. The Intensive was evaluated highly, but from the perspective of faculty staff there were issues relating to timing and lack of clinical context to give real meaning and purpose to the basic concepts underpinning the learning areas. The Intensive was designed to demonstrate to students the importance of PPD. A counter position is that students lack the clinical context required for effective learning of PPD topic areas. We discuss these conflicting beliefs and the changes made to the Intensive programme in 2010. As a result of the lessons, we changed the 2010 Intensive programme to strongly emphasise professionalism; patient safety was moved to the later years.