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Ethical Concerns When Minors Act as Standardized Patients

Khoo EJ, Schremmer RD, Diekema DS, Lantos JD

Pediatrics, 2017 Mar;139(3).
PMID: 28174202 DOI: 10.1542/peds.2016-2795

When minors are asked to assist medical educators by acting as standardized patients (SPs), there is a potential for the minors to be exploited. Minors deserve protection from exploitation. Such protection has been written into regulations governing medical research and into child labor laws. But there are no similar guidelines for minors' work in medical education. This article addresses the question of whether there should be rules. Should minors be required to give their informed consent or assent? Are there certain practices that could cause harm for the children who become SPs? We present a controversial case and ask a number of experts to consider the ethical issues that arise when minors are asked to act as SPs in medical education.

Matched MeSH terms: Education, Medical, Undergraduate/ethics*
Fulltext Unethical behavior and professionalism among medical students in a private medical university in Malaysia

Yadav H, Jegasothy R, Ramakrishnappa S, Mohanraj J, Senan P

BMC Med Educ, 2019 Jun 18;19(1):218.
PMID: 31215454 DOI: 10.1186/s12909-019-1662-3

BACKGROUND: Ethical behavior and professionalism is an ideal characteristic required of medical students and included as 'must achieve' and critical aspect of medical students' curriculum. This study proposes to determine the perceived unethical and unprofessional behavior among medical students in a private medical university from year 1 to year 5 of the medical curriculum.
METHODS: A cross-sectional study was conducted among year 1 to year 5 medical students in a private medical university. A self-administered questionnaire was used with the 3 major domains of professionalism and ethics i.e. discipline plagiarism and cheating.
RESULTS: A total of 464 respondents responded to the survey and they included medical students from year 1 and year 2 (pre-clinical) and years 3-5 (clinical years). Majority of the students, 275 (59.2%) answered that they had not seen any form of unethical behavior among other students. The females seem to have a larger number 172(63%) among the same gender compared to the males. Majority 352 (75%) of them had not heard of the 'Code of Professional Conduct by the Malaysian Medical Council'. About fifty three (53.1%) of the students answered that the training was sufficient.
CONCLUSIONS: This study showed that the perception of unethical behavior was 58.8% in the 1st year (pre-clinical) and it increased to 65.2% in the 5th year (clinical). The 3 main discipline issues were students do not show interest in class (mean 2.9/4), they are rude to other students (mean 2.8/4) and talking during class (mean 2.6/4). Despite the existence of unethical behavior among the students majority of them (71.7%) claimed that they had adequate training in ethics and professionalism. It is proposed that not only the teaching of ethics and professionalism be reviewed but an assessment strategy be introduced to strengthen the importance of professionalism and ethics.

Matched MeSH terms: Education, Medical, Undergraduate/ethics*
Fulltext Are medical students confident in taking a sexual history? An assessment on attitude and skills from an upper middle income country

Ariffin F, Chin KL, Ng C, Miskan M, Lee VK, Isa MR

BMC Res Notes, 2015;8:248.
PMID: 26082003 DOI: 10.1186/s13104-015-1220-y

BACKGROUND: Sexual history training during undergraduate education is essential for preparing future doctors to handle patients' sexual health concerns. The purpose of this study was to assess the attitudes and perceptions of final-year medical students in Malaysia toward sexual history taking and the training they receive from their medical schools.
METHODS: The study used a cross-sectional survey of 379 final-year medical students from three medical schools in Malaysia. Students were asked to rate their attitudes and perceptions regarding training on taking sexual histories using a newly developed questionnaire with good internal consistency (Cronbach's alpha = 0.73). Ethics approval was obtained from the relevant medical schools, and the statistical analysis was conducted using SPSS, Version 20.0.
RESULTS: The mean age of participants was 23.58 ± 0.65 SD. Participants reported high interest in sexual health and felt it was important for doctors to know how to take a sexual history (95%). Among the participants, only half felt comfortable in taking sexual histories from patients. The participants identified cultural and religious differences between the doctor and the patient as a potential barrier for discussing sexual health. Participants were aware of their own practice and ability, as well as their limitations, in taking sexual histories. Less than half (46%) felt that the training they received adequately prepared them to take sexual histories.
CONCLUSIONS: This study identified gaps in sexual health training among medical schools in Malaysia. The delivery of sexual health education program should incorporate confidence building and to make students feel comfortable to take sexual histories from patients. The barrier caused by differences in culture or religion between a doctor and a patient may be overcome through cross cultural and cultural competency training. This is important for multi-faith, multi cultural societies such as Malaysia and other similar countries.

Matched MeSH terms: Education, Medical, Undergraduate/ethics

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