Barrier J H, Brazeau-Lamontagne L, Pottier P, Boutoille D
Service de médecine interne B, Hôtel-Dieu, CHU, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
Rev Med Interne. 2005 Feb;26(2):128-36. doi: 10.1016/j.revmed.2004.09.022.
The study looks for medical students ethical understanding during their internal medicine hospital rotations. As a secondary purpose, the study screens if internal medicine ward provides an environment appropriate for pregraduate medical students ethical training.
Retrospective analysis and comparison of logbook writings from 2 different pregraduate groups of students : Group A = 29, third year medical students and Group B = 28, sixth year medical students, (that is last year pre-graduation). The task instructions were the same for the two groups : to identify and to analyse an ethical problem personally witnessed on the ward and to propose a solution either local or personal. Cognitive semantic units (CSU) were first drawn from the writings then subsequently analysed through two grids 1* according to fundamental principles (P) and 2* according to professional responsibilities (R).
Students from group A produced a mean of 13,7 CSU per writing (total of 396 CSU) and those from Group B, 7,3. (total of 205 CSU) ; significant difference with P <0,004 between the 2 groups. Both identification of ethical dilemma itself and outbreaking it in (P) and (R) items and articulating solutions were significantly different between the 2 groups(P <0,004 Wilcoxon). Patient-physician relationship was predominantly present in both groups. While end-of-life and therapeutic issues were more prominent among group B, students of group A disagreed more with staff. Students of group B focused on external causes to excuse their demotivation (final exams'preparation), being more fatalist than cynical towards ethical issues.
There is an erosion of clinical ethical sensitivity during pregraduate training. This study shows that internal medicine hospital rotation provides enough opportunities (both in number and in variety) to promote keen clinical ethical learning.
