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Building Medical Ethics Education to Improve Japanese Medical Students’ Attitudes Toward Respecting Patients’ Rights

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Building Medical Ethics Education to Improve Japanese Medical Students’ Attitudes Toward Respecting Patients’ Rights Tohoku J. Exp. Med., 2011, 224, 307-315Ethical Development among Medical Students 307 Building Medical Ethics Education to Improve Japanese Medical Students’ Attitudes Toward Respecting Patients’ Rights Yukiko Saito,1 Yasushi Kudo,2 Akitaka Shibuya,2, 3 Toshihiko Satoh,4 Masaaki Higashihara5 and Yoshiharu Aizawa6 1Department of Medical Humanities, Research and Development Center for Medical Education, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan 2Department of Health Care Management, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan 3Department of Risk Management and Health Care Administration, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan 4Kitasato Clinical Research Center, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan 5Department of Hematology, Internal Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan 6Department of Preventive Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan In medical education, it is important for medical students to develop their ethics to respect patients’ rights. Some physicians might make light of patients’ rights, because the increased awareness of such rights might make it more difficult for them to conduct medical practice. In the present study, predictors significantly associated with “a sense of resistance to patients’ rights” were examined using anonymous self-administered questionnaires. For these predictors, we produced original items with reference to the concept of ethical development and the teachings of Mencius. The subjects were medical students at the Kitasato University School of Medicine, a private university in Japan. A total of 518 students were analyzed (response rate, 78.4%). The average age of enrolled subjects was 22.5 ± 2.7 years (average age ± standard deviation). The average age of 308 male subjects was 22.7 ± 2.8 years, while that of 210 female subjects was 22.1 ± 2.5 years. The item, “Excessive measures to pass the national examination for medical practitioners,” was significantly associated with “a sense of resistance to patients’ rights.” However, other items, including basic attributes such as age and gender, were not significant predictors. If students spent their school time only focusing on the national examination, they would lose the opportunity to receive the ethical education that would allow them to respect patients’ rights. That ethical development cannot easily be evaluated with written exams. Thus, along with the acquisition of medical knowledge, educational programs to promote medical students’ ethics should be developed. Keywords: ethical development; medical education; medical students; patients’ rights; questionnaire Tohoku J. Exp. Med., 2011, 224 (4), 307-315. © 2011 Tohoku University Medical Press In medical ethics education, improving medical stu- lies at the core of a patient’s decision-making based on their dents’ attitudes toward respecting patients’ rights is an free will. essential task (American Hospital Association 1972; World Eckles et al. (2005) suggested that there are two points Medical Association 1981; Annas and Densberger 1984; of view regarding the purpose of teaching medical ethics: Beauchamp and McCullough 1984; Saito 1997; Ministry of “creating virtuous physicians” and “providing physicians Education, Culture, Sports, Science, and Technology 2001; with a skill set for analyzing and resolving ethical dilem- Post 2004a, 2004b; Eckles et al. 2005; Beauchamp and mas.” In Japan, the Ministry of Education, Culture, Sports, Childress 2008; Ministry of Education, Culture, Sports, Science, and Technology (2001) reported that the purpose Science, and Technology 2008). The “Patient’s Bill of of medical education is to “create physicians who are com- Rights (American Hospital Association 1972)” and mitted to ethics and have problem-solving skills.” “Declaration of Lisbon on the Rights of the Patient (World Subsequently, the Ministry of Education, Culture, Sports, Medical Association 1981)” state that a physician must Science, and Technology (2008) added the following respect the rights of patients. In the field of medical ethics, regarding qualities needed to become physicians in a model “respect for autonomy” (Beauchamp and Childress 2008) core curriculum: “keep physician’s responsibilities and Received May 9, 2011; revision accepted for publication July 21, 2011. doi: 10.1620/tjem.224.307 Correspondence: Yasushi Kudo, Department of Health Care Management, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan. e-mail: [email protected] 307 308 Y. Saito et al. medical