ОПРЕДЕЛЕНИЕ ЭТИЧЕСКИХ ПРОБЛЕМ В УЧЕБНОМ ПЛАНЕ ВРАЧЕЙ ОБЩЕЙ ПРАКТИКИ

Ариунзая Г.¹, Енкхбаяр У.²

¹ Национальный университет медицинских наук, Дорноговь, Монголия, ² Центральная больница, Дорноговь, Монголия

ОПРЕДЕЛЕНИЕ ЭТИЧЕСКИХ ПРОБЛЕМ В УЧЕБНОМ ПЛАНЕ ВРАЧЕЙ ОБЩЕЙ ПРАКТИКИ

Аннотация

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

Ariunzaya G.¹, Enkhbayar U.²

 ¹ Dornogovi National University of Medical Science of Mongolia, ² Dornogovi Central hospital of Mongolia

DEFINITION OF ETHICAL PROBLEMS OF GENERAL PRACTITIONERS BY THE CURRICULUM

Abstract

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.

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, 6^th 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	χ2
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 3^th  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 3-6^th 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.

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.

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