Assessment of Knowledge, Attitude and Practice of Medical Ethics and Associated Factors Among Surgery Residents in Addis Ababa University: a Cross Sectional Study

doi:10.21203/rs.3.rs-2976301/v1

Download PDF

Research Article

Assessment of Knowledge, Attitude and Practice of Medical Ethics and Associated Factors Among Surgery Residents in Addis Ababa University: a Cross Sectional Study

https://doi.org/10.21203/rs.3.rs-2976301/v1

This work is licensed under a CC BY 4.0 License

Version 1

posted

You are reading this latest preprint version

Introduction

Medical ethics is concerned with principles of moral issues and their application in various medical practice. While there is a growing public concern about the conducts of physicians as “poor adherence to ethical principles” in general, there is no published study done about the knowledge, attitude and practice of surgery trainees at Addis Ababa University. This study aimed to assess the knowledge, attitude and practice of surgery residents with some associated factors regarding to medical ethics.

Methodology

A sample of the residents in surgery department were the study participants. Data was collected by a self-administered questionnaire distributed using Google Forms on the internet. It was analyzed using SPSS 2020.

Results

A total of 133 residents were included with male to female ratio of 5.3:1 and 66.2% between the ages 24 to 29 years. About 78.2% of the residents are not satisfied with their work. Most took formal medical ethics course (83.5%), took any form of training (75.2%), and read Hippocratic Oath (86.5%). However, few of them read Nuremberg code (17.3%), Declaration of Geneva (18%), and medical ethics booklet in Ethiopia (29.3%). The percentage of respondents who gave correct answers to the questions of autonomy, justice and non-maleficence was 94%, 75.9% and 85% respectively. The question about beneficence was correctly answered by 53.4%. Using 25% level of significance, knowledge, attitude and practice levels analysis shows only 23(17.3%) are knowledgeable, 47(35.3%) have positive attitudes and 45(33.8%) have good practices of code of ethics. Multivariate analyses shows significant associations between reading general ethics books and knowledge level, between attitude level and knowledge level, level of satisfaction as well as between practice level and work experience, taking formal medical ethics course and level of satisfaction.

Conclusion

The overall assessment of knowledge, attitude and practice is unsatisfactory. Knowledge level, level of satisfaction, work experience and taking formal medical ethics course are factors significantly associated with positive attitude and practice level in a positive way.

medical ethics

knowledge

attitude

practice

Ethics is the study of morality – careful and systematic reflection on and analysis of moral decisions and behavior. As a system of study it tries to guide us to do “what is good” in our daily activities. Medical ethics - a branch of ethics - is concerned with principles of moral issues and their application in different fields of medical practice. [1, 2]

In the history of medicine important professional oaths have been publicly and solemnly pledged by physicians as they are admitted to the medical profession. The first of these professional codes was the Oath of Hippocrates, 4th century B.C. Others like Oath of Maimonides, around the 12th century A.D, Thomas Percival’s draft of Code of Medical Ethics in 1803 which become significant contribution to the modern western ethical history, later become adopted as a Code of Ethics by the American Medical Association’s in 1947. These different Oaths and codes served as a foundations to base and guide physicians moral decisions while practicing medicine in the best interest of the patient. However after World War II, the world learned the horrors of German doctors working in the concentration camps and conducting deadly scientific experiments in which the subjects had no say. This and similar other conducts shifted the paradigm of physician autonomy into patients autonomy. The Hippocratic Oath was first revised and brought up-to-date by the World Medical Association as the Declaration of Geneva which was adopted by the Third General Assembly of the World Medical Association at Geneva, Switzerland, September 1948 and, later, by the International Code of Medical Ethics adopted by the General Assembly of the World Branch Association held In London, England, October, 1949. The World Medical Association (WMA) since its establishment in1964 was sworn to put patients’ interest first and to strive for the best possible health care for all regardless of race, creed, political allegiance and social standing. Its major activity was focused on medical ethics, medical education and socio-medical affairs. In 2003 WMA established an Ethics Unit with main goal to establish and promote highest possible standards of ethical behavior and care by doctors. [3–5]

In Ethiopia, the Ministry of Health together with EMA and medical schools prepared an ethical code booklet entitled “Medical ethics for physicians practicing in Ethiopia” in 1988. Since its second edition in 1992, it is still the binding ethical document that assists practicing doctors not to be involved in malpractice and thereby protects the public at large.