ethics, and always take patient-oriented view honor of their teachers. points” and “have a well-rounded character while being This type of education stresses that medical students deeply conscious of the dignity of life.” become aware of and improve their attitudes toward daily In the field of ethics development, the following four living through such education. These activities may con- concepts are mostly regarded as influential factors in the tribute to the creation of a desirable environment for devel- ethical development of people: “role-models” (Merton et al. oping students’ ethical reasoning. To the best of our knowl- 1957; Wright 1998; Eckles et al. 2005), “respect for people” edge, no Japanese universities actually implement such (Durkheim 1973; Ministry of Education, Culture, Sports, educational activities. These activities may affect the ethi- Science, and Technology 2006), “utilitarianism” (Bentham cal reasoning to respect the rights of patients. This study 1988; Post 2004c; Iseda and Katagi 2006), and “compli- also examines the associations between “shurei-keijin edu- ance” (Kohlberg 1976). cation” and the “students’ ethical reasoning.” Application of the above ethical concepts (Merton et al. 1957; Durkheim 1973; Kohlberg 1976; Bentham 1988; Subjects and Methods Wright et al. 1998; Post 2004c; Eckles et al. 2005; Iseda Participants and Katagi 2006; Ministry of Education, Culture, Sports, The subjects were 661 medical students of the Kitasato Science, and Technology 2006) to Japanese medical stu- University School of Medicine, a private university in Japan. dents can be effective to analyze their ethical development. Students who had withdrawn from school temporarily were excluded. However, the previous studies on ethics education for medi- During the period of January to February 2009, the anonymous self- cal students have only investigated their awareness or actual administered questionnaires (original version in Japanese, see the conditions regarding ethics, such as surveys of students’ Appendix) with return envelopes and the Japanese explanations of the awareness of ethics education (Tanida et al. 2003; Miyata study were distributed to the students. To get the students’ truthful and Yamamoto 2010), surveys of ethical issues in medical opinions, the completed questionnaires were then sealed in envelopes education (Kato and Suzuki 2005; Hirakawa et al. 2005), by the students themselves. The students could either place the ques- and curriculum surveys (Kodama et al. 2009; Matsui et al. tionnaires in the collection boxes or hand them directly to the person- nel in charge. A collection box was placed at the door of the adminis- 2009). trative office to the end of March 2009. To the best of our knowledge, there are no studies that applied the above four ethical concepts in the field of ethics education to medical education. The present study involved Survey items 1. A sense of resistance to patients’ rights the preparation of a questionnaire by referring to those four This item was produced with reference to previous studies concepts. We evaluated the associations between those (American Hospital Association 1972; World Medical Association concepts and the attitude toward patients’ rights among 1981; Annas and Densberger 1984; Beauchamp and McCullough medical students. 1984; Saito 1997; Ministry of Education, Culture, Sports, Science, The term “shurei-keijin” in Japanese was taken from and Technology 2001; Post 2004a, 2004b; Eckles et al. 2005; the teachings of the Chinese philosopher, Mencius. This Beauchamp and Childress 2008; Ministry of Education, Culture, philosophical term conveys the meaning of “treating others Sports, Science, and Technology 2008). Respecting the patients’ with decency and respect” and has been passed down for rights is extremely important for medical students. However, if such generations as the concept best expressing the ideal for awareness increases, some students may imagine that they might get human beings (Kaizuka 1999; Aizawa 2007). Our medical various complicated demands from the patients. If that happens, they school focuses on not only teaching medical knowledge and may consequently consider the patients’ rights negatively. skills but also humanity to our students. To do so, Kitasato “A sense of resistance to patients’ rights” was rated on a 7-point University School of Medicine has focused on the Mencian scale from “definitely agree” to “definitely disagree” by asking “If the philosophical idea of “shurei-keijin” and has conducted awareness of patients’ rights increases, it may become more difficult educational programs to put this unique philosophy into to conduct medical practice.” practice since 2007. So that medical students can examine their attitudes 2. Concepts affecting ethical development toward daily living, educational
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