What Do Students Perceive as Ethical Problems? A Comparative Study of Dutch and Indonesian Medical Students in Clinical Training

Abstract

Previous studies show that medical students in clinical training face ethical problems that are not often discussed in the literature. In order to make teaching timely and relevant for them, it is important to understand what medical students perceive as ethical problems, as various factors may influence their perception, including cultural differences and working environment. The purpose of this qualitative study was to explore students' perceptions of what an ethical problem is, during their clinical training in the hospital, and compare the results from two different countries. We observed a total of eighteen ethics group discussions and interviewed fifteen medical students at two medical schools, in Indonesia and the Netherlands. Data were interpreted and analyzed using content analysis. We found that students in both settings encounter problems which are closer to their daily work and responsibilities as medical students and perceive these problems as ethical problems. Indonesian students perceived substandard care and inequity in healthcare as ethical problems, while Dutch students perceived that cases which are not matters of life and death are less worthy to discuss. Our study suggests that there might be a gap between ethical problems that are discussed in class with teachers, and problems that students actually encounter in practice. Teachers should be aware of the everyday situations in clinical training which may be perceived by students as ethically problematic and should acknowledge and discuss these ethical problems with students as part of the learning processes in ethics education.

Experience of Indonesian medical students of ethical issues during their clinical clerkship in a rural setting

“…Issues regarding substandard care due to limited facilities and resources were also found in previous studies in Indonesia ( 24 – 26 ). This finding was consistent with those of another study, where problems of justice and quality of care were ubiquitous in Indonesia, compared to the Netherlands ( 24 ).…”

Capacity Building: Continuity and Change

“…I take this opportunity to congratulate the winners, and to thank all competition participants, as well as our panel of judges: Professor Ruth Macklin, Professor Vikki A. Entwistle and Professor Alastair V. Campbell. Additionally, I am delighted to present in this journal issue an update from our colleagues in Japan on withdrawal of treatment (Nakazawa et al 2019), two papers on the ethics of human stem cell research from our colleagues in Malaysia (Sivaraman 2019;Gopalan 2019) and a comparative study on medical ethics education by our colleagues in Indonesia and the Netherlands (Muhaimin et al 2019).…”

Staying neutral or intervening?

“…In the first 14 interviews, the questions about the alarming cases were part of a larger list of open questions on the goals and organization of ethics education in the clerkship phase, as part of a comparative study between Indonesia and the Netherlands (Muhaimin et al 2019(Muhaimin et al , 2020. Somewhere in the interview, the following question was posed: "Have you had any experience with hearing a case from a student that you thought was harmful for a patient or student, and that you thought you needed to do something about?"…”