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ORIGINAL ARTICLE
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Perceptions of the first-year MBBS students about professionalism and ethics after foundation course of competency-based medical education curriculum


1 Dept of Physiology, Army College of Medical Sciences, New Delhi, India
2 Dept of Pediatrics, Army College of Medical Sciences, New Delhi, India

Date of Submission22-Apr-2020
Date of Decision17-Jun-2020
Date of Acceptance18-Jun-2020

Correspondence Address:
Bindu T Nair,
Department of Paediatrics, Army College of Medical Sciences, Delhi Cantt, New Delhi - 110 010
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mjdrdypu.mjdrdypu_202_20

  Abstract 


Introduction: In India, with the introduction of the new Competency-Based Medical Education curriculum in 2019, the “Foundation Course” has become mandatory for the newly admitted medical undergraduates. “Professional Development, including Ethics” which is an important part of this course, has dedicated 40 h of teaching. Materials and Methods: This was a descriptive cross-sectional questionnaire-based study conducted in August 2019 during the “Foundation Course” for the 1st-year medical students of Army College of Medical Sciences. A well-structured module validated by the members of the Medical Education Unit was used for teaching “Professional Development including Ethics.” At the end of 40 h of teaching, the students' perception about the “Professional development, including Ethics” module was taken with the help of an anonymous validated feedback questionnaire. Results: Most of the students (94.19%) felt that professionalism and ethics are very important for doctors and should be taught. About 90.7% felt that the care of the patient should be the first concern of a doctor. The students (94.19%) also felt that teaching of “Ethics” should be included in the curriculum, 89.53% felt that it will influence and improve the behavior of doctors, and 91.86% felt that it will finally lead to improvement of the patient-doctor relationship. Conclusion: The study concludes that “Professional Development including Ethics” incorporated in the foundation course, is a much-needed necessity for the students entering into the medical profession. The teaching of professionalism and ethics will definitely lead to more awareness of these values in our future doctors.

Keywords: Competency-based medical education, ethics, medical undergraduates, professionalism



How to cite this URL:
Gupta RR, Prakash A, Nair BT. Perceptions of the first-year MBBS students about professionalism and ethics after foundation course of competency-based medical education curriculum. Med J DY Patil Vidyapeeth [Epub ahead of print] [cited 2021 Dec 6]. Available from: https://www.mjdrdypv.org/preprintarticle.asp?id=321288




  Introduction Top


The Medical Council of India has felt the need to teach and evaluate professionalism and ethics in our medical undergraduates. Hence, the decision to incorporate it in the “;Foundation Course”[1] and formally teach the subject in a structured manner to the medical undergraduates has been taken. Medical teachers have been made responsible for the task of imparting these desired skills, qualities, and attitudes to the future doctors of the country. Working Party of the Royal College of Physicians defined “Medical professionalism” as “a set of values, behaviors, and relationships that underpin the trust the general public has in doctor.”[2] Future doctors are expected to commit themselves to the four main moral values, namely, autonomy, non-maleficence beneficence, and justice, which forms the foundation of “Professional Development including Ethics.”[3] These four principles of biomedical ethics have been derived from the “Principles of Biomedical Ethics” authored by Beauchamp and Childress.[4]

In India, with the introduction of the new Competency-Based Medical Education (CBME) curriculum in 2019, the “Foundation Course” has become mandatory for the newly admitted medical undergraduates. “Professional Development including Ethics” forms an important part of this course with a dedicated 40 h of teaching. The aim of this study was to assess the perceptions of the 1st-year MBBS students about professionalism and ethics after the Foundation Course of CBME curriculum.


  Materials and Methods Top


This was a descriptive cross-sectional questionnaire-based study conducted in August 2019 during the “Foundation Course” for 1st year medical undergraduates of Army College of Medical Sciences. Consent from the Dean of the college for the study was taken before the start of the Foundation Course. Ethical clearance from the Institutional Ethics Committee was also obtained. Forty hours were devoted to teaching “Professional development including Ethics” to the freshly admitted medical undergraduates during the 1-month Foundation Course.

A well-structured module validated by the members of the Medical Education Unit (MEU) of the college was used for this purpose. The module comprised of role-plays, videos, cinemeducation, Hands-on activities, and Small Group Discussions. The module comprised of topics on concepts of “Professional Development including Ethics𔄙 like white coat ceremony, professional and altruistic behavior, working in a health care team, disability competencies, cultural competence, stress management, time management, role of yoga, mentoring, interpersonal relationship and collaborative learning. At the end of 40 h of teaching, the students' perception about the “Professional Development including Ethics” module was taken with the help of an anonymous validated feedback questionnaire.