However, until recently, the general curricula of the existing medical schools in Ethiopia didn’t not include medical ethics course. The recent move towards teaching medical ethics in as part of the undergraduate curriculum is an awareness of inadequacy of the “hidden curriculum” to maintain a culture of strict adherence to codes of ethics and a change of the society on one side and technological advancement on the other side. Medical ethics in post graduate residency program is still not included in the curricula. [5–6]

Looking into the basic principles, throughout almost all of recorded history and in virtually every part of the world, being a physician has meant something special. People come to physicians for help with their most pressing needs – relief from pain and suffering and restoration of health and well-being. They allow physicians to see, touch and manipulate every part of their bodies, even the most intimate ones. This great responsibility of physicians is supposed to decide and be guided by general ethical principles/values. Many professional ethicists recommend using four basic values, or principles, to decide ethical issues: These four basic principles are: Autonomy (patients basically have the right to determine their own healthcare), Justice (distributing the benefits and burdens of care across society), Beneficence (doing the good for the patient) and Non-maleficence (making sure you are not harming the patient). [2, 7, 8]

In addition there are other important values to consider, such as truth-telling, transparency, showing respect for patients and families, and showing respect for patients' own values. Medical ethics is not just a thought process. It also involves people skills, such as gathering the facts needed to make a decision and presenting the decision in a way that wins over the confidence of all parties. (9)

Surgery being as one of the medical fields, its practice is highly associated with ethical issues. It involves taking any relevant history from the patient, doing physical examination and requesting different types of laboratory and radiological studies to diagnose the specific disease the patient is suffering. Relieving suffering in surgery is more complicated as it involves cutting someone’s body. The actions taken by the practitioner could have been taken as a crime (like cutting someone’s body), if the intention of the practice was not to treat illness. In all of these actions of diagnoses and treatment, the surgeon or the surgical practitioner should develop trust which makes also the healing process more effective. Such an act of practice needs to abide to the core values of medical ethics strictly because it is when patients trust their surgeons, they submit to surgery (7, 9). Surgeons have always tried to limit the harm that they do to their patients in extending the healing power of their craft, but historically they have commonly taken unilateral decisions on the acceptability of risks, and patient choices. Current practice must entail sharing the right to make clinical choices with patients, with families, with other physicians, and with the managers of necessary resources. Surgeons, surgical trainees, and medical students in a changing world need a reliable scholarly source to help them chart the shifting terrain of surgical ethics so that they can conduct themselves in a morally responsible fashion in patient care, surgical research, and education (8). While there is a growing public concern about the conducts of physicians in general as “poor adherence to codes of ethics”, there is no published study done about the knowledge, attitude and practice of surgery trainees at Addis Ababa University.

A review of three years (January 2011 to December 2011) analysis of medical malpractice, claims and measures proposed by the federal health professionals’ ethics committee of Ethiopia showed sixty complaints among health professionals. Of which nine of the claims were against General Surgeons, which makes them to stand second, next to Obstetrics and Gynecology Specialists. The committee verified significant number (23.3%) of the claims were associated with ethical breach, though the majority (76.7%) of the claims were said to be wrong. (10) Another study recently done on the practice of code of ethics on 500 doctors in both private and government hospitals in Addis Ababa, showed that only 152 (30.4%) of medical doctors had good practice of code of ethics, which concludes overall poor practice of code of ethics. According to this study, identified determinants of practice of code of ethics were age, type of hospital, knowledge, attitude, lack of motivation, unfavorable working environment, working at various health facilities simultaneously, public awareness, medical ethics course, lack of unethical conduct reporting and compliant handling system, incompetence of medical doctors and weak collaboration among key stakeholders.(11) In support of the above literatures, a study done at Wolaita Sodo University showed the overall satisfaction of outpatient health care services provided by teaching Hospital was low.(12)

Similar study done in Nepal on the knowledge, attitude and practice of resident doctors, demonstrated that a significant proportion of the doctors were unaware of major documents of healthcare ethics: Hippocratic Oath (33% of doctors were unaware), Nuremberg code (90% were unaware) and Helsinki Declaration (85% of doctors were unaware). A high percentage of respondents said that their major source of information on healthcare ethics were lectures (67.5% doctors), books (62.4%), and journals (59%). (13) Another done in one of the teaching hospital of showed Pakistan showed the knowledge of medical ethics and its application on the surgical floors is extremely poor. In this study, the knowledge, attitude and practice of medical ethics among surgical residents and interns in three teaching hospitals of Pakistan was assessed. The results showed over 50% of the respondents had heard about the Code of Ethics formulated by the Pakistan Medical and Dental Council and 43.6 had read the code. Seven percent of them had no knowledge about it. Forty-seven percent reported taking consent for procedures. Forty-two percent of respondents gave correct answers on questions of confidentiality and knowledge of law pertaining to trauma victims. Only 11percent reported having been taught ethics as students. Recently graduated doctors respond less correct answers. (14) A cross-sectional study, conducted in a university hospital of Egypt, assessed the knowledge, perceptions and practices towards medical ethics of physician residents. In this study, self-administered structured questionnaire was used for knowledge and perceptions and a checklist for observations of doctor–patient interactions in the outpatient setting. The result has shown, only 18.0% of the 128 participating residents had obtained their knowledge from their medical education. Most of the residents had satisfactory knowledge and 60.2% had satisfactory perceptions regarding ethical issues. The lowest perception score was in the domain of disclosing medical errors. Only 48.0% of the residents were compliant with the principles of medical ethics in practice and 52.0% of patients were dissatisfied with their treating physicians. (15)

