Purpose Medical students are expected to cultivate professionalism as a core competency, which is reflected in their perceptions of academic ethics. This study examined how students’ perceptions of academic ethics, both for themselves and their peers, evolve during their time in medical school and whether these changes differ by sex.
Methods We surveyed 87 medical students enrolled in a South Korean medical school in the years 2020 and 2023. The survey was designed to measure medical students’ perceptions of academic ethics and comprised questions regarding both self-perception and peer perception. Data analysis was performed using paired t-tests.
Results Both male and female students reported continuous improvement in their academic ethics as they progressed through medical school. Female rated their academic ethics more highly than male and demonstrated a more significant change in scores over time. Additionally, female observed an increase in their peers’ academic ethics, whereas men perceived a decline. Notably, upper-year students rated their peers’ academic ethics more favorably than did lower-year students.
Conclusion This study reveals differences in the evolution of academic ethics perceptions between male and female students, highlighting the need for sex-specific academic ethics education in medical school curricula. Moreover, it demonstrates how medical students’ perceptions of academic ethics evolve over time, emphasizing the importance of academic ethics education across school years. These findings offer practical insights for improving medical school curricula and underscore the potential of academic ethics education in fostering ethical awareness among future medical professionals.
Purpose This study aimed to examine the necessity for research ethics and learning objectives in ethics education at the undergraduate level.
Methods A total of 393 fourth-year students, selected from nine medical schools, participated in a survey about learning achievement and the necessity for it.
Results It was found that the students had very few chances to receive systematic education in research ethics and that they assumed that research ethics education was provided during graduate school or residency programs. Moreover, the students showed a relatively high learning performance in life ethics, while learning achievement was low in research ethics.
Conclusion Medical school students revealed low interest in and expectations of research ethics in general; therefore, it is necessary to develop guidelines for research ethics in the present situation, in which medical education mainly focuses on life ethics.
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Purpose The purpose of this study was to compare the perception of learning outcomes between faculty and students in medical schools.
Methods A total of 1,766 medical students and 436 faculty members participated in the survey. They responded to the perception of four learning outcomes: medical knowledge and problem solving, clinical skills, medical ethics, and clinical communication. The participants responded to the education and achievement levels of the learning outcomes.
Results In all four learning outcomes, the student's perception of education level differed by educational system, and the students in mixed systems had the highest scores. Students differed significantly in achievement level of medical ethics between genders, wherein male students perceived their achievement level to be higher than females. Students perceived their achievement level to be lower than the education level. The students' clinical skills were the highest in the education and achievement levels. The faculty perceived the education level to be higher than the student's achievement level. In particular, the faculty's perception of education level of medical knowledge and problem solving was the highest, whereas the students' achievement level of it was lower. The faculty assessed the education level to be higher than students. The students showed higher perception of achievement level than faculty.
Conclusion There were perceptual differences in learning outcomes between students and faculty. The results of this study are expected to be used to design outcome-based learning methods.
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PURPOSE Simple instructional systems design (ISD) model is based on a fast development, usability test, and continuos feedback, which are necessary for educational program development in medical school. This study aims to figure out the usability of Simple ISD model for a medical ethics education program by describing a developmental details of each phase and its evaluation results.
METHODS Research has been conducted in two steps. First, while researchers participated in the program development by using Simple ISD model, we collected empirical data of each development activities. Second, the developed program was evaluated by students' web-based usability test, a 8-students' focus group interview and 5 faculty members' individual interviews in 4 domains; learning contents, instructional methods and strategies, achievement evaluation, and self-evaluation.
RESULTS Following the circular process of analysis, design, development, and usability test of Simple ISD model, a 10-week medical ethics program covering 9 instructional topics was developed. The average points of response on the developed medical ethics program in 2008 and 2009 are increased from 3.96 to 4.59 and 4.41, respectively. The prospects and limitations of the program are discussed.
CONCLUSION From a development study of the medical ethics program by using Simple ISD model, we could implement a more usable medical ethics program, and found 4 different usability of the Simple ISD model; the rapid development of educational program, program improvement by continuous feedback, faculty members' engagement in instructional design, and professional development of the faculty members.
