Perception of newly graduated physicians toward ethical education in medical schools: a Brazilian cross-sectional nationwide study

Gameiro, Gustavo Rosa; Gameiro, Giovana Rosa; Miotto, Bruno Alonso; Guilloux, Aline Gil Alves; Cassenote, Alex Jones Flores; Scheffer, Mario César

doi:10.1590/1806-9282.20230108

Acessibilidade / Reportar erro

Brasil

Revista da Associação Médica Brasileira

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • Rev. Assoc. Med. Bras. 69 (6) • 2023 • https://doi.org/10.1590/1806-9282.20230108 copy

Perception of newly graduated physicians toward ethical education in medical schools: a Brazilian cross-sectional nationwide study

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

The objective of this study was to evaluate fresh medical graduates’ perceptions regarding the general aspects of ethics teaching in Brazilian medical schools.

METHODS:

A structured questionnaire was applied to 4,601 participants among the 16,323 physicians who registered in one of the 27 Regional Medical Councils of Brazil in 2015. Answers to four questions regarding general aspects of ethics education in medical school were analyzed. Sampling procedures involved two stratification variables: legal nature (public vs. private) of medical schools and monthly household income higher than 10 minimum wages.

RESULTS:

A large percentage of the participants had witnessed unethical behaviors during contact with patients (62.0%), toward coworkers (51.5%), and in relationships with patients’ families (34.4%) over the course of their medical training. Even though most of the responders (72.0%) totally agreed that patient-physician relationship and humanities education were part of their medical school curriculum, important topics such as conflicts of interest and end-of-life education were not satisfactorily addressed in the participants’ medical training. Statistically significant differences were found between the answers of public and private school graduates.

CONCLUSION:

Despite great efforts to improve medical ethics education, our findings suggest the persistence of deficits and inadequacies in the ethics training currently given in medical schools in Brazil. Further modifications in ethics training must be made to address the deficiencies shown in this study. This process should be accompanied by continuous evaluation.

KEYWORDS:
Medical education; Ethics; Curriculum; Physicians; Demographics

	Completely agreed			Partially agreed			Completely disagreed
	Freq. %	95%CI	n	Freq. %	95%CI	n	Freq. %	95%CI	n
My medical school training appropriately covered the topic “how to deal with death”	24.0	22.9–32.2	884	55.0	54.6–56.1	2023	20.9	13.3–22.4	770
My medical school training sufficiently addressed the topic of conflicts of interest, particularly between physicians and the pharmaceutical and medical device industry	23.1	21.2–29.4	826	48.5	47.1–49.7	1736	28.4	23–30.4	1016
Humanities and doctor-patient relationship training were part of my medical school curriculum	72.0	69.7–79.2	2662	25.8	19.7–27.4	956	2.2	1.2–3.2	80
	Yes			–			No
Subjects answered the question that they experienced or witnessed inadequate ethical attitudes	80.1	79.1–86.1	3685				19.9	13.9–20.9	916
(A) I have experienced or witnessed inadequate ethical attitudes, especially during contact with patients (i.e., clinical visits, wards, and emergencies)	62.0	52.6–62.9	2286				38.0	37.1–47.4	1399
(B) I have experienced or witnessed inadequate ethical attitudes, especially in relationships with patients’ families	34.4	25–37.1	1268				65.6	62.9–75	2417
(C) I have experienced or witnessed inadequate ethical attitudes, especially in relationships with the community and general public	16.9	12.7–17.3	624				83.1	82.7–87.3	3061
(D) I have experienced or witnessed inadequate ethical attitudes, especially toward work colleagues, multidisciplinary teams, and administrative personnel	51.5	41.4–55.1	1896				48.5	44.9–58.6	1789
(E) I have experienced or witnessed inadequate ethical attitudes, especially in decision-making in the classroom	20.2	14.4–22.2	744				79.8	77.8–85.6	2941
(F) I have not experienced or witnessed any unethical attitude	12.3	11.8–17.8	452				87.7	82.2–88.2	3233

