Bissonette R, O'Shea R M, Horwitz M, Routé C F
Department of Family Medicine (DFM), State University of New York at Buffalo School of Medicine and Biomedical Sciences 14215, USA.
Acad Med. 1995 Nov;70(11):1035-7. doi: 10.1097/00001888-199511000-00023.
To use issues identified by students in order to establish an experience- and evidence-based approach to medical ethics education.
A total of 628 sophomore and senior students at the State University of New York at Buffalo School of Medicine and Biomedical Sciences were asked to identify incidents during their clinical training that had raised ethical concerns. The sophomores were surveyed during two time periods: 1979-80, and 1991-92 and 1992-93; the seniors were surveyed in 1991-92 and 1992-93. Responses were analyzed and categorized through content analysis.
In all, 249 students (45% of the sophomores and 20% of the seniors) responded. The categories of issues identified were professional norms, limits of intervention, defensive shielding of professional colleagues, respect toward patients, communication, and student boundaries (situations where the student feels uncomfortable). The most frequently reported incidents reflected the students' perceptions of lapses in level of care (under- or over-treatment), communication, respect toward patients, and maintenance of professional norms. The seniors and the 1979-80 sophomores reported respect toward patients as an issue less often than did the 1991-92 and 1992-93 sophomores. The seniors most often identified concerns raised over limits of intervention and resource allocation.
The differences between the responses of the sophomores and seniors tend to support other research suggesting a retardation of moral sensitivity in the course of medical education. It may be that clinical teaching and faculty behavior model values at odds with what is taught in the classroom. Ethics education should focus on issues relevant to students' experience.
利用学生所发现的问题，建立一种基于经验和证据的医学伦理教育方法。
纽约州立大学布法罗分校医学与生物医学科学学院的628名大二和大四学生被要求指出其临床培训期间引发伦理问题的事件。大二学生在两个时间段接受调查：1979 - 1980年，以及1991 - 1992年和1992 - 1993年；大四学生在1991 - 1992年和1992 - 1993年接受调查。通过内容分析对回复进行分析和分类。
共有249名学生（大二学生中的45%和大四学生中的20%）做出了回应。所确定的问题类别包括专业规范、干预限度、对专业同事的保护性屏蔽、对患者的尊重、沟通以及学生界限（学生感到不舒服的情况）。报告最频繁的事件反映了学生对护理水平失误（治疗不足或过度）、沟通、对患者的尊重以及专业规范维护的看法。大四学生和1979 - 1980年的大二学生比1991 - 1992年和1992 - 1993年的大二学生更少将对患者的尊重视为一个问题。大四学生最常指出的是对干预限度和资源分配引发的担忧。
大二学生和大四学生回复之间的差异倾向于支持其他研究，这些研究表明在医学教育过程中道德敏感性有所下降。可能是临床教学和教师行为所体现的价值观与课堂所教内容不一致。伦理教育应关注与学生经历相关的问题。
