The Effect of Educational Intervention on the Degree of Compliance with Standards of Medical Ethics in Morning Report Sessions

Morning report is one of common and valuable clinical training methods worldwide. In this method, participants attempt to resolve a diagnostic puzzle by discussing the patient's conditions. Morning report sessions are held in the form of scientific conferences containing material on cases and their evaluation by the head of a hospital ward, professors, assistants and interns who have been on duty the night before in such a manner that the students report the measures taken and the related professors resolve their weaknesses and shortcomings. The morning report is known as a tool to evaluate clinical services and to ensure their quality. It is essential to observe the medical ethics in all aspects of education and professors, while observing the principles of medical ethics, teach them to their students theoretically and practically. One of the most important aspects of clinical training is morning report sessions. It should be noted that medical ethics is not merely expression of moral traits, or physician's treatment with the patient or codification of professional laws on religious and behavioral customs of physician-patient communication. In other words, medical ethics is an analytical activity, in which thoughts, beliefs, commitments, behavior, emotions, reasoning and various discussions are carefully and critically examined in the field of medical ethics decisions and instructions are issued, if necessary. Since patients complete information such as demographic data, family history, current situation and potential diagnoses are fully expressed during the morning report sessions, students need to learn how to properly report patient's history and their privacy and fully implement it. This study aimed to determine the effect of ethical standards on the quality of the morning reports sessions from the perspective of practitioner students of Shahrood University of Medical Sciences.
The current study is an interventional study with before and after design that was conducted on 120 medical interns in Imam Hossein Hospital, Shahrood in 2014. To prepare the research instrument, a researcher-made questionnaire, the validity and reliability of which were respectively measured by medical ethics experts and Cronbach's alpha coefficient of 0.79 after conducting a pilot study, was used. In addition to demographic data such as age, gender and duration of internship, this questionnaire contains 19 specific 5-option questions on the standards of medical ethics, including maintaining the patient's dignity, confidentiality, lack of emotional harm, lack of discrimination, lack of gender differences, lack of stigmatization, lack of violating privacy, lack of extra costs, and etc. 5-item Likert Scale was used for the assessment with Always, Usually, to some extent, sometimes and never options. Considering the number of questions, minimum and maximum scores of 19 and 95 are considered, respectively. This gap is divided into three equal parts and grouping is carried out based on scores obtained so that if the total scores between 20-45, 46-70 and 71-95 are respectively considered as undesirable, average and desirable. After the pre-test, an orientation training workshop on medical ethics was held for the participant students for 12 hours. Also, a booklet containing regulations and standards of medical ethics and its application in the patient's presentation was given to all professors working in Imam Hossein Hospital and participating interns. The posttest was held after three months of morning reports sessions, in which the respected professors and medical ethics professors with ethics group style participated. After being collected, data was analyzed using SPSS v.16. Frequency tables were used in the descriptive part, and to compare the average rank in the analytical part of statistical tests, Fisher and one-way ANOVA were used. Significance level was considered at 0.05.
Ethical considerations: This study has been approved by Ethics Committee of Shahrood Medical University with code of 93.167. Verbal informed consent of participants was obtained followed by an explanation about the purpose of the study, anonymity and confidentiality of patient's information.
Findings: Male and female participants account for 33 (27.5%) and 87 (72.5%) of the participants, respectively. The average internship time spent by interns was 10.5 ±6.5 months (range 3-17 months) and the mean age of students was 26.6±4.6 years (range 22-31 years). Before the training, the average number of desirable cases was 17 cases from the perspective of students and reached to 38 cases after the implementation of medical ethics standards (p = 0.001). Before teaching ethics in the morning report, 45.8% of participants evaluated that the rate of compliance with these standards are not desirable. While unfavorable situation of morning report presentation was reduced to 19.2% after in-hospital intervention from the perspective of students. Also, the following items were significantly improved from the perspective of the participants: situation of lack of emotional trauma (p = 0.03), lack of privacy violation (p = 0.02), compliance with general principles of data collection (p = 0.05), referral of patients without expression of birth certificate specifications (p = 0.001), follow-up of recently admitted patients (p = 0.04) and lack of repeated examinations of patients (p = 0.03). Medical ethics education led to a significant improvement in student's views on the quality of the morning reports sessions.
Discussion and Since students and some professors have insufficient knowledge regarding code of professional ethics, it is recommended to design interventional programs. These findings suggest that the morning report sessions led to desirable changes in observing principles of medical ethics at Shahrood University of Medical Sciences following teaching the fundamentals of medical ethics. However, due to lack of experience of the students in the application of the principles of medical ethics in the morning report, it is recommended to form a scientific committee and consider the views of professors and students in order to improve the quality of the morning report sessions based on medical ethics. Also, it is recommended to implement continuous training program on compliance with the principles of medical ethics during the morning report sessions on the arrival of medical students in the clinical setting.