Abstract
Aim:
The study aims to understand the current levels of knowledge and attitude of medical graduates toward medical ethics.
Methods:
A questionnaire-based cross-sectional study was conducted among 138 medical graduates via Google Forms. The collected data were analyzed using SPSS v20 and expressed as frequency and percentages.
Results:
Among the 138 medical graduates with a mean age of 26.25 ± 2.55 years, the vast majority (94.2%) of participants believe that medical ethics is either significant or highly significant in clinical practice. 57.2% medical graduates feel moderately assured about resolving ethical dilemmas, 97.8% agree or strongly agree that medical ethics should be an integral part of the medical curriculum. Most respondents (80.4%) felt they handled the ethical dilemmas adequately, indicating a general sense of competence despite the challenges faced. 39.9% participants believe the current medical curriculum does not provide sufficient training in medical ethics.
Conclusion:
This study concludes positive attitudes among medical graduates toward medical ethics and their perceived competence in handling ethical dilemmas. The insights from the study underscore the importance of contextually relevant and integrated approaches to teaching medical ethics that can better prepare graduates for the ethical challenges they will face in their professional lives.
Keywords: Attitude, ethical dilemma, medical curriculum, medical ethics
Résumé
Objectif:
L’étude vise à comprendre les niveaux actuels de connaissances et l’attitude des diplômés en médecine envers l’éthique médicale.
Matériel et Méthodes:
Une étude transversale par questionnaire a été menée auprès de 138 diplômés en médecine via Google Forms. Les données recueillies ont été analysées avec SPSS v20 et exprimées en fréquences et en pourcentages.
Résultat:
Parmi les 138 diplômés en médecine, dont l’âge moyen était de 26,25 ± 2,55 ans, la grande majorité (94,2 %) des participants estiment que l’éthique médicale est significative ou hautement significative dans la pratique clinique. 57,2 % des diplômés en médecine se sentent moyennement confiants quant à la résolution des dilemmes éthiques, et 97,8 % sont d’accord ou tout à fait d’accord pour dire que l’éthique médicale devrait faire partie intégrante du cursus médical. La plupart des répondants (80,4 %) estiment avoir géré les dilemmes éthiques de manière adéquate, témoignant d’un sentiment général de compétence malgré les difficultés rencontrées. 39,9 % des participants estiment que le cursus médical actuel n’offre pas une formation suffisante en éthique médicale.
Conclusion:
Cette étude conclut à l’attitude positive des diplômés en médecine envers l’éthique médicale et à leur capacité perçue à gérer les dilemmes éthiques. Les conclusions de l’étude soulignent l’importance d’approches contextuellement pertinentes et intégrées pour l’enseignement de l’éthique médicale, afin de mieux préparer les diplômés aux défis éthiques auxquels ils seront confrontés dans leur vie professionnelle.
Mots-clés: Éthique médicale, cursus médical, attitude, dilemme éthique
INTRODUCTION
Medical ethics education is a critical component of medical training, aiming to equip future healthcare professionals with the necessary skills to navigate complex ethical dilemmas in clinical practice. As healthcare systems evolve and face new challenges, the importance of instilling strong ethical foundations in medical graduates has become increasingly recognized.
Historically, medical ethics education has undergone significant transformations. Early models primarily focused on imparting knowledge about ethical theories and principles, often neglecting the practical application of these concepts in real-world scenarios.[1] Recent trends advocate for a more integrated approach that encompasses not only cognitive skills but also personal values, attitudes, and behaviors.[2] This shift reflects a growing consensus that effective ethics education must address the complexities of patient care and the moral challenges that arise in clinical settings.