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PURPOSE Small group discussions are useful tools in medical ethics education. We aimed to assess student satisfaction with specific components of a small group discussion and to evaluate student self-assessment of the objectives of education. METHODS: A structured questionnaire was developed after a literature review and a focus group interview.
Components of the small group discussion were categorized by discussion case (self, other), individual activities (self-study, making materials, presentation experience), and group activities (preclass/in-class/postclass/plenary discussion, instructor's comments). The items for student self-assessment were: "To specify ethical issue in actual practice", "To get new knowledge", "To consider doctor's entity", "Empathy to others", "To get multidimensional viewpoint", "Viewpoint change", "To deliver my thought clearly", and "Ability to confront the medical ethics dilemma in the future". After the survey, an in-depth interview was performed to determine the reason behind the students' answers. RESULTS: A total of 121 students responded, for whom overall satisfaction and self-assessment were high. Students reported greater satisfaction with self-case, presentation experience, in-class discussion, and instructor's comments but less satisfaction with self-study before class and postclass discussion. Student self-assessment was highest in the ability to specify an ethical issue and lowest for viewpoint change and self-confidence. After multivariate analysis, higher student self-assessment was associated with greater satisfaction with the small group discussion. CONCLUSION: To improve the quality of medical ethics education, close investigation and monitoring of each component of the small group discussion and student achievement are essential, as is continuous feedback.
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PURPOSE We developed an objective structured oral examination (OSOE) case to assess the medical ethics of students. The aim of this study was to assess the reliability of OSOE with generalizability theory.
METHODS One 10-minute OSOE that contained key questions was developed. The evaluation sheet consisted of 4 domains: moral sensitivity, moral reasoning, decision making, and attitude. The total number of items was 13. The numbers of checklist items and global rating items were 11 and 2, respectively. Items and key questions were validated by 6 professionals. Standardization of the raters and the pilot study was performed before the OSOE. Fifty-four third-year medical students participated in the OSOE. The OSOE was duplicated, and 2 professors assessed 1 student independently. Each station lasted 8 minutes and was followed by a 2-minute interval,during which raters completed the checklist forms. We analyzed the reliability of the OSOE with the GENOVA program.
RESULTS The reliability (generalizability coefficient) was 0.945, and the interrater agreement was 0.867. The type of item, checklist or global rating, was the largest variance component. The reliability of the checklist alone was 0.668 and that of the global rating alone was 0.363.
CONCLUSION The OSOE is reliable and can be used to assess ethics. More research should focus on achieving validity.
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PURPOSE Ethics objective structured clinical examination (OSCE) scenarios was developed and were applied to medical students to see whether it would be suitable for assessing the students' ethical behaviors. METHODS: The data for this study were gathered from the end-of-clerkship patient-doctor-society OSCE, involving third-year medical students along the academic year of 2006. 54 students who participated in the ethics OSCE, which consisted of three stations, responded. Nine standardized patients (SPs) participated in the evaluation. The SPs were trained for 4 hours to conduct the medical interview and for 2 hours for evaluating students' performance using the checklist for each station. RESULTS: The consistency (Cronbach's alpha) of the SPs was 0.796. Mean score was 57.33. There was no difference among circuits and gender. CONCLUSION: We found that the ethics OSCE was adequate for evaluating students' performances.
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Learning objectives achievement in ethics education for medical school students Sujin Chae, Kiyoung Lim Korean Journal of Medical Education.2015; 27(2): 131. CrossRef
PURPOSE The purpose of this study is to evaluate the effectiveness of a medical ethics course taught in medical school by examining the students' abilities to identify medical ethics issues, the applicability of a medical ethics course, and self-efficacy. METHODS: 366 subjects were recruited from three different groups (medical students, interns, and residents) who had completed a medical ethics course. Data were collected using a 20-item questionnaire.
Analysis was done with a SPSS statistics program. RESULTS: Of the three groups, the students scored the highest in identifying medical ethics issues. When asked how often they see medical ethics issues in real medical situations (students were asked how often they would expect to see these ethical issues in medical settings), the students responded with the highest number, followed by the interns.