The objective of the study is to assess the knowledge, attitude and practice of medical ethics and associated factors among surgery residents in the department of surgery at AAU, CHS.

Study settings

A cross-sectional study was conducted among surgery resident doctors in the department of surgery, CHS, AAU. There were about 231 surgery residents on training in the time of the study, of which 123 general surgery residents, 22 pediatrics surgery residents, 26 Urology residents, 45 Neurosurgery residents, and 15 Plastic and Reconstructive surgery residents. These residents practice in different teaching hospitals of Addis Ababa University.

Study Population

Surgery residents at AAU are postgraduate students who underwent 4 to 5 years of training to become a certified surgeon in their respected units. They underwent an average of 5–6 years undergraduate training in different medical schools of the country including one year of internship. There work experience before becoming a resident, as a general practitioner differ from person to person.

Questionnaire and Variables

A 50 item self-administered structured questionnaire was adapted from the literature reviews and from the standards set by different codes of ethics. The major parts of the questionnaire were sociodemographic data, knowledge, attitude and practice of medical ethics questions. Eleven questions were designed to assess the respondents’ knowledge about medical ethics which contain “YES” or “NO” responses as well as multiple choice questions. The first seven questions were designed to assess the source of medical ethics knowledge and the next four multiple choice questions were questions about the four basic principles of medical ethics (Autonomy, Beneficence, Non maleficence and Justice). Responses to the questions were values as zero for those who said “NO” for the first seven questions and gave incorrect answer for the other for questions, one was given to those who said “YES” and gave correct answer respectively. The 16 attitude questions as well as the 14 practice questions were designed as Likert scale and scored from 1 to 5 accordingly.

The variables were classified as dependent variables that includes knowledge on medical ethics codes, attitude on medical ethics codes and adherence/practice on medical ethics. The independent variables were socio demographic characteristics, year of training, work experience, level of satisfaction, ethics training/reading of ethics books, literatures, reading different code/declaration of ethics, attitude level as well as practice level.

Operational Definitions

Knowledge

The knowledge that the respondents have regarding basic concepts of medical ethics and different code of ethics.

Attitude

The feeling and beliefs of respondents with regard to the ethical issues.

Practice

The actions being done by the respondents regarding ethical conduct.

The knowledge, attitude and practice levels’ operational definitions are shown on Table 1.

Table 1

Operational Definition for Knowledge, Attitude and Practice level
		Score	Percentage
Knowledge level	Knowledgeable	> 8/11	≥75%
Knowledge level	Not knowledgeable	≤ 8/11	<75%
Attitude Level	Positive Attitude	≥ 60/80	≥75%
Attitude Level	Negative Attitude	< 60/80	<75%
Practice level	Good practice	> 52/70	≥75%
Practice level	Poor Practice	≤ 52/70	<75%

Sampling procedure and data collection

A convenient non random sampling technique was followed and the sample size (n) was calculated according to the modified Cochran formula (n = n₀/(1+(n0-1/N)) where n0 = z²*p (1-p)/ME², where z = 1.96, P = 0.5, N = 231, ME = 0.05) which was 144. Data was collected by a self-administered questionnaire distributed using Google Forms on the internet by sending the link to the telegram groups of the residents as well as by a private message.

Data analysis

Data was analyzed using Statistical Package for Social Sciences (SPSS) version 20 after it was encoded on excel and imported to SPSS. Descriptive statistical analyses was done using simple frequency and percentages as well as cross tabulations with Chi square tests for univariate analyses. Multivariate analyses was done by using binary logistic regression to identify significantly associated factors.

Ethical approval

Ethical clearance was obtained from the college and department research committee and participants gave their consent through online consent form.

Out of 144 respondents, 133 had responded all the required questions making the response rate 92%.

Sociodemographic characteristics

As shown in table 2, the sociodemographic data shows majority of study participants (112/133, 84.2%) were males making male to female ratio 5.3:1. About 88(66.2%) of study participants’ age is below 30 yrs. (24-29 yrs.). Orthodox Christians account 85(63.9%), followed by Protestants 26(19.5%).