The feedback questionnaire had three sections. The first section comprised of demographic profile and awareness of the students before the course. The second section contained close-ended questions (which was marked using a 5-point Likert scale as a response scale ranging from 1 = strongly disagree to 5 = strongly agree).[5] and the third section contained open-ended questions. Feedback was taken only from consenting students.

Data analysis

Data were collected from pre-validated feedback questionnaires from students. The data were analyzed on the Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp.) version 23. Descriptive statistics, frequency, and percentages were calculated for all categorical variables. Appropriate tables and figures were used for the data.


  Results Top


Out of 100 students in the 1st year MBBS, only 86 filled the feedback questionnaire. Forty (46.51%) of these students were male, whereas 46 (53.49%) were female. Only 8 (9.3%) students were of age <18 years, while 35 (40.70%) were in the age group 18–19 years, 29 (33.72%) were of age 20–21 years and only 14 (16.28%) were >21 years [Table 1].
Table 1: Demographic profile of students (n=86) and awareness of students

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Most of the students 65 (75.58%) said that their source of information on professionalism and ethics was structured classes/teaching (Lectures/seminars/case discussions). In comparison, 10 (11.63%) said online resources from the Internet, 4 (4.65%) confirmed media (TV, newspapers), 1 (1.16%) said medical journals and 6 (6.98%) told that they had no prior knowledge on professionalism and ethics before attending the course. Most students, 58 (67.44%) were aware of the existence of an “Institutional Ethics Committee” in the college. Only 19 (22.09%) were aware of all the 4 terms related to “Principles of Medical Ethics” [Table 1].

Analysis of Feedback questionnaire from students on their perceptions about “Professionalism of Doctors” is shown in [Figure 1]. All students (100%) agreed or strongly agreed that doctors should have utmost respect for human life. Ninety-three percent felt that they should update and practise current knowledge, 86.05% felt that they should examine a female patient only in the presence of an attendant, 93.02% felt that patient's confidentiality should be protected, 90.7% felt that doctors should not criticize another physician in front of a patient. A large majority of students (97.67%) also felt that an ideal doctor should seek guidance whenever in doubt, 90.7% felt that care of the patient should be the first concern of a doctor, 83.72% felt that patients should be treated with empathy, 93.02% felt that patient's dignity and privacy should be respected, and 88.37% felt that during treatment, the doctor should pay respect and listen to patient's views also.
Figure 1: Perception of students regarding professionalism in doctors

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Regarding perceptions of students on ethical practices to be followed by doctors [Figure 2], 87.21% felt that doctors should disclose all relevant information to the patient, 74.42% felt that it is necessary to involve the patient in treatment decisions, 89.53% felt that doctors could not be held responsible for ill-effects of therapy and 87.21% felt that doctors should be aware of the complexity of the practice of medicine. Besides, 84.89% felt that teaching ethics to medical students is important, and 94.19% felt that the topics taught in ethics were relevant to the practice of their profession. The students (94.19%) also felt that ethics teaching should be included in the curriculum, 89.53% felt that it will influence and improve the behavior of doctors, 75.58% felt that it will enable them to tackle cases with ethical issues in a better manner and 91.86% felt that it will finally lead to improvement of the patient-doctor relationship.
Figure 2: Perception of students regarding ethics in doctors

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Varied inputs were obtained on the open-ended questions. The main themes that were generated from them is shown in [Figure 3].
Figure 3: Thematic analysis of Open-ended questions

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  Discussion Top


Researchers found that teaching professionalism and medical ethics should start from the time the students enter medical school.[6],[7] Besides learning cognitive and psychomotor skills, affective skills, including professionalism and ethics, should start immediately as a part of the developmental process.[8],[9] Therefore, this has led to a lot of focus on the importance of professionalism and ethics in medical education and implementing the same in the medical curriculum.

Studies have shown that if professionalism and ethics are taught to medical students as they enter medical school, they understand its importance. These qualities evolve and improve as they are taught further during their medical career and further polished by exploration, self-reflection, mentoring by seniors, and their own experience.[10],[11]

The study evaluated the perception, awareness, and attitudes among the newly admitted 1st year MBBS students after 40 h of the teaching of professionalism and medical ethics. The response rate of the students to the anonymous feedback questionnaire in the present study was 86%, which is very similar to that of other studies.[12],[13] The study showed a female dominance in the medical school like in studies in other parts of the world also.[14] However, the population of medical students in some countries had a male predominance like in Taiwan, where the male students-to-female ratio was 3.73:1.[15] In Pakistan also, similar results were found with female medical students being only 43% in government colleges[16] and only 47.5% in private medical colleges.[17]

The perception of professionalism and ethics is very high in the present study when compared to Imam and El Kheir study in medical schools of Khartoum in 2012.[18] This may be attributed to the increased awareness about professionalism and ethics in the present younger generation through other sources like social media, television, etc.

