Definition of ethical problems of general practitioners by the curriculum

Professional ethics as one of the components of the educational system. Characterization of referring people to situations is critical and impartial. A feature of improving the value system. The role of ethical problems among general practitioners.

Рубрика Иностранные языки и языкознание
Вид статья
Язык английский
Дата добавления 17.04.2018
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Definition of ethical problems of general practitioners by the curriculum

Ариунзая Г.

Енкхбаяр У.

Background

Excellence of GP includes such professional skills as high knowledge, sense of new social attitudes and clients requirements, ability solve problems when it is necessary, ability to work independenty and in team and to work with doctors of other profession. Since 1998 ethic is included in medical education curriculum as an elective.

Goal

As core problems of the professional ethic is different depending on clinical practices. Our goal is to definite ethical problems of medical students and GPs, to compare results of two groups and improve ethical curriculum in the future.

Objectives

· According to opinions of doctors, senior students, clinical instructors and professional ethical researchers to study how some elements of professional ethic respond to real social requirements.

· To definite correct ways to form GPs ethics.

A new idea

Time demands that GPs must to have a correct ethical orientation in order to reach health goals and correctly direct medical care that differ them from traditional medicine workers therefore we took some aspect of these problems and expressed our ideas.

Object

In our study took part the doctors of 7 general hospitals of Gobi region, clinicians of MNUMS and senior students.

Method

We acquainted with GPs curriculum, for questionairy taken from 4, 5, 6th courses students used method of Delphy evaluation on base of which combined ethical opinions, analyzed documents related to ethical problems used chi2 tests for statistical analyzes. Processing of study works executed by SPSS 16 program.

Results

In the study took part 312 medical students, 248 physicians, 47 clinical teachers of whom 528 (87%) were males and 79 (13%) were females. Participants were people of age 24-53. On question: “How do you understand the concept professional ethics?” 62 (21%) of physicians and clinical teachers answered that in their student years they were given miserable ours of lessons in ethic and consequently have inssifficient know ledge at it. On question about contemporary youth ethical education only 43 (7.1%) gave “yes” answer that shows that this problem rests to wish the better. Majority of respondents (94.2%) that the ethic have to be taught. Analysis of researchers opinions about ethical topics to be taught shows that there are many pressing questions. In order to solve this problem we sent results of preliminary study to clinical and ethical experts and took their ideas and opinions. We gave to analyze our study to 5 researchers and clinical teachers and compared with offers of the first study. Of total 47 topics experts include 24 ethical topics for a curriculum. The offered topics are: basic knowledge of ethic, ethical teaching, research ethic, authentity of medical profession, personal competency, appearance, communication with co-workers and other professionals, relation with clients, professional duty and responsibility, professional secrecy, confidence relation to press, responsibility for call, sufficient time for clients, documentation, standardization, directive observation, direction to qualified doctors when is need, clients registration, respect of client privacy, to include in decision making, impartiality, pain management, avordance of incorrect treatment.

Table 1 - Study of requirement for contemporary GPs:

Content

Students

Physicians and clinical teachers

Total

ч2

Care Giver

Yes

301 (96.5)

283 (95.9)

584 (96.2)

0.1**

No

11 (3.5)

12 (4.1)

23 (3.8)

Decision Maker, researchers

Yes

275 (88.1)

278 (94.2)

553 (91.1)

7.0*

No

37 (11.9)

17 (5.8)

54 (8.9)

Health advocate, provider, consultant

Yes

108 (34.6)

174 (59.0)

282 (46.5)

36.2

No

204 (65.4)

121 (41.0)

325 (53.5)

Learner

Yes

179 (57.4)

214 (72.5)

393 (64.7)

15.3*

No

133 (42.6)

81 (27.5)

214 (35.3)

Instructor, humanist

Yes

79 (25.3)

97 (32.9)

176 (29.0)

4.2**

No

233 (74.7)

198 (67.1)

431 (71.0)

Communicator

Yes

253 (81.1)

231 (78.3)

484 (79.7)

0.8**

No

59 (18.9)

64 (21.7)

123 (20.3)

Doorman, resource manager

Yes

54 (17.3)

78 (26.4)

132 (21.7)

7.4*

No

258 (82.7)

217 (73.6)

475 (78.3)

Total

312 (100.0)

295 (100.0)

607 (100)

Explanation: data was expressed by percentage and count significance. p<0.05,**p<0.01*.