The role of medical ethics in the training of healthcare professionals has gained increasing recognition in India, particularly as the healthcare landscape evolves and faces new ethical challenges. Medical ethics encompasses the moral principles that govern the practice of medicine, guiding practitioners in making decisions that affect patient care and public health. In recent years, there has been a concerted effort to incorporate ethics education into the medical curriculum, driven by the need to prepare graduates for the complexities they will encounter in clinical practice. The National Medical Commission (NMC) has introduced initiatives such as the attitude, ethics, and communication module, which aims to enhance the understanding of ethical principles among medical students.[3]
Despite advancements in medical ethics curricula globally, many studies indicate that medical graduates still feel inadequately prepared to confront ethical dilemmas.[4] Some published studies reported the lack of adequate knowledge about medical ethics among medical students and doctors.[,6,7] However, despite these efforts, there remains a notable gap in students’ perceptions of their training adequacy. A significant proportion of medical graduates express concerns regarding the sufficiency of their ethics education and highlight the necessity for more integrated clinical training that includes workshops and practical case studies.[1]
In view of this research gap, the current study aims to explore the current levels of knowledge and attitude of medical graduates toward medical ethics. By investigating these issues, we hope to contribute to the ongoing discourse on improving medical ethics education and fostering a more ethically aware generation of medical professionals.
METHODS
A questionnaire-based cross-sectional study was conducted in a Medical School in India. A prevalidated structured questionnaire was distributed among 138 medical graduates through Google Forms who consented to participate in the study. The questionnaire was validated for its appropriate structure, language, and content by four experienced professors having appropriate knowledge and expertise in medical education. An extensive literature search was conducted before finalizing the questionnaire. The questionnaire consisted of three sections. The first section of the questionnaire covered demographic information such as age and gender of the participants. The second part contained questions about their knowledge on medical ethics and its importance, and the third part was about their attitudes on various issues of medical ethics.
Inclusion criteria
Medical graduates of a Medical School in India who have completed compulsory rotating medical internship.
Exclusion criteria
Medical graduates who have not completed a compulsory rotating medical internship.
Sample size
The proportion of perception of participants observed in an earlier publication,[8] with 95% confidence level and 15% relative allowable error, minimum sample size comes to 75. Expecting 30% nonresponse rate, n = 75 + 23 ≈ 98 (sample size: 98).
n = 75 + 23 ≈ 100
Where,
Z1 - α/2 = 1.96
P = 0.696
q = 0.304
d = 15% of p
Statistical methods
Data were entered into an Excel sheet, analyzed using SPSS v20 (IBM Corp., Armonk, New York, United States), and expressed as frequency and percentages. Findings were expressed as descriptive statistics.
Ethical issues
The study was conducted after getting approval from the Institutional Ethics Committee (IEC study ref no: 110/24/IEC).
RESULTS
Among the 138 participants whose responses were analyzed, 73.9% were female and 26.1% were male. Their ages ranged from 23 to 34 years, with a mean age of 26.25 ± 2.55 years.
Table 1 summarizes responses from 138 medical graduate students regarding their knowledge of medical ethics within the context of their curriculum and clinical practice. The majority (85.5%) of respondents have received formal training in medical ethics as part of their educational curriculum.
Table 1.