A maximum number of students (94.44%) stated that professionalism and medical ethics were of great importance to doctors, while only 5.56% stated that it is only marginally important [Table 1]. In their studies, Chatterjee and Sarkar,[19] Acharya and Shakya[20] also had similar findings. The majority of the students (75.58%) felt that they learnt professionalism and ethics through structured formal education only. This was quite in contrast to other studies.[13],[21] This reflects the importance of including professionalism and ethics in the current medical curriculum to improve the knowledge and attitude of medical students.

The importance of teaching professionalism and medical ethics by role models, simulations, role-plays, or case-based scenarios cannot be over-emphasized. The positive perception [Figure 1] and [Figure 2] obtained from the students reinforces that teaching professionalism and ethics as soon as they enter medical schools will ensure better uptake and attitude as they are further taught during their years in medical colleges. This will make them better professionals and enhance their skills to tackle cases with ethical dilemmas better.[22] However, Riley and Kumar believe that even though professionalism can be taught, the students should have inherent qualities that would form the foundation of professionalism.[23]

Technical terms and basic terminologies of professionalism such as autonomy, non-maleficence beneficence, and justice and were correctly known by 62%, 52%, 58%, and 70% and of the students, respectively. Only 22.09% of students could correctly answer all these four terms. Therefore, more knowledge of these with examples have to be imparted to the students in the future classes of “Attitude, Ethics and Communication (AETCOM)” module of CBME curriculum.

On thematic analysis of open-ended questions, the most prominent themes that emerged were that the students considered punctuality and attending to patients promptly as the most important qualities of professionalism. Receiving gifts and free parties/tours from pharmaceutical companies were also considered to be highly unethical. Similarly, receiving gifts from patients or relatives was also considered to be incorrect practice. Similar moral dilemmas have been discussed in other studies.[24],[25]

This maiden study helped the institution to assess the perceptions of the 1st year medical students toward professionalism and ethics. This would go a long way to modify the Foundation Course to provide maximum benefits to the newly admitted MBBS students and also to know the areas of stress required while teaching them the AETCOM module in the later years of their MBBS curriculum.

Limitations

The limitation of the study is that it is a cross-sectional study done in a single medical college. India is a large country with different standards of professionalism and ethics varying in society due to cultural and societal differences. Therefore, the generalization of the findings to all medical colleges in the country may not be appropriate. We need similar studies with more batches of students as well as in more medical colleges of the country.


  Conclusion Top


The study concludes that “Professional Development including Ethics” incorporated in the foundation course, was much appreciated by the students entering into the medical profession. It seems likely that teaching of professionalism and ethics will definitely lead to more awareness of these values in our future doctors though this will need to be assessed in future.

Empirical research. Meanwhile, it can be hoped that the teaching of medical ethics and medical professionalism will help the doctors of tomorrow to have better attitudes, ethics, moral values, and professionalism, which will lead to better healthcare in the society and positive doctor-patient relationship.

Acknowledgment

We are highly grateful to the members of MEU, ACMS for all the support rendered and also the students of Batch 2019, ACMS for their enthusiastic participation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Medical Council of India (homepage on the internet), Foundation Course. Available from: https://www.nmc.org.in/wp-content/uploads/2020/08/FOUNDATION-COURSE-MBBS-17.07.2019.pdf  Back to cited text no. 1
    
2.
Konkin J, Suddards C. Creating stories to live by: Caring and professional identity formation in a longitudinal integrated clerkship. Adv Health Sci Educ Theory Pract 2012;17:585-96.  Back to cited text no. 2
    
3.
Macklin R. Applying the four principles. J Med Ethics 2003;29:275-80.  Back to cited text no. 3
    
4.
Beauchamp T, Childress J. Principles of Biomedical Ethics. 7th ed.. New York: Oxford University Press; 2013.  Back to cited text no. 4
    
5.
Likert R. A Technique for the measurement of attitudes. Arch Psychol 1932;140:1-55.  Back to cited text no. 5
    
6.
Selic P, Cerne A, Klemenc-Ketis Z, Petek D, Svab I. Attitudes toward professionalism in medical students and its associations with personal characteristics and values: A national multicentre study from Slovenia raising the question of the need to rethink professionalism. Adv Med Educ Pract 2019;10:437-46.  Back to cited text no. 6
    