Table 2 - General medicine graduate curriculum for the medical school of MNUMS

Learning place

lecture

(цаг)

seminar

(цаг)

practice

(цаг)

Independence

(цаг)

total(without independence)

total (with independence)

Linear training

4

8

12

Bloc 1

4

8

12

Bloc 5

8

20

28

Bloc 14

4

20

24

Bloc 16

4

24

28

Bloc 21

6

8

14

Internship

8

16

16

48

40

88

Facilitate

2

4

4

16

10

26

Total

40

20

108

64

168

232

The table shows that an academic learning make up 168/5.2 bloc hours not including an independence learning. That occupies 2.1% of total learning hours. In first week of entrance medical school is given basic concepts of ethic and beginning from 3th course ethic is included as an elective for 42/2 bloc hours that is not so sufficient. Main work for students are to be acquainted with originals make notes and to work independently but in today's university teachers lead lectures and then. They risk all they said and it can't develop students thinking ability. It is very important to prepare every student so that they can enter real life with real goal and ability to be fully responsible for themselves. To implement newly developed curriculum it was necessary to establish at MNUMS general profession and family and preventive medicine families, in which work 2 pediatricians, 1 cardiologist, 1 surgeon, 1 obstetrician and 1 internist. In order to improve teaching skill of faculty members it is important to create optimal learning environment and materials, provide teachers with such progressive teaching methods as problem based and evidence based ones. First year students of institutes and university study humanitarian and basic subjects and 80% of second year subjects are related to professional topics and students begin to pass professional observational practice. Beginning from the second year students have to master ability to work in team and understand how important is a personal success for the team achievements. For the purpose of this student join teams with 4-5 members who write report, take part in faculty, school, university, city and state scientific conferences. In 3-6th years they take part in research work with the help of supervisors. One of the important aspects of professional ethic is to raise students juridical knowledge. For this purpose it is important to organize training and seminars where students can understand that many aspects of juridical and ethical matters are closely interrelated bur has differences and what to be solved by law and what will be resolved by ethical regulations. Intensification of online telemedical trainings and research works. Also play an important role in ethical training. professional educational ethic value

Discussion

Result of our study were proximatly identical with those done in some developed countries. And it was the first step in renewing and entiching official and unofficial curriculums for GPs ethic.

Conclusion

1. We consider as optimal to master medical education for 6 years gaining knowledge, skills and attitudes and including 24 ethical topics into basic sciences.

2. The way to form professional ethical attitudes are official and unofficial trainings. During the official training physicians and students are giver the topic “Fundamentals of Medical ethics” in independent in the curriculum of every subject. As to unofficial training it mast be organized in forms of online and distant learning. Forming of the professional ethics through research works is the most effective method.

Proposals

1. “If someone is eager to learn the way will lead him unimpeded” Trainings oriented towards ethical leadership, communication and attitudes must be organized, implemented and stabilized.

2. “To be a skilled doctor ethics is no problem” It is important that universal causes of ethics must be included in medical schools curriculum in topical forms.

3. “Ethical attitudes are learned not at medical schools but in a family environment” Must be taken effective nearures to make children rigounosly observe ethical and cultural norm from their early childhood.

4. “Ethical orientation is formed rather in observing interrelations and attitudes of senior colleagues and other health workers than in reading books or listening to lectures” In interrelations of doctors and client it is important such ethical principles as recommendation and secrecy.