Knowledge on medical ethics among students
| Response of questions | Frequency (%) |
|---|---|
| Have you received formal training in medical ethics as part of your curriculum? | |
| Yes | 118 (85.5) |
| No | 20 (14.5) |
| Assess your understanding of the principles of medical ethics | |
| Average | 49 (35.5) |
| Excellent | 4 (2.9) |
| Good | 72 (52.2) |
| Poor | 13 (9.4) |
| Which of the following sources did you use to learn medical ethics? | |
| Clinical posting | 8 (5.8) |
| Clinical posting, peer discussion | 3 (2.2) |
| Lecture class | 16 (11.6) |
| Lecture class, clinical posting, peer discussion | 4 (2.9) |
| Lecture class, peer discussion | 5 (3.6) |
| Lecture class, virtual training, clinical posting, peer discussion | 5 (3.6) |
| Lecture class, virtual training, peer discussion | 7 (5.1) |
| Peer discussion | 7 (5.1) |
| Textbooks, clinical posting | 8 (5.8) |
| Textbooks, lecture class | 23 (16.7) |
| Textbooks, lecture class, clinical posting | 8 (5.8) |
| Textbooks, lecture class, clinical posting, peer discussion | 27 (19.6) |
| Textbooks, lecture class, virtual training, clinical posting, peer discussion | 11 (8.0) |
| Textbooks, peer discussion | 3 (2.2) |
| Virtual training | 3 (2.2) |
| What is your opinion on the significance of medical ethics in the context of clinical practice? | |
| Fairly significant | 8 (5.8) |
| Highly significant | 75 (54.3) |
| Significant | 55 (39.9) |
| Are you confident in your ability to resolve ethical dilemmas in clinical practice? | |
| Highly confident | 26 (18.8) |
| Lacking confidence | 19 (13.8) |
| Moderately assured | 79 (57.2) |
| Slightly self-assured | 14 (10.1) |
| Medical ethics should be an integral part of the medical curriculum. | |
| Agree | 60 (43.5) |
| Strongly agree | 75 (54.3) |
| Strongly disagree | 3 (2.2) |
Most respondents rated their understanding of medical ethics as “Good” (52.2%) or “Average” (35.5%), while only a small percentage feels they have an “Excellent” understanding (2.9%). Conversely, 9.4% consider their understanding “Poor.” Respondents learned medical ethics from a diverse array of sources, a combination of textbooks, lecture classes, clinical postings, and peer discussions (19.6%) being the most common, followed by textbooks and lecture classes (16.7%). The vast majority (94.2%) of participants believe that medical ethics is either “Significant” or “Highly significant” in clinical practice. 57.2% medical graduates feel “Moderately assured” about resolving ethical dilemmas, a significant percentage demonstrates varying degrees of insecurity (23.9% when combining “Lacking confidence” and “Slightly self-assured”). An overwhelming majority (97.8%) agree or strongly agree that medical ethics should be an integral part of the medical curriculum.
Table 2 outlines responses to questions on attitude regarding medical ethics by medical graduates, their decision-making in these contexts, the level of confidence in their education, and their perceptions of the adequacy of training in medical ethics.
Table 2.
Attitude of medical students toward medical ethics
| Response of questions | Frequency (%) |
|---|---|
| A terminally ill patient asks for help to end his or her life. What would you do? | |
| Decline to provide assistance and instead offer comfort care | 97 (70.3) |
| Explain the ethical issues concerned with such a decision and offer palliative care to ease suffering. Shall discuss DNR | 3 (2.2) |
| Explain the legal restrictions on euthanasia | 3 (2.2) |
| Give mental support and offer complete treatment, and offer comfort care | 4 (2.9) |
| I would continue to give my treatment, comfort care, and also advice psychological support, so as to enable the patient | 3 (2.2) |
| Respect the patient’s autonomy and support their decision to end their life | 28 (20.3) |
| Have you ever faced an ethical dilemma during your clinical training? | |
| Yes | 83 (60.1) |
| No | 55 (39.9) |
| If yes, how well do you think you handled the situation? | |
| Adequately | 111 (80.4) |
| Poorly | 10 (7.2) |
| Very well | 5 (3.6) |
| Well | 12 (8.7) |
| During your medical training, have you ever felt pressured to act against your ethical beliefs? | |
| Yes | 54 (39.1) |
| No | 84 (60.9) |
| Are you confident that your current medical curriculum offers sufficient training in medical ethics? | |
| Agree | 21 (15.2) |
| Disagree | 55 (39.9) |
| Neutral | 49 (35.5) |
| Strongly disagree | 13 (9.4) |