Majority of the study participants (78.2%) are not satisfied with their work. There were more senior residents (third year and above) than junior residents (42.9%). The number of residents having work experience less than four years with that of work experience four and above is comparable 50.4% vs.49.6%.

Table 2: Sociodemographic characteristics of surgery residents (N = 133)

Characteristics		Frequency	Percentage
Age	Less than 30 years	89	66.9%
Age	Thirty years and above	44	33.1%
Sex	Male	112	84.2%
Sex	Female	21	15.8%
Religion	Orthodox	85	63.9%
	Muslim	13	9.8%
	Protestant	26	19.5%
	Others	9	6.8%
Level of Training	Junior Residents	57	42.9%
Level of Training	Senior Residents	76	57.1%
Work Satisfaction	Satisfied	29	21.8%
Work Satisfaction	Not Satisfied	104	78.2%
Work Experience	Less than 4 years	67	50.4%
Work Experience	Four years and above	66	49.6%

Knowledge

Source of Knowledge

Most of the respondents (83.5%) took formal medical ethics course, took any form of training (75.2%), and read Hippocratic Oath (86.5%). However the few of them read Nuremberg code (17.3%), Declaration of Geneva (18%), and medical ethics booklet in Ethiopia (29.3%). The results the respondents’ sources of knowledge are shown on table (Table 3).

Table 3: Source of Medical Ethics Knowledge (N=133)

	Yes
	Frequency	Percentage
Took medical ethics as a course	111	83.5
Took any medical ethics Training (workshops, case conferences, Lecture, …)	100	75.2
Read general ethics books, journals	69	51.9
Read Hippocratic oath	115	86.5
Read Nuremberg code/Declaration of Helsinki	23	17.3
Read Declaration of Geneva	24	18
Read ‘Medical Ethics for physicians’ booklet in Ethiopia	39	29.3

Knowledge of core principles of medical ethics (MCQs)

In regard to the knowledge of core principles, most of the participants responded the correct answers for autonomy, justice and non-maleficence, 94%, 75.9% and 85% respectively. The question about beneficence was correctly answered only by 53.4%. (See Bar chart 1)

Knowledge, Attitude and Practice level

Using 25% level of significance, knowledge, attitude and practice levels were analyzed after score was made from the respective questions and changed into percentage (according to the operational definition using cut off value 75%). Majority of the respondents fall in low level of knowledge, poor practice and negative attitude. (See table 4 below)

Table 4: Levels of each category (KAP) score (N =133)

		Frequency	Percentage
Knowledge level	Knowledgeable	23	17.3
Knowledge level	Not knowledgeable	110	82.7
Attitude Level	Positive Attitude	47	35.3
Attitude Level	Negative Attitude	86	64.7
Practice level	Good practice	45	33.8
Practice level	Poor Practice	88	66.2

Associated Factors

Univariate analyses among the listed independent variables, variables found to have associations with knowledge level were: level of training ( X² = 5.667, p = 0.017), taking medical ethics course (X² = 5.512, p = 0.019), reading Hippocratic oath(X² = 4.353, p = 0.037), reading general ethics books(X² = 21.343, p = 0.000), reading Nuremberg code or declaration of Helsinki (X² = 87.947, p = 0.000), reading declaration of Geneva ( X²= 41.843, p = 0.000) as well as work experience (X² = 4.096, p = 0.043). However the multivariate analyses of the above variables regarding to the knowledge level shows only those who read general ethics books show significant association (AOR = 20.109, 95% CI: 1.255, 321.992).

On the other hand univariate analyses of the independent variables done to see any association with attitude level was found level of training (X²= 6.318, p = 0.012), level of satisfaction (X² = 6.385, p = 0.012) , reading general ethics books(X² = 4.158, p = 0.041) as well as knowledge level (X² = 5.654, p = 0.017). In this regard, multivariate analyses has shown both knowledge level and level of satisfaction having significant associations with attitude level. (See table 5)

Table 5: Multivariate analyses using binary logistic regression of associated factors with Attitude level (N = 133)

Characteristics

Attitude level

P value

AOR

95% CI

Positive attitude

Negative attitude

Lower

Upper

Level of work satisfaction

Satisfied

0.012*

0.329

0.138

0.780

Not satisfied

Knowledge level

Knowledgeable

0.020*

0.325

0.127

0.835

Not knowledgeable

In the univariate analyses of factors associated with ethical practice level are age (X²= 5.258, p = 0.022), level of satisfaction (X²= 10.177, p = 0.001), taking formal medical ethics course (X²= 7.209, p = 0.007), work experience (X²= 7.220, p = 0.007) as well as reading Hippocratic Oath (X²= 4,802, p = 0.028). The multivariate analyses of logistic regression of this factors show significant association of practice level with work experience, taking formal medical ethics course as well as level of satisfaction. (See table 6 below).

