Nothing new here. In fact age old.
Doctors, like it or not is required to practice ethically. So where does ethic come from and when is it best to "learn" ethics?
Much effort has been made locally and internationally to provide standard requirements for ethics in medical practice. International code of ethics, much derived from ancient Hippocratic Oath has been made and many universities has attempted to integrate these code into their curriculum.
The Q: Has it succeeded?
How are ethics being taught currently?
Most universities have official classes on ethics. IIUM's curriculum comes in the form of Islamic Input classes as well as pre-clinical extra curricular sessions. Then the informal teachings, during ward rounds, when clerking patients, when scolded by specialists, senior preachings and so on.
Few other Qs: Are these the right people? Are these the best methods? Are these methods effective in producing ethical doctors?
These are some of the questions that were raised in today's Seminar on Medical Ethics.
It starts from selection of students before entering medical schools.
A Story: Servant's Heart
A student from California applied to become a doctor in one of the state's distinguished university. His problem: he himself is not distinguished. Nothing special. Not even academically. There any application forms that did not meet standard requirement were dumped into the trashcan (rejects). Lucky for the dude, all trash applications were rereviewed over there - just in case they accidently missed something. The referee discovered the dude's form and in doing so discovered one other thing: It was mentioned in his application form that he had a Servant's Heart. The referee thought that based on this alone he was qualified to enter the university as a med stud. So he did and now he is a specialist.
Problem with selection, which is also age old is to weed out uninterested students. Currently all over the world, selection is based largely on academic excellence, which might not necessarily be a bad thing since it was quoted that most students that quit housemanship or had problems were later found out to be low achievers. However it is not fair rather that people with pure interest are not given the chance they deserve.
However, selection based on character alone is very subjective and no standardize or good system has been implemented so far. Some of the proposals were to screen for extra curricular involvements, character screenings and so on. However these are very subjective and very risky.
Story 2: The Boy With Wealth On His Mind.
A boy was interviewed to become a doctor.
Standard Q: "Why do you want to become a doctor?"
Not very standard reply (or mebe quite normal): "I want to be rich." (something like that la the answer).
Now... The intention is not good you to become a doctor. Everyone knows that money should not be a factor. But - the boy answered honestly, a trait sought in the medical profession. So he was recruited, drafted or whatever the word.
What they conclude is that a better system of selection must be made to select potential students and doctors.
Everybody agrees that role models are essential in imparting good ethics. Students spend most their time in the wards not under their lecturers, rather more with HOs, MOs, specialists, nurses and consultants. Students often perceive the norm as right and acceptable. However that's not always the case as has been said in the seminar. The norm now is that consultants do not look at patients in the eye when doing their rounds, the norm now is delegating patient referrals to junior HOs, the norm now is to write sloppily on tickets. Unfortunately these norm are mimicked and inculcated into these future doctors.
So there is a need to change the norm. The current doctors now have to make an attempt to change themselves.
But its hard to teach old dogs new tricks, especially good ones. Bapak rintik anak lentik. Something like that.
Another phase important in imparting ethics is all the time. The teachers have the responsibility to constantly groom and shape their students macam anak sendiri. You leave them on their own and they become naughty boys and girls.
One more thing is that universities are doing their best in having ethic classes. However as one of the speakers noted (UM's Dep Dean of Education and Research Dev Unit), many students tend to skip these classes as it was deemed not important. These subjects were only minimally introduced in examination if there are any. They pass their exams anyway. Why should students bother with boring topics such as ethics?
There are several strategies to get around this:
MAKE IT A BIG PART OF EXAM
Pls ar wei. Why is everything be made into exams? Haih. Cant students be less exam oriented for a change?
Anyway, UKM has another method. They have what they call PPD (Personalized and Professional Development) camps to force students to participate and in the process inculcate team building skills and make group discussions regarding ethical issues.
Other Universities overseas (kalo x silap) have 2 solid weeks for just ethical studies by which they assign students to research designated topics, prepare slides and 3000+ word essay and teach their colleagues.
Another university encouraged Medical Debates, most notably in Glasgow so that students will be more interested with ethical issues.
Banyak benda to discuss regarding ethics.
One last thing needs to be mentioned. Medical students when seeing a doctor (regardless or rank) doing something wrong or unethical should not keep quiet. They should voice out. In the process, they may educate themselves and the doctor. But be prepared la for any "SUKA HATI AKU LA" answers.
Lastly as has been mentioned, Ethics should not be just taught. Rather it should be inculcated into an individual. So whichever methods used, this should be brought to mind.
Anyway I found going to seminar like these beneficial, though expensive. But hey! if you can spend money on phones and cameras and movies, why not invest a bit for your education?
Now banyak ideas. I feel elated.