| What are your thoughts on the areas that require improvement in the medical ethics education provided at your institution? | |
| Integrated clinical training | 16 (11.6) |
| Integrated clinical training, workshops, simulation scenarios | 11 (8.0) |
| Integrated clinical training, workshops, simulation scenarios, guest lectures | 3 (2.2) |
| Lectures, practical case studies, integrated clinical training, simulation scenarios | 3 (2.2) |
| Lectures, practical case studies, integrated clinical training, workshops, simulation scenarios | 8 (5.8) |
| Lectures, practical case studies, integrated clinical training, workshops, simulation scenarios, guest lectures | 10 (7.2) |
| Practical case studies | 4 (2.9) |
| Practical case studies, integrated clinical training | 8 (5.8) |
| Practical case studies, integrated clinical training, simulation scenarios | 14 (10.1) |
| Practical case studies, integrated clinical training, simulation scenarios, guest lectures | 8 (5.8) |
| Practical case studies, integrated clinical training, workshops | 4 (2.9) |
| Practical case studies, integrated clinical training, workshops, guest lectures | 7 (5.1) |
| Practical case studies, integrated clinical training, workshops, simulation scenarios | 16 (11.6) |
| Practical case studies, integrated clinical training, workshops, simulation scenarios, guest lectures | 8 (5.8) |
| Practical case studies, simulation scenarios | 4 (2.9) |
| Practical case studies, workshops, simulation scenarios | 9 (6.5) |
| Workshops, simulation scenarios, guest lectures | 5 (3.6) |
| What are the chances of me receiving further education or training in medical ethics after completing my degree? | |
| Likely | 26 (18.8) |
| Moderately | 42 (30.4) |
| Unlikely | 39 (28.3) |
| Very likely | 8 (5.8) |
| Very unlikely | 23 (16.7) |
The majority (70.3%) of respondents chose to decline assistance and instead provide comfort care to a terminally ill patient. A smaller percentage, 20.3%, respects patients’ autonomy and supports their decision to end their life. 60.1% of respondents have encountered ethical dilemmas during their clinical training. Most respondents (80.4%) felt they handled the ethical dilemmas adequately, indicating a general sense of competence despite the challenges faced.
A majority (60.9%) of respondents reported not feeling pressured to act against their ethical beliefs, which is a positive sign for the ethical climate within their training programs. However, the 39.1% who did feel pressured raises concerns and indicates that some students may struggle with conflicting values in practice.
A considerable number of respondents (39.9%) believe the current medical curriculum does not provide sufficient training in medical ethics. Conversely, only 15.2% agree with its sufficiency of the current medical curriculum training in ethics. 11.6% respondents emphasized a need for integrated clinical training, workshops, practical case studies, and simulation scenarios.
Responses regarding the likelihood of receiving further training in medical ethics after completing their degree are mixed. While 30.4% feel moderately confident, a notable proportion (28.3%) thinks further training is unlikely.
DISCUSSION
The present study aims to understand the current levels of knowledge and attitude of medical graduates towards medical ethics. The study findings indicate that a significant majority of medical students (85.5%) have received formal training in medical ethics, with 54.3% considering it highly significant in clinical practice. Despite this, only 2.9% rated their understanding of medical ethics as excellent, suggesting a gap between training and confidence in ethical decision-making.
The findings of the study involving 138 medical graduate students reveal significant insights into their training and understanding of medical ethics within their curriculum and clinical practice. The majority (85.5%) of respondents have received formal training in medical ethics, suggesting it is a well-integrated part of their medical education. This finding is in harmony with Shetty and Geetha,[9] who reported similar results on medical ethics. Although the majority (85.5%) of respondents reported receiving formal training in medical ethics, only a small percentage (2.9%) rated their understanding as excellent. This discrepancy raises important questions about the effectiveness of the training provided and its practical application in clinical settings.