Table 6: Multivariate analyses using binary logistic regression of associated factors with Practice level (N = 133)

Characteristics		Practice level		P value	OR	95% CI
		Good practice	Poor practice			Lower	Upper
Work experience	Less than 4 years	30	37	0.010*	0.353	0.160	0.783
	Four years and above	15	51
Level of work satisfaction	Satisfied	17	12	0.014*	0.322	0.130	0.795
	Not satisfied	28	76
Took medical ethics course	No	2	20	0.050*	4.699	1.001	22.046
	Yes	43	68

Our assessment of knowledge, attitude and practice of medical ethics among surgery residents revealed majority of the research participants has low level of knowledge, negative attitude and poor level of practices. Most of the reviewed literatures concluded satisfactory knowledge about the specific ethical principles, unfavorable attitude and poor practice. However where Knowledge about local and international codes of ethics is assessed knowledge is uniformly unsatisfactory. (9-12)

Knowledge

Knowledge of different code of ethics is generally low with significant number of them not read the Hippocratic Oath (13.5%), Nuremberg and declaration of Helsinki (86.7%), and Declaration of Geneva (76%). They have better awareness about Hippocratic Oath compared to research in Nepal (86.5% vs. 66%). However comparably unaware of the Nuremberg/Declaration of Helsinki, Declaration of Geneva (80-85% vs. 85-90%). Books and journals as source of knowledge are also used by participants though bit lower than the research in Nepal (52% vs 59-67%). (11-15)

About 75.2 - 83.5% of the study participants took medical ethics training and/or course. This is significantly higher in comparison with the Pakistan and Egypt finding (11% in Pakistan, 18% Egypt). However, most of them are not aware of the major medical ethics codes, this may be because of lack systematized ethics curriculum which includes the ethical codes.(11-15)

On the other hand most residents answered correctly the questions about the core principles of ethics (autonomy 94%, and Non-maleficence 85% and Justice 75.9%). Significant number of residents (46.6%) don’t responded correct answer to the question about beneficence, indicating that they are not well versed about the principles of beneficence.

The Odds of those who read general ethics books is 20.109 than the odds of those who don’t read general ethics books (AOR = 20.109, 95% CI: 1.255, 321.992).

Attitude

The positive attitude reflected in the results is only 35.7 %. This is lover in comparison to the research in Egypt which is 60.2%. Level of satisfaction, level of training, reading general ethics books and knowledge level were identified as having significant associations in the univariate analyses, However only level of satisfaction and knowledge level were found to have significant association in multivariate analyses. Those who are satisfied with their career are 67.1% less likely to have negative attitude than those who are unsatisfied with their career. (AOR = 0.329, 95%CI: 0.138, 0.780). Knowledgeable residents are 67.5% less likely to have negative attitudes. (AOR = 0.325, 95% CI: 0.127, 0.835).

Practice

The level of good medical ethics practice is only in 45 (33.8%) of the residents. This is comparable to a research done on doctors in Addis Ababa (30.2%), which concluded poor practice of ethics, as well as a research in Egypt (48%). (11)

Level of satisfaction, taking medical ethics course, reading Hippocratic oath as well as work experience have significantly associated in univariate analyses, but only level of satisfaction(AOR= 0.322, 95% CI: 0.130, 0.795) and work experience (AOR = 0.353, 95% CI: 0.160,0.783) were significantly associated in multivariate analyses.

Those who has less than 4 years’ experience are 64.7% less likely to have poor practice than those who have four and above years. This may be because of young doctors are more exposed to ethical education and eager to practice accordingly, less to burnout as well.

Knowledge, attitude, and practice study of medical ethics among surgery residents show only 23 out of 133 (17.3%) are knowledgeable, 47 out of 133(35.3%) have positive attitude, and 45 out of 133(33.8%) have good practice. This shows that overall assessment of knowledge, attitude and practice is unsatisfactory.

Though knowledge to core principles of medical ethics is good, most of the residents have no awareness about the different international codes. Those who read general ethics books, show significant association to have better knowledge. Knowledgeability and satisfaction are identified factors for having positive attitude. On the other hand level of satisfaction and work experience are factors significantly associated with ethical practice. In this study knowledge and attitude were not found significantly associated factors with practice.

There should be a paradigm shift that formal medical ethics training, should be included