7.
Kebede S, Gebremeskel B, Yekoye A, Menlkalew Z, Asrat M, Medhanyie AA. Medical professionalism: Perspectives of medical students and residents at Ayder Comprehensive and Specialized Hospital, Mekelle, Ethiopia A cross-sectional study. Adv Med Educ Pract 2018;9:611-6.  Back to cited text no. 7
    
8.
Sullivan WM. Medicine under threat: Professionalism and professional identity. CMAJ 2000;162:673-5.  Back to cited text no. 8
    
9.
Hultman CS, Connolly A, Halvorson EG, Rowland P, Meyers MO, Mayer DC, et al. Get on your boots: Preparing fourth-year medical students for a career in surgery, using a focused curriculum to teach the competency of professionalism. J Surg Res 2012;177:217-23.  Back to cited text no. 9
    
10.
Reimer D, Russell R, Khallouq BB, Kauffman C, Hernandez C, Cendán J, et al. Pre-clerkship medical students' perceptions of medical professionalism. BMC Med Educ 2019;19:239.  Back to cited text no. 10
    
11.
Professionalism begins in medical school. Virtual Mentor 2003;5:399-400.  Back to cited text no. 11
    
12.
Srimathi T. A study on students feedback on the foundation course in first year MBBS curriculum. Int J Med Res Health Sci 2014;3:575-9.  Back to cited text no. 12
    
13.
Haque M, Zulkifli Z, Haque SZ, Kamal ZM, Salam A, Bhagat V, et al. Professionalism perspectives among medical students of a novel medical graduate school in Malaysia. Adv Med Educ Pract 2016;7:407-22.  Back to cited text no. 13
    
14.
Ismail S, Rahman NIA, Nasir Mohamad N, Jusoh NM, Hood AIB, Arif LA, et al. Preference of teaching and learning methods in a new medical school of Malaysia. J Appl Pharm Sci 2014;4:48-55.  Back to cited text no. 14
    
15.
Tsai TC, Lin CH, Harasym PH, Violato C. Students' perception on medical professionalism: The psychometric perspective. Med Teach 2007;29:128-34.  Back to cited text no. 15
    
16.
Akhund S, Shaikh ZA, Ali SA. Attitudes of Pakistani and Pakistani heritage medical students regarding professionalism at a medical college in Karachi, Pakistan. BMC Res Notes 2014;7:150.  Back to cited text no. 16
    
17.
Sobani ZU, Mohyuddin MM, Farooq F, Qaiser KN, Gani F, Bham NS, et al. Professionalism in medical students at a private medical college in Karachi, Pakistan. J Pak Med Assoc 2013;63:935-9.  Back to cited text no. 17
    
18.
Imam JA, El Kheir DY. Assessment of the concepts of medical professionalism among medical students. Khartoum Med J 2014;7:407-22.  Back to cited text no. 18
    
19.
Chatterjee B, Sarkar J. Awareness of medical ethics among undergraduates in a West Bengal medical college. Indian J Med Ethics 2012;9:93-100.  Back to cited text no. 19
    
20.
Acharya RP, Shakya YL. Knowledge, attitude and practice of medical ethics among medical intern students in a Medical College in Kathmandu. Bangladesh J Bioethics 2015;6:1-9.  Back to cited text no. 20
    
21.
Salam A, Song CO, Mazlan NF, Hassin H, Lee LS, Abdullah MH. Professionalism of future medical professionals in Universiti Kebang- saan Malaysia (UKM) Medical Centre. Int Med J 2012b; 19:224-8.  Back to cited text no. 21
    
22.
Hudon A, Laliberté M, Hunt M, Sonier V, Williams-Jones B, Mazer B, et al. What place for ethics? An overview of ethics teaching in occupational therapy and physiotherapy programs in Canada. Disabil Rehabil 2014;36:775-80.  Back to cited text no. 22
    
23.
Riley S, Kumar N. Teaching medical professionalism. Clin Med (Lond) 2012;12:9-11.  Back to cited text no. 23
    
24.
Weijer C. Point-counterpoint: Should physicians accept gifts from their patients? No: Gifts debase the true value of care. West J Med 2001;175:77.  Back to cited text no. 24
    
25.
Takayama JI. Giving and receiving gifts: One perspective. West J Med 2001;175:138-9.  Back to cited text no. 25
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

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