INTERNATIONAL ETHICS Teachers' views of WHO
teaching guidelines on health ethics for undergraduate medical education in
Bangladesh
Md. Humayun Kabir Talukder, Fatima
Parveen Chowdhury, Muhammad Mizanur Rashid Shuvra
Medical colleges must produce doctors capable
of maintaining the public's health, curing patients of their illnesses, and
expanding medical knowledge - all in an ethical manner. In Bangladesh, the
medical profession has traditionally enjoyed great respect. However, the
situation is changing as cases of medical negligence are brought to court.
Professional organisations are becoming conscious of the importance of a code of
conduct and of ethical behaviour but health ethics is not on the medical
curriculum. The mandatory course in forensic medicine contains some discussion
of malpractice and professional misconduct. A limited ethics education is
provided during para-clinical teaching sessions. On the whole, however, ethics
is learnt by observation rather than through formal study.
In the South East
Asia Region, the World Health Organization undertook an effort to incorporate
the teaching of health ethics in clinical teaching, with an emphasis on helping
students internalise ethics in their clinical practice (1).
The WHO
guidelines may prove to be an effective way to teach health ethics in
Bangladesh. The success of such an effort will depend partly on how medical
colleges respond to the idea (2). It will also depend on the opinions of key
persons involved in the process. It is suggested that teachers are the first
group whose views should be obtained in this regard.
The survey is based on
self-administered, structured questionnaires given to 39 teachers from seven
departments (medicine, paediatrics, surgery, gynaecology and obstetrics,
psychiatry, community medicine, and forensic medicine) of Dhaka Medical College.
These teachers had attended orientation workshops on the WHO guidelines for
teaching health ethics and their usage. Following the workshop, the teachers
used the guidelines and selected case reports to hold lectures, tutorials and
bedside lectures with a total of 965 students.
These teaching sessions took
place between April 2002 and August 2003. After the sessions a
self-administered, structured questionnaire was used to collect teachers'
views. Participation in the survey was voluntary.
Teachers were asked
to grade the following issues : students' willingness to learn health ethics;
the relevance of the case report with the identified topic; effectiveness
of case reports as a teaching tool in health ethics; and the overall
effectiveness of various teaching methods for teaching health ethics.
In
response to the first question, 38.5% of respondents felt students were
'highly willing' to learn health ethics; 35.9% were 'willing' and 25.6% were
'moderately willing'. None of the teachers felt students were unwilling to
learn about health ethics.
Regarding the relevance of the case reports, 30.8%
felt they were 'highly relevant'; 46.2% felt they were 'relevant' and 23.1% felt
they were 'moderately relevant'. None of the teachers felt the case
reports were irrelevant to learn about health ethics.
Regarding the
effectiveness of case reports as a teaching tool for health ethics, 17.9% felt
they were 'highly effective', 51.3% felt they were 'effective', 28.2% felt
they were 'moderately effective' and 2.6% felt they were 'less
effective'.
Clinical bedside teaching and tutorials were reported to be more
satisfactory as teaching methods. Lectures were less satisfactory as these were
large groups and in non-clinical departments such as community medicine and
forensic medicine.
Conclusion
Overall, teachers felt
that students were willing to learn health ethics. A very small minority of
respondents indicated reservations about the effectiveness of case reports as
teaching methods. The general impression is that the WHO teaching guidelines on
health ethics should be included in undergraduate medical education in
Bangladesh. For this, ethics should be incorporated into the regular course
schedule and teachers should be trained to use these guidelines. Case reports
based on identified areas in health ethics need to be developed for various
clinical settings in the local context. The guidelines should contain an
introduction on conceptual and theoretical issues for the benefit of teachers.
Acknowledgements:
The study was supported by funding from WHO, SEARO.
References
1. World Health
Organization. Teaching and application of health ethics in South East Asia:
health ethics teaching guidelines for SEAR countries. WHO, SEARO in
collaboration with College of Public Health, Chulalongkorn University,
Bangkok,2002.
2. World Health Organization, SEARO. Health ethics in
South-East Asia, Vol.1. New Delhi, June 1999: 1-9.
MD HUMAYUN KABIR TALUKDER*, FATIMA PARVEEN CHOWDHURY**, MUHAMMAD MIZANUR
RASHID SHUVRA***.
*Assistant Professor, curriculum development **Director;
***Research Assistant, Centre for Medical Education, Mohakhali, Dhaka. Address
for correspondence: Md Humayun Kabir Talukder, National Health Library Building,
3rd floor, Mohakhali, Dhaka 1212, BANGLADESH. e-mail:hktalukder@yahoo.com |
