Ethics in medical education

The Malaysian Academy of Medicine held its annual seminar on medical ethics yesterday. I was invited to be in the panel. Points I considered important are:

1) Core curriculum in medical ethics are already well described. There is an international agreed core curriculum available and is followed by many medical schools

2) What medical students consider as ethical are what they see in practice during their 5 or 6 years being an apprentice in the profession.

3) It is thus worrying as many so-called 'norms' are certainly questionable and have many ethical issues behind them

4) If it has become 'norm' that a service ward round consists of fleeting visits of consultants to see patients, with little eye contacts and communication between the sick and the healer; this 'norm' would certainly 'rub off' and translated into students' behaviour

5) A consultant who does not pay attention to cases being referred to him, but delegate the case to junior colleagues and has little time to reply personally to the referring doctor. This may become 'norm' that will be emulated by students

6)Senior consultants who interact freely with drug companies, are often not comfortable to talk about ethics on pharmaceutical companies and sponsorships of medical doctors.Such relationships may eventually be seen as 'normal' and something to be expected as being part of the profession.This may in the long run affect students' attitude adversely.

7) There are of course many more examples of what medical students may see in their daily life; events which have shaped their thoughts and action.

8) Perhaps medical educationists will have to take extra measures to address these issues and assist fellow colleagues to maintain a high level of etiquette. These are the 'microethics' : so potentially powerful and may even serve to reverse all the good contents of ethics curriculum

9) Academic leaders need to create an environment where ethics and microethics thrive positively. Severe constraints on staff, extreme desire to make them publish research data in lieu of performing their clinical duties may result in them resorting to short-cut , off-the-cuff behaviours that can be unethical.

10) Ample opportunities can be created within the existing curriculum to give students a chance to learn and practice ethics in a real community setting and not in the artificial ambiance of a cosy classroom.