		Legal nature of the medical school
		Public		Private		Total
		Freq. %	95%CI	Freq. %	95%CI	Freq. %	95%CI
^a a p<0.001; My medical school training appropriately covered the topic “how to deal with death”
	Completely agreed	10.5	9.8–11.4	15.5	14.6–16.5	25.5	22.9–32.2
	Partially agreed	19.4	18.4–20.5	35.5	34.3–36.8	55.4	54.6–56.1
	Completely disagreed	5.4	4.9–6.0	13.5	12.7–14.4	17.4	13.3–22.4
^a a p<0.001; My medical school training sufficiently addressed the topic of conflicts of interest, particularly between physicians and the pharmaceutical and medical device industry
	Completely agreed	4.6	1.4–14.3	20.5	12.7–31.3	25.1	21.2–29.4
	Partially agreed	13.2	3.7–37.7	35.2	21.7–51.5	48.4	47.1–49.7
	Completely disagreed	8.9	2.5–27	17.7	11.4–26.3	26.5	23–30.4
^a a p<0.001; Humanities and doctor-patient relationship training were part of my medical school curriculum
	Completely agreed	17.7	4.7–48.4	57.0	32–78.9	74.7	69.7–79.2
	Partially agreed	7.8	2.3–23.5	15.5	10–23.3	23.3	19.7–27.4
	Completely disagreed	0.9	0.2–3.3	1.1	0.6–1.8	1.9	1.2–3.2
^a a p<0.001; (A) I have experienced or witnessed inadequate ethical attitudes, especially during contact with patients (i.e., clinical visits, wards, and emergencies)
	No	8.1	2.2–25.5	34.1	21–50.1	42.2	37.1–47.4
	Yes	18.2	4.9–48.9	39.7	24.6–57.1	57.8	52.6–62.9
^a a p<0.001; (B) I have experienced or witnessed inadequate ethical attitudes, especially in relationships with patients’ families
	No	15.5	4.2–43.8	53.7	30.4–75.6	69.3	62.9–75
	Yes	10.7	3.1–31.2	20.0	13.1–29.4	30.7	25–37.1
^a a p<0.001; (C) I have experienced or witnessed inadequate ethical attitudes, especially in relationships with the community and general public
	No	21.2	5.5–55.7	63.9	34.6–85.5	85.1	82.7–87.3
	Yes	5.0	1.5–15.5	9.9	6.6–14.5	14.9	12.7–17.3
^a a p<0.001; (D) I have experienced or witnessed inadequate ethical attitudes, especially toward work colleagues, multidisciplinary teams, and administrative personnel
	No	10.9	3–32.3	40.9	23.8–60.4	51.8	44.9–58.6
	Yes	15.3	4.2–42.9	32.9	21–47.6	48.2	41.4–55.1
^b b p=0.030. (E) I have experienced or witnessed inadequate ethical attitudes, especially in decision-making in the classroom
	No	20.3	5.2–54	61.8	33.5–83.8	82.0	77.8–85.6
	Yes	6.0	1.8–18.4	12.0	7.9–17.9	18.0	14.4–22.2
^a a p<0.001; (F) I have not experienced or witnessed any unethical attitude
	No	24.3	6.1–61.2	61.2	34.2–82.7	85.5	82.2–88.2
	Yes	1.9	0.5–6.7	12.6	8.1–19	14.5	11.8–17.8
	Total	26.2	6.5–64.6	73.8	35.4–93.5	100.0	100–100
	Total (n)	1676		2009		3685

		Household income higher than 10 minimum wages
		Yes		No		Total
		Freq. %	95%CI	Freq. %	95%CI	Freq. %	95%CI
^a a p=0.001; My medical school training appropriately covered the topic “how to deal with death”
	Completely agreed	17.2	14.5–20.2	10.2	8–12.9	27.4	23–32.2
	Partially agreed	30.8	29.5–32.1	24.4	22.6–26.2	55.2	54.1–56.3
	Completely disagreed	9.4	7.4–11.9	8.1	5.9–10.9	17.4	13.3–22.5
^b b p=0.009; I have experienced or witnessed inadequate ethical attitudes, especially in relationships with patients’ families
	No	39.1	35.4–43	30.1	26.5–34	69.2	62.8–74.9
	Yes	18.4	15.2–22	12.4	9.8–15.6	30.8	25.1–37.2
^c c p=0.014. I have experienced or witnessed inadequate ethical attitudes, especially toward work colleagues, multidisciplinary teams, and administrative personnel
	No	30.9	27–35	21.0	17–25.6	51.8	44.7–58.8
	Yes	26.6	22.7–31	21.6	18.5–25	48.2	41.2–55.3
Total		57.5	49.7–66	42.5	35.5–50.6	100	100–100
Total (n)		2018		1592		3610

Associação Médica Brasileira R. São Carlos do Pinhal, 324, 01333-903 São Paulo SP - Brazil, Tel: +55 11 3178-6800, Fax: +55 11 3178-6816 - São Paulo - SP - Brazil
E-mail: ramb@amb.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] *Corresponding author: gustavo.gameiro@fm.usp.br