Tenenbaum Annabelle, Moutel Grégoire, Wolikow Maryse, Vial-Dupuy Amandine, Azogui-Levy Sylvie
Department of Dental Public Health, Faculty of Dentistry, University Paris Diderot, Paris, France.
Education and Health Practices Laboratory (LEPS) (EA 3412), UFR SMBH, Paris 13 University, Sorbonne Paris Cité, Bobigny, France.
J Int Soc Prev Community Dent. 2020 Aug 31;10(5):569-578. doi: 10.4103/jispcd.JISPCD_364_19. eCollection 2020 Sep-Oct.
A medical ethics course was launched in 2012 in a French University Dental School. We compared knowledge and attitudes, before and after implementation of that course. The aim of this study was to compare students who received an ethics course (third year) to those who did not have such training, however, most of them did have some clinical traineeship.
An anonymous questionnaire was sent to the second-, third-, and sixth-year students. It comprised questions with Likert item format answers and clinical vignettes with open responses. The results were analyzed by two approaches: a statistical analysis (chi-square or Fischer exact tests) and a content analysis using a predefined grid.
A total of 299 respondents replied (75% students) the questionnaire. The analysis showed a statistically significant association between knowledge of the law and information procedures ( < 0.0001), access to medical files ( = 0.004), and recording consent ( = 0.049). It was also significant between knowledge of the law and the principles of biomedical ethics ( < 0.0001 for autonomy and beneficence). The third-year students could state the principles of medical ethics with their percentage always greater than the sixth-year students. After the third year, the students' attitudes switched from a social to a medical emphasis, and their point of view regarding patient's autonomy evolved. Patient's refusal of care raised potential conflicts between autonomy, professional judgment, information, and consent.
Ethics teaching could offer a way to turn positive attitudes into real competencies and should be considered at an early stage.
2012年，法国一所大学的牙科学院开设了一门医学伦理学课程。我们比较了该课程实施前后学生的知识和态度。本研究的目的是将接受伦理学课程的学生（三年级）与未接受此类培训的学生进行比较，不过，后者大多数都有过临床实习经历。
向二、三、六年级的学生发放了一份匿名问卷。问卷包括采用李克特量表格式回答的问题以及需要开放式回答的临床案例。结果通过两种方法进行分析：统计分析（卡方检验或费舍尔精确检验）和使用预定义表格的内容分析。
共有299名受访者（75%为学生）回复了问卷。分析表明，法律知识与信息程序（<0.0001）、获取医疗档案（=0.004）以及记录同意书（=0.049）之间存在统计学上的显著关联。法律知识与生物医学伦理原则之间也存在显著关联（自主性和有益性方面<0.0001）。三年级学生能够阐述医学伦理原则，其比例始终高于六年级学生。三年级之后，学生的态度从强调社会因素转变为强调医学因素，他们对患者自主性的看法也有所演变。患者拒绝治疗引发了自主性、专业判断、信息告知和同意书方面的潜在冲突。
伦理学教学可以提供一种将积极态度转化为实际能力的方法，并且应该在早期阶段就予以考虑。