The residents responded with the lowest number. Regarding the applicability of the medical ethics course, while students believed the course was highly useful and applicable to real medical settings, interns and residents did not agree. The participants' self-efficacy and satisfaction were generally low. The majority of all three groups thought that medical ethics education should be more practical and that it should be taught during internship as well as during residency. CONCLUSION: Our findings suggest two important directions for medical ethics education.
First, the current medical ethics curriculum should be offered during both internship and residency. Second, the content should focus more on actual clinical scenarios ('clinical ethics') than theoretical principles.
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PURPOSE This paper examines current situation of medical ethics education in the United States of America to have an overview on contents, learning methods and educational strategies for medical ethics education.
METHODS The author analyzes medical ethics courses, related integrated courses and their teaching methods published in Curriculum Directory Association of American Medical Colleges (2000) and reviewed literature relevant to the subject.
RESULTS The statistical data show that 125 medical schools in America provided 679 medical ethics classes, which were 5.4 classes per school. More than 90% of formal classes were conducted in preclinical years: 67.3% of all ethics-related classes were opened in the first academic year; 24.8 % in the second academic year. Lectures were most prevalent teaching methods, following small group discussion, case-based study, tutorial, and so on. Medical educators have hardly reached consensus over details of medical ethics, although they agree on the necessity of medical ethics education. In spite of incomplete information, this study shows a general tendency of medical ethics education in U.S.A.
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A Comparison of Moral Intuitions about Professional Ethics between the Medical Students and Residents in a University Hospital* So Youn PARK, Ivo KWON, Oh Young KWON, Tai Young YOON Korean Journal of Medical Ethics.2014; 17(2): 159. CrossRef
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PURPOSE This paper aims at reporting and examining the experiences of medical ethics education with case-based learning and large-group discussion.
METHODS The subjects were a group of 100 students in the third year medical student. The medical ethics course was designed to minimize unidirectional lectures and to maximize interactive work with a large group at the classroom utilizing cases as teaching material. In the middle of the course, all students were divided into small group of 4~5 members. Each group was to find and, based upon group discussion, analyze each different case containing ethical dilemma, and present it as a midterm report. To examine the effectiveness of case based learning in medical ethics education in a large classroom, the authors analyze the students' feedback and evaluation delivered in survey questionnaires from 94 out of 96 students.
RESULTS Students' feedback showed that small-group discussion, interactive work in a classroom, and case-based studies were effective as well as practicable for medical ethics education for a large group.
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The Korean medical establishment has traditionally shown little concern for formal training in medical ethics; only recently have courses in medical ethics been included in the curricula of Korea's medical schools. The importance and effectiveness of such courses is still a matter of some debate. This study attempted to measure the effects of a course in medical ethics on senior medical students. For this study, a discussion based course was designed, which made considerable use of video-taped ethical situations.
Students were requested to answer a series of ethics related questions both before and after taking the course. Prior to taking the course, students indicated that treatment refusal, abortion, sex pre-selection, and euthanasia are the most important ethical issues in contemporary medical practice in Korea. However, after taking the course, students modified this list slightly by replacing the issue of euthanasia with that of equal access to health care resources. No significant changes were observed in students' value systems. The students' response to the course was favorable.
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Medical Ethics Education: Its Objectives and Curriculum Ilhak Lee Korean Medical Education Review.2014; 16(3): 147. CrossRef
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The Korea's first-ever on-line biomedical ethics education class began in September 1999. The class, one of the 18 on-line lectures offered in the Fall Semester, 1999 by Seoul National University Virtual Campus, allows the Korean general public the opportunity to attend an SNU lecture.
Although the discussion sites are limited to the randomly selected 40 students taking the 16-week-long course, any one can read the instructor's lecture on the Internet.
(http://snuvc. snu.ac.kr/class/h601) The topics of this course include abortion, euthanasia, organ transplantation, human cloning and etc. As members of the team responsible for this unprecedented biomedical ethics education program in Korea, we, the authors, report the experiences that the team went through both in preparing for and running the course. We concludes from the experience that we had that 16 weeks are too long for an on-line course without academic credits or sufficient number of tutors. Also, we suggest that in the near future the on-line biomedical ethics course should be able to be used for continuing education of such medical professions as medical doctors and nurses.