Several studies emphasize the necessity of integrating bioethics into the medical curriculum, highlighting that comprehensive training is crucial for developing competent medical professionals who can navigate ethical dilemmas effectively. This aligns with the current study’s finding that while formal training exists, many students still feel inadequately prepared to handle ethical challenges.[10,11]
Research conducted at various Indian institutions has indicated that traditional teaching methods, primarily lectures and textbooks, may not be sufficient for instilling a deep understanding of medical ethics. Many educators believe ethics education should be integrated into practical settings rather than taught in isolation or theory, which resonates with the current study’s findings on the sources of learning about medical ethics.[12,13] Past studies discuss how medical ethics education is often perceived as an add-on rather than a core component of medical training in India. This perception can lead to a lack of engagement and understanding among students, as noted in the current study, where a significant percentage rated their understanding as average or poor.[,14,15]
The recent overhaul of the undergraduate medical curriculum by the NMC mandates the inclusion of medical ethics, reflecting a growing recognition of its significance in clinical practice. The current study echoes this sentiment, with 94.2% of participants believing that medical ethics is significant or highly significant in their future roles as healthcare providers, similar to the results of previous studies.[,17,18,19,20]
Respondents in the current study learned medical ethics from a diverse array of sources, with textbooks and lecture classes being the most common. The combination of textbooks, lecture classes, clinical postings, and peer discussions indicates a multifaceted approach to learning, suggesting that learners draw from both formal education and more interactive, experiential methods. This is supported by the findings of Sharma et al.[18] who advocated the use of deliberate teaching as a source of learning medical ethics by students. The least commonly used sources (like virtual training and peer discussion alone) suggest that while these resources exist, they may not be primary avenues for learning. Virtual training as a source of learning medical ethics is preferred by very few (2.2%) respondents of our study, which is contrary to Govindraj et al.[15] who suggested the use of online platforms as a medium to learn medical ethics alongside clinical work.
While the current study indicates that 57.2% of students feel moderately assured about resolving ethical dilemmas, previous studies have shown that structured and integrated curricula can significantly enhance students’ confidence and competence in ethical decision-making. This is contrary to the study that found that continuous exposure to ethical discussions improved students’ ability to navigate complex ethical situations.[9,10] This suggests that despite formal education, Indian students may still lack sufficient confidence compared to their counterparts in better-structured programs.
Previous studies have pointed out systemic issues such as overcrowded curricula and a lack of trained faculty as barriers to effective ethics education in India.[16,21] The current study reflects some of these challenges but also shows a strong desire among students for improved integration of ethics into their education, indicating a potential gap between policy intentions and actual implementation.
Most respondents favor comfort care over active euthanasia, indicating traditional perspectives on these issues aligned with palliative care principles. A majority (60.9%) of respondents reported not feeling pressured to act against their ethical beliefs, which is a positive sign for the ethical climate within their training programs. A considerable number of respondents (39.9%) believe the current medical curriculum does not provide sufficient training in medical ethics. Respondents emphasized a need for integrated training, workshops, practical case studies, and simulation scenarios. This feedback highlights a demand for more hands-on experience and interactive learning opportunities that could enhance students’ understanding and application of medical ethics in clinical settings.
The study highlights a significant ethical dilemma where 70.3% of respondents chose to provide comfort care rather than assist in ending a terminally ill patient’s life, while 20.3% respected the patient’s autonomy to end their life. This raises controversy regarding the balance between respecting patient autonomy and providing palliative care, especially in cultures where end-of-life decisions are heavily influenced by ethical, religious, or societal norms. Previous studies have shown that medical professionals often struggle with this balance, leading to varied approaches in clinical practice.[22]
The finding that 39.1% of respondents felt pressured to act against their ethical beliefs raises concerns about the ethical climate within medical training programs. This reflects broader issues within healthcare systems where institutional pressures may conflict with personal ethics, leading to moral distress among healthcare providers. Similar sentiments have been echoed in international studies, suggesting a systemic problem that requires attention.[23]
A considerable number of respondents (39.9%) of the present study believe that the current medical curriculum does not provide sufficient training in medical ethics. This perception contradicts the increasing emphasis on ethics education in medical schools worldwide and highlights potential gaps in curriculum design and implementation. The debate continues how best to integrate ethics training into medical education effectively.[23,24]
Future research could benefit from longitudinal studies tracking the effectiveness of ethics education over time, assessing how well graduates apply ethical principles in clinical practice after completing their training. Further research should explore how cultural contexts influence medical ethics training and decision-making processes among healthcare professionals across different regions and healthcare systems. Studies examining the relationship between institutional culture and the ethical behavior of healthcare professionals could provide valuable insights into how to foster environments that support ethical decision-making.
