目的 探索在医学伦理教育中,采用案例分析法与定量评估法相结合的方式,调查医学研究生对伦理问题的识别和分析论证能力现状。方法 基于一项干细胞治疗引发的伦理问题,采用自主设计的评分表,对北京协和医学院2019级176名研究生的案例分析答卷进行定量评分,并分析影响评分的因素。结果 对研究生案例分析答卷的总体评价为良好。89.8% (158/176)的研究生能够识别案例中存在的不充分知情、不可接受的风险-受益比、缺乏责任担当等伦理问题,但仍然有50.1%(90/176)的研究生未能充分展开分析论证,其中仅有35.2%(62/176)的研究生能够充分论述患者知情同意情况。多因素logistic回归结果显示,女生充分论述患者知情同意状态的可能性是男生的3.36倍(OR＝3.36,95％ CI=1.27~8.88)。结论 绝大部分研究生具备识别伦理问题的能力,但伦理分析论证能力仍然有待提高,男性研究生应当更多关注患者知情同意情况。采用案例分析法与定量评估法相结合的方式可以客观评价医学研究生伦理问题的识别和分析论证能力,进而为提高医学研究生伦理教育质量提供科学的证据。
Objective To explore the method of case analysis combined with quantitative analysis to evaluate the capacity of medical graduates in recognizing and analyzing ethical issues. Methods Based on the ethical issues presented in stem cell therapy from clinical case,the questionnaire was distributed to 176 graduates enrolled in 2019 in Peking Union Medical College and the influencing factors of the questionnaire scores were analyzed with a self-designed scale. Results The general result was well. 89.8% (158/176) graduate students recognized the problems like inadequate informed consent from patients, unacceptable risk-benefit ratio, lack of responsibility, but 50.1%(90/176) of students failed to evaluate the weakness linking to ethical principles and just 35.2%(62/176) of them fully demonstrated informed consent status of patients. The multivariate logistic analysis showed thatfemale students are 3.36 times than male students to fully discuss the informed consent (OR=3.36,95%CI was 1.27 to 8.88). Conclusions Most graduates can recognize ethical issues, while the capacity of analysis need to be improved especially for male students in terms of gaining informed consent. Method of quantitative research in case analysis may evaluate the ethical capacity of graduates and provide scientific evidences for improving ethical education.
[1]Miles SH, Lane LW, Bickel J, et al. Medical ethics education: coming of age[J]. Acad Med, 1989,64(12):705-714. DOI: 10.1097/00001888-198912000-00004.
[2]Sherer R, Dong H, Cong Y, et al. Medical ethics education in China: lessons from three schools[J]. Educ Health (Abingdon), 2017,30(1):35-43. DOI:10.4103/1357-6283.210501.
[3]Brooks L, Bell D. Teaching, learning and assessment of medical ethics at the UK medical schools[J]. J Med Ethics, 2017,43(9):606-612. DOI: 10.1136/medethics-2015-103189.
[4]Robeson R, King N. Performable case studies in ethics education[J]. Healthcare (Basel), 2017,5(3):57-69.DOI:10.3390/healthcare5030057.
[5]AlMahmoud T, Hashim MJ, Elzubeir MA, et al. Ethics teaching in a medical education environment: preferences for diversity of learning and assessment methods[J]. Med Educ Online, 2017,22(1):1328257. DOI:10.1080/10872981.2017.1328257.
[6]郑聪毅, 张新庆. 定量评估医学研究生伦理认知和论证能力的现状研究[J].中华医学教育杂志,2017,37(4):518-521,546.DOI:10.3760/cma.j.issn.1673-677X.2017.04.010.
[7]Vladislav V, Simovic MB, Marina G, et al. Ethical and safety issues of stem cell-based therapy [J]. International Journal of Medical Sciences, 2018,15(1):36-45. DOI:10.71 50/ijms.21666.
[8]Oates K, Wilson I, Hu W, et al. Changing medical student attitudes to patient safety: a multicentre study[J]. BMC Med Educ, 2018,18(1):1-7. DOI: 10.1186/s12909-018-1313-0.
[9] Löffler-Stastka H, Seitz T, Billeth S, et al. Significance of gender in the attitude towards doctor-patient communication in medical students and physicians[J]. Wiener Klinische Wochenschrift, 2016,128(17-18):663-668.DOI:10.1007/s00508-016-1054-1.