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Assessing the Effectiveness of Medical Ethics Education Sung Soo Kim, Byung Kyu Park, Chulhun L. Chang, Hae Kyu Kim, Shin Young Kang, Seong Wan Baik Korean Journal of Medical Education.2008; 20(1): 73. CrossRef
Gachon Medical School has developed and implemented a medical ethics course entitled, "Life and Society II". The course uses dilemma discussion based on medical case studies to allow students to develop their moral reasoning ability in both clinical and hospital settings.
The course was developed by the faculty of medicine during the 1998-1999 academic years. The program was designed in a four-stage process: 1) learning objectives were identified, 2) contemporary controversies and relevant ethical issues were chosen based on relevance to modern medical practice, 3) a syllabus was drafted based on the aforementioned ethical issues and teaching methods appropriate for each issue were integrated into the syllabus, and 4) tutorial manuals were produced. The course was taught to 41 second-year premedical students and evaluated by student surveys.
The learning goals were identified through both a literature survey of contemporary issues in medical ethics and an in-house survey of important content to teach in a medical ethics course. The curriculum was designed based on the identification of specific learning objectives per ethical issue, selection of appropriate materials and content, organization of dilemma scenarios and formulation of questions for discussion.
The course was taught using a variety of teaching formats: dilemma discussions, seminars, tutorials, lectures, assigned readings and student presentations. Positive results were obtained from the student surveys: it was discovered that most students thought that the course's learning objectives were achieved. Furthermore, of all the teaching methods employed, most of our students felt that discussing dilemmas was the most effective method for developing moral reasoning ability.
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Student Satisfaction and Self-Assessment after Small Group Discussion in a Medical Ethics Education Program Hee-Kyung Joh, Jwa-Seop Shin Korean Journal of Medical Education.2009; 21(3): 243. CrossRef
Drawing on our observation that many medical professionals have considerable difficulty in using what they know about ethics, we have developed a course for teaching the fifth year medical students a systematic approach to ethical reasoning and problem-solving, rather than teaching bioethical theories or prominent current ethical issues in developed countries. This course consisted of a series of guided group discussions and debates in classroom using over 50 cases classified under seven major headings. Responses and reactions from students and participating clinicians are encouraging. Several ideas for improving medical ethics curricula are discussed, including emphases on the thorough understanding of various aspects of human relations in medical practice, enhancing the ability of articulate the students own values, provoking the student to get involved in the ethical situation when studying the cases, and the need to introduce social science concepts in analyzing the ethical issues in the health care system.
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Medical ethics education in the medical school curriculum Jang Han Kim Journal of the Korean Medical Association.2017; 60(1): 18. CrossRef
Student Satisfaction and Self-Assessment after Small Group Discussion in a Medical Ethics Education Program Hee-Kyung Joh, Jwa-Seop Shin Korean Journal of Medical Education.2009; 21(3): 243. CrossRef
Assessing the Effectiveness of Medical Ethics Education Sung Soo Kim, Byung Kyu Park, Chulhun L. Chang, Hae Kyu Kim, Shin Young Kang, Seong Wan Baik Korean Journal of Medical Education.2008; 20(1): 73. CrossRef
BACKGROUND Ethical issues in medical practice focuses mainly on critically ill hospitalized pateints or sophiscated technologic developments. However, in the outpatient setting physicians enco unter many problems that require ethical decision making. This study is an assessment of awareness and understanding of ethical issues commonly encountered in ambulatory setting in order to develop education curriculum.
METHODS A questionnaire was designed to evaluate general knowledge of medical ethics using 12 clinical vignettes. The questionnaire was distributed to medical students and residents who were asked to answer whether an ethical issue was present, its significance, and what the specific issues was involved.
RESULTS The response rate was 53%, with 106 of 200 students or residents completing the questionnaire-63 medical students, 14 interns and 25 residents. Respondents' ability to identify that an ethical issue was involved in each vignette ranged from 42.9% to 78.3%. The significance rating ranged from 2.9 to 4.1 on the Likert scale of 1 to 5.
A majority of respondents did not identify the correct ethical issue invloved in each vignette.
CONCLUSION This survey showed that the medical students and residents seem to have insufficient knowledge to recognize ethical dilemmas in ambulatory setting.
Appropriate medical ethics education should be developed in medical education with particular emphasis on commonly encountered situation.
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