How do Medical Students Learn Ethics?

Guest Post by Carolyn Johnston

How interested are medical students in learning ethics and law? I have met students who have a genuine interest in the issues, who are engaged in teaching sessions and may go on to intercalate in ethics and law. On the other hand some consider that ethics is “just common sense”. They want to know only the legal parameters within which they will go on to practice and do not want to be troubled with a discussion of ethical issues for which there may not be a “correct” answer.

Ethics and law is a core part of the undergraduate medical curriculum and so in order to engage students successfully I need to know whether my teaching materials are relevant, useful and interesting. In 2010 I ran a student selected component in which MBBS Year 2 students created materials for medical ethics and law topics for pre-clinical students which they considered were engaging and relevant, so that students might go further than learning merely to pass exams. One student, Marcus Sorensen, who had managed a design consultancy focusing on web design and development before starting his medical studies, came up with the idea of a website as a platform for ethics materials for King’s students and he created the website

It was through our ongoing discussions that we identified a lack of information about students’ experiences of learning medical ethics and law, especially outside the classroom environment.  Thus, the idea came about to run an audit to ascertain the sources and quantity of ethics learning that medical students are exposed to, in both pre-clinical and clinical settings and their reflections on it. Marcus set up a web platform for the research and we developed the design of the online survey. Our intention was to find out the total ethics and law learning for each year of study, however, with hindsight, running the audit over an entire academic year was rather ambitious. A snapshot over a shorter period, say one month, may have engaged a greater number of students.

Although the number of participants was relatively small the survey generated a wealth of data, from a total of 383 separate logs. It was time consuming process to go through PDFs of all the logs to evaluate the responses, cross checking against year of study and topic of learning. Three medical students, Ben Williamson, Thomas Prew, and Jonathan Mok helped enormously with this task and it was useful to have their student perspective.

Part A of each online log provides information about the nature of the learning experience and the topics covered. However, most valuable are the students’ reflections in Part B logs which demonstrate the range of learning that takes place, well beyond the classroom environment. Consent, capacity and best interests are predictable topics of learning but other issues included domestic violence and the cultural and religious beliefs of patients and the impact on their care. What is particularly striking is that students in their clinical years are frequently experiencing ethically challenging situations in their interaction with patients and senior clinicians for which they may not be adequately prepared or supported. Examples include a student asked to translate and obtain informed consent from a woman requiring an emergency caesarean when there was no one else available who spoke the language, use of force to take bloods from a patient with paranoid delusions, and a student on elective abroad asked to scrub in and assist in an operation on a patient who did not speak English and who had not signed a consent form. The students nevertheless reflected how such experiences may change their future practice, as illustrated in the paper. Our next stage of research is to evaluate the types of ethical and legal issues that Foundation Doctors encounter and whether undergraduate ethics and law learning provides adequate preparation for their everyday practice.

I would like to express my gratitude to Marcus for his ongoing enthusiasm and commitment which made this research possible and to the medical students who took part. I found it fascinating, and often humbling, to gain insight into their experiences of learning ethics and law.

Read the full paper here.