Strengths and limitations
By examining decision-making processes and perceived competence in handling ethical dilemmas, the study addresses the practical implications of ethics education. The study effectively identifies critical areas for improvement in medical ethics training, such as the need for integrated clinical training and workshops. The reliance on self-reported data may introduce bias, as respondents might overestimate their competence or downplay their struggles with ethical dilemmas. The cross-sectional nature of the study limits the ability to assess changes in attitudes and competencies over time. The current study is conducted within a single institution or region, so findings may not be generalizable to broader populations or different cultural contexts.
CONCLUSION
While there are positive indicators regarding medical graduates’ attitudes toward ethics and their perceived competence in handling ethical dilemmas, significant gaps remain in terms of curriculum adequacy and practical application of ethical principles. The integration of comprehensive ethics education throughout medical training is essential for fostering a robust understanding and capability to navigate complex ethical dilemmas effectively in clinical practice. The insights from the study underscore the importance of contextually relevant and integrated approaches to teaching medical ethics that can better prepare graduates for the ethical challenges they will face in their professional lives.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
Nil.
REFERENCES
- 1.Rameshkumar K. Ethics in medical curriculum; ethics by the teachers for students and society. Indian J Urol. 2009;25:337–9. doi: 10.4103/0970-1591.56192. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Young PD, Papanikitas AN, Spicer J. Medical ethics education as translational bioethics. Bioethics. 2024;38:262–9. doi: 10.1111/bioe.13257. [DOI] [PubMed] [Google Scholar]
- 3.Attitude. Ethics and Communication (AETCOM) Competencies for the Indian Medical Graduate. [[Last accessed on 2024 Dec 24]]. Available from: https://www.nmc.org.in/wp-content/uploads/2020/01/AETCOM_book.pdf .
- 4.Moreira F, Teixeira P, Leão C. Effectiveness of medical ethics education: A systematic review. MedEdPublish (2016) 2021;10:175. doi: 10.15694/mep.2021.000175.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Singh S, Sharma PK, Bhandari B, Kaur R. Knowledge, awareness and practice of ethics among doctors in tertiary care hospital. Indian J Pharmacol. 2016;48:S89–93. doi: 10.4103/0253-7613.193320. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Ranasinghe AW, Fernando B, Sumathipala A, Gunathunga W. Medical ethics: Knowledge, attitude and practice among doctors in three teaching hospitals in Sri Lanka. BMC Med Ethics. 2020;21:69. doi: 10.1186/s12910-020-00511-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Shrestha C, Shrestha A, Joshi J, Karki S, Acharya S, Joshi S. Does teaching medical ethics ensure good knowledge, attitude, and reported practice? An ethical vignette-based cross-sectional survey among doctors in a tertiary teaching hospital in Nepal. BMC Med Ethics. 2021;22:109. doi: 10.1186/s12910-021-00676-6. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Kokila S, Sivaprakasam P, Sudhir Ben Nelson BT, Midhun Kumar GH. Perception of interns and postgraduates towards medical ethics education. Int J Curr Microbiol App Sci. 2013;2:198–203. [Google Scholar]