5. “Although ethical subject are important but in our overloaded curriculum there is no place for ethical lessous” Therefore we need to overcome these difficulties and provide enough time and resources for ethical subjects. The world Association of Medical Education and the World Health Association also are looking ahead to resolve this problem.

References

1. Ministry of Health. On establishment of the working group. Joint order of ministers of Health and Education, Culture and Science No 3781484. Ulaanbaatar 2009.

2. Implementation sphere of Master plan of government and Health Branches of Mongolia 2006-2010. Ulaanbaatar. 2007.

3. The law of Mongolia on Government and Higher education. Ulaanbaatar. 2006.

4. Order of Minister of Health. 2008.

5. B. Some basic problems of Medical ethics and Deontology. Ulaanbaatar. 1986.

6. I. Medical ethics. Ulaanbaatar. 1979.

7. D, Damdinjav. Kh. et al. Professional and Consumer Ethics. Ulaanbaatar. 2007.

8. Kh, Altantsetseg. T. et al. Ethics of Health professionals. Ulaanbaatar. 2008.

9. Ts, Tserendavga. D, Otgonbayar. D, Amarsaikhan. D. et al. Medical education. Ulaanbaatar. 2009.

10. Ts, Dungerdorj. D. Tserendavga. D, et al. Medical education. First edition. Ulaanbaatar. 2009.

11. Family Medicine Curriculum of MNUMS and medical schools. Ulaanbaatar. 2009.

12. D. theoretical and methodological problems on medical schools curriculum improvement. Dissertation for MD degree. Ulaanbaatar. 2003.

13. Kh. Sociophylosophical problems of biomedical ethics in Mongolian Health system. Dissertation for MD degree. Ulaanbaatar. 2004.

14. Medical ethics manual. World Medical Association. 3rd edition 2015.

15. Taylor KL, Chudley AE. Meeting the needs of future physicians: a core curriculum initiative for postgraduate medical education at a Canadian university. Med Educ 2001; 35: 973-982.

16. Association of American Medical Colleges. AAMC GME core curriculum project: draft for comment. Washington, DC, USA: Association of American Medical Colleges; 1999.

17. Kern DE, Thomas PA, Harward DM, Bass ED. Curriculum Development for Medical Education: A Six Step Approach. Baltimore: John Hopkins Press; 1998.

18. Nazaraly Usubaliev, Training Family medicine Practitioners at the Family medicine training centre in Issyk-kul oblast, 2000 May, Kyrgyzstan.

19. Republic of Armenia Ministry of Health. Unified Family Medicine Curriculum. Yerevan 2003.

20. Henri-Ingrid Maaroos, University of Tartu, Department of Polyclinic and Family

21. Family medicine basic, residency and doctorate training curriculum. 1998.

Annotation

Professional ethics education is one of components of an educational system and a part of philosophy that helps us to choice a correct life style. More than tradition and devotion and based on logical foundations ethics interpetes us what permitted us to do and we shouldn't do and helps us to relate critically and impartially and regularly enchance our set of values. Therefore among GPs traits ethical problems occupy an important place. In developed countries is paid a particular attention to the problem how to from it in GPs but there are many problems to be solved.

Keywords: ethics, general practitioner, forming, satisfaction, skills, health, medicine.

Профессиональная этика - один из компонентов образовательной системы и части философии, который помогает нам выбрать правильный стиль поведения. Сильнее, чем традиция и привязанность, и основанная на логической этике, профессиональная этика разъясняет, что разрешено делать и что мы не должны делать, а также помогает относиться к ситуациям критически и беспристрастно, и регулярно совершенствовать систему ценностей. Именно поэтому, среди врачей общей практики этические проблемы занимают важное место. В развитых странах на эти проблемы обращено особое внимание, но есть также много проблем, которые еще требуют решения.

Ключевые слова: этика, врач общей практики, формирование, исполнение обязательств, навыки, здоровье, медицина

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