School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
Department of Pediatrics, E-Da Hospital, Kaohsiung, Taiwan.
JMIR Med Educ. 2024 Jan 5;10:e52711. doi: 10.2196/52711.
The emergence of the COVID-19 pandemic has posed a significant ethical dilemma in the allocation of scarce, life-saving medical equipment to critically ill patients. It remains uncertain whether medical students are equipped to navigate this complex ethical process.
This study aimed to assess the ability and confidence of medical students to apply principles of medical ethics in allocating critical medical devices through the scenario of virtual patients.
The study recruited third- and fourth-year medical students during clinical rotation. We facilitated interactions between medical students and virtual patients experiencing respiratory failure due to COVID-19 infection. We assessed the students' ability to ethically allocate life-saving resources. Subsequently, we analyzed their written reports using thematic analysis to identify the ethical principles guiding their decision-making.
We enrolled a cohort of 67 out of 71 medical students with a mean age of 34 (SD 4.7) years, 60% (n=40) of whom were female students. The principle of justice was cited by 73% (n=49) of students while analyzing this scenario. A majority of them expressed hesitancy in determining which patient should receive life-saving resources, with 46% (n=31) citing the principle of nonmaleficence, 31% (n=21) advocating for a first-come-first-served approach, and 25% (n=17) emphasizing respect for patient autonomy as key influencers in their decisions. Notably, medical students exhibited a lack of confidence in making ethical decisions concerning the distribution of medical resources. A minority, comprising 12% (n=8), proposed the exploration of legal alternatives, while 4% (n=3) suggested medical guidelines and collective decision-making as potential substitutes for individual ethical choices to alleviate the stress associated with personal decision-making.
This study highlights the importance of improving ethical reasoning under time constraints using virtual platforms. More than 70% of medical students identified justice as the predominant principle in allocating limited medical resources to critically ill patients. However, they exhibited a lack of confidence in making ethical determinations and leaned toward principles such as nonmaleficence, patient autonomy, adherence to legal and medical standards, and collective decision-making to mitigate the pressure associated with such decisions.
新冠疫情的爆发给重症患者稀缺救命医疗设备的分配带来了重大伦理困境。目前尚不清楚医学生是否有能力应对这一复杂的伦理过程。
本研究旨在通过虚拟患者评估医学生在分配关键医疗设备时应用医学伦理原则的能力和信心。
研究招募了临床轮转中的三、四年级医学生。我们促进了医学生与因 COVID-19 感染而呼吸衰竭的虚拟患者之间的互动。我们评估了学生在伦理上分配救生资源的能力。随后，我们使用主题分析分析他们的书面报告，以确定指导他们决策的伦理原则。
我们招募了 71 名医学生中的 67 名，平均年龄为 34 岁（标准差 4.7），其中 60%（n=40）为女性学生。在分析这种情况下，73%（n=49）的学生提到了正义原则。他们中的大多数人在确定哪位患者应获得救生资源方面犹豫不决，46%（n=31）引用了不伤害原则，31%（n=21）提倡先来先服务的方法，25%（n=17）强调尊重患者自主权作为他们决策的关键影响因素。值得注意的是，医学生在做出有关医疗资源分配的伦理决策方面表现出缺乏信心。少数人，占 12%（n=8），提出探索法律替代方案，而 4%（n=3）建议使用医疗指南和集体决策作为替代个人伦理选择的潜在方法，以减轻与个人决策相关的压力。
本研究强调了在时间限制下使用虚拟平台提高伦理推理能力的重要性。超过 70%的医学生认为在向重症患者分配有限的医疗资源时，正义是主要原则。然而，他们在做出伦理判断方面表现出缺乏信心，并倾向于采用不伤害、患者自主权、遵守法律和医疗标准以及集体决策等原则，以减轻与这些决策相关的压力。