- 9.Shetty KA, Geetha S. Perception on medical ethics in teaching among medical students in India. Bioinformation. 2022;18:613–6. doi: 10.6026/97320630018613. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Allana AA, Ali SK, Ghias K. Bioethics curriculum for undergraduate medical students: An evaluation study utilizing mixed methods approach. BMC Med Educ. 2024;24:385. doi: 10.1186/s12909-024-05376-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Nayak V, Nayak KR, Goyal S, Jain S, Prabhath S, Palimar V, et al. Tangible impact of patient communication modules on medical students and interns. Adv Physiol Educ. 2024;48:40–8. doi: 10.1152/advan.00092.2023. [DOI] [PubMed] [Google Scholar]
- 12.Singh S, Solanki M, Vaney N, Bhan A. Medical ethics teaching in the new undergraduate physiology competency-based curriculum in medical institutions in Delhi: A pilot, feasibility study. Indian J Med Ethics. 2023;VIII:209–15. doi: 10.20529/IJME.2023.018. [DOI] [PubMed] [Google Scholar]
- 13.Ghosh A, Bir A. Role of written examination in the assessment of attitude ethics and communication in medical students: Perceptions of medical faculties. J Educ Health Promot. 2021;10:23. doi: 10.4103/jehp.jehp_424_20. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Giubilini A, Milnes S, Savulescu J. The medical ethics curriculum in medical schools: Present and future. J Clin Ethics. 2016;27:129–45. [PubMed] [Google Scholar]
- 15.Govindraj L, Santhosh S, Sunish SC, Gopalakrishnan AV, Chandy SJ, Oommen V, et al. Effectiveness of teaching medical ethics to medical students on an online platform: An analysis of students’ perceptions and feedback. Indian J Med Ethics. 2023;VIII:32–8. doi: 10.20529/IJME.2022.034. [DOI] [PubMed] [Google Scholar]
- 16.Patil JS, Latha S, Patil V, Hugar L. Competency-based medical education: Perception and challenges among students. J Datta Meghe Inst Med Sci Univ. 2023;18:63–9. [Google Scholar]
- 17.Lal S, Sehgal P. Integration of attitude, ethics, and communication competencies into competency-based UG curriculum. Indian J Community Med. 2022;47:4–7. doi: 10.4103/ijcm.ijcm_1022_21. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Sharma S, Sharma R, Khyalappa RK, Sharma S, Kandoth S. Student perceptions: Background to a new ethics curriculum in Indian medical colleges. J Educ Health Promot. 2021;10:284. doi: 10.4103/jehp.jehp_982_20. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Udgiri R, Ganganahalli P. Perceptions of attitude, ethics, and communication (AETCOM) modules among Indian medical graduates in their first professional year: An educational observational study. Cureus. 2024;16:e64611. doi: 10.7759/cureus.64611. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Rani V. Knowledge and attitude about medical ethics among undergraduate medical students – A cross sectional comparative study. Indian J Health Sci Biomed Res (KLEU) 2022;15:131–6. [Google Scholar]
- 21.Mahajan R, Aruldhas BW, Sharma M, Badyal DK, Singh T. Professionalism and ethics: A proposed curriculum for undergraduates. Int J Appl Basic Med Res. 2016;6:157–63. doi: 10.4103/2229-516X.186963. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Lo B, Malina D, Pittman G, Morrissey S. Fundamentals of medical ethics – A new perspective series. N Engl J Med. 2023;389:2392–4. doi: 10.1056/NEJMe2308472. [DOI] [PubMed] [Google Scholar]
- 23.Roy S, Shah MH, Ahluwalia A, Harky A. Analyzing the evolution of medical ethics education: A bibliometric analysis of the top 100 cited articles. Cureus. 2023;15:e41411. doi: 10.7759/cureus.41411. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.Hlaing PH, Hasswan A, Salmanpour V, Shorbagi S, AlMahmoud T, Jirjees FJ, et al. Health professions students’ approaches towards practice-driven ethical dilemmas; a case-based qualitative study. BMC Med Educ. 2023;23:307. doi: 10.1186/s12909-023-04089-4. [DOI] [PMC free article] [PubMed] [Google Scholar]