Knowledge of Medical Ethics Among Medical Undergraduate Students in a Medical College in South India

Introduction: All around the world medical training has become more and more commercialized and medical ethics has taken a backseat. Doctors should know medical ethics not only just to avoid blame of negligence but they should also respect the human morals principles. If we teach ethics to medical students it has shown significant influence on professionalism and moral qualities of medical professionals. The aim of this study is to assess the knowledge of bioethics in medical undergraduate students in a medical college in south India. Materials and methods: The study is conducted on 108 undergraduate students who were studying at KMC, Manipal. A preformed proforma containing few questions regarding medical ethics will be given them to fill. The results are analyzed using simple statistics methods. Results: Our study showed that 86.11% of students have knowledge of ethics. 57.4% of the students think that knowledge of ethics is very important in medical curriculum. Conclusion: The study will help us to find the knowledge of medical ethics among the undergraduate medical student in a medical college in south India. It will also reflect the student view about the importance of knowledge of ethics in Medical curriculum.

Health professionals are often met with numerous ethical dilemmas during their routine daily practice. Now a day people are very much concerned about the ethical behavior of doctors. This is most commonly seen when they show grievances about reduced ethical behavior and an increase in the legal action against doctors (2).
There are numerous codes of behavior and laws regulating the profession have been incorporated in the health experts' teaching core programme in numerous countries, and there is an increase in the number of people who teach ethics and ethical committees. In spite of this, there is increase in grievances against healthcare professionals. This can be a because of either there is increase in people awareness about it or bad practices doctors (2).
The conventional medical curriculum teaching provides very little information on how to resolve ethical dilemmas which they will encounter when they will become a doctor. According to Medical council of India training undergraduate students in medical ethics is compulsory but it is taught in Forensic Medicine (3).
So, the objective of this study was to know about the knowledge of medical ethics in medical undergraduate students in a medical college in south India.

MATERIAL and METHODS
The study is conducted on 108 medical undergraduate students who have completed 1 year course of MBBS and are studying in 2nd year. The study was approved by the institutional ethics committee.
A preformed proforma containing 10 questions regarding medical ethics was given them to fill after taking informed consent. The results are analyzed using simple statistics methods.

RESULTS
The results of our study show that most of the students have knowledge of ethics. Most of the students don't know about nuremberg code and helsinki declaration. More than 50% of the students think that knowledge of ethics is very important in medical curriculum. Most of the students got the knowledge of Medical ethics from the lectures and seminars conducted for them.
In our study we found that 82.4% of the students know about informed consent and 87.96% students know that there is an ethics committee in our institution. Percentage of students answering each question is shown in table 1.

DISCUSSION
Nowadays, medical ethics is being commonly taught to undergraduate and graduate students during classes as well as in clinics (4). The goals of teaching medical ethics should be to (i) enable students to learn better the implications of ethics in all phases of their profession, (ii) prepare students to develop the skill to recognize fundamental ethical problems and difficulties in day to day medical practice, and (iii) train them to consider substitutes under the particular situations and make conclusions based on acceptable moral ideas and traditional practices.
Janakiram C did the study about knowledge of ethics in medical and dental postgraduates he found that Medical and dental postgraduates get to know about bioethics from "other sources such as the Internet, newspapers, etc", followed by their "undergraduate training" and"experience at work". But in our study most of the students got the knowledge of ethics from lectures/seminars. Nearly 68% of the postgraduates did not had any bioethics training and in our study 63.88% had not undergone any training. About 98% of the medical postgraduates knew about ethics committee in their institution while in our study 87.96% of students know that our institution has an ethics committee(3). Seetharaman Hariharan et al conducted a study on all ranks of staff in Queen Elizabeth Hospital in Barbados to know about the awareness of healthcare ethics, law and the role of an Ethics Committee in health care organization. They found that 11% of the doctors did not know what the Hippocratic Oath contain in our study also 12.96% of students do not know about Hippocratic Oath. In their study 29% of doctors did not know that their hospital had a ethics committee and in our study 12.03% of students do not know that our institution has an ethics committee (2).
Bernard Asamoah Barnie et al conducted a study on health care workers to check their knowledge and opinion regarding their training in ethics, confidentiality and medico-legal issues. They found that 74% had knowledge on ethics while in our study 86.11% students had the knowledge of Medical ethics (5).
Aacharya RP , Shakya YL conducted a study on 46 Medical undergraduate interns of Maharajgunj Medical Campus, the medical college of Nepal. They found that the most common source of knowledge on ethics for them was lectures/seminars (35.7%) followed by experience at work (24.5%), training (21.4%) and own reading (17.3%) in our study also the most common source was lectures/seminars (41.6%) followed by own reading (21.2%), training (20.3%) and others (internet, newspapers etc) (3%). The main contents of Hippocratic Oath were known to 98.8% but in our study 87.03% of student knows about Hippocratic Oath. Great majority (91.3%) regard ethics as very important in medical profession but in our study only 57.4% think that ethics as very important in medical profession (6).
Chatterjee B, Sarkar J conducted a study to assess the knowledge of and attitudes towards medical ethics among 322 undergraduate medical students of a medical college in West Bengal. They found that the students generally agreed that awareness of ethics was important but in our study only 57.4% think that ethics as very important in medical profession. For their students lectures (54.7%) and books (47.8%) were the predominant sources of knowledge in our study also lectures/seminars (35.7%) were the predominant source followed by experience at work (24.5%). In their study only 10.9 % were aware of the existence of an institutional ethics committee but in our study 87.96% know that there is an ethics committee in our institution (7). Adhikari S, Paudel K, Aro AR, Adhikari TB, Adhikari B and Mishra SR conducted a study on 118 resident doctors and 86 ward nurses in the tertiary care teaching hospital of Nepal. They found that 33 % of doctors and 51 % of nurses were unaware Hippocratic Oath but in our study only 12.9% of students were unaware of Hippocratic Oath. They also found that 90% of both groups were unaware of Nuremberg code in our study also 72.22% of students were unaware of Nuremberg code. In their study 85 % of doctors and 88 % of nurses were unaware of Helsinki Declaration in our study also 74.07% students were unaware of Helsinki Declaration. In their study major source of information on healthcare ethics were lectures (67.5 % doctors versus 56.6 % nurses) followed by books (62.4 % doctors versus 89.2 % nurses), and then journals (59 % doctors versus 89.2 % nurses) in our study also most common source was lectures/seminars (41.6%) followed by own reading (21.2%), training (20.3%) and others (internet, newspapers etc.) (3%) (8).
Awareness of medical ethics is a necessary part of routine clinical practice. Medicine is one of the few professions that defines a code of conduct for its doctors.
Students need to develop a balanced attitude to resolve medical problems that they will face in the future. So, as they learn different subjects in their medical curriculum they will also learn to treat medical complications, in the same way they should also learn on how to tackle ethical dilemmas which they can face during their practice in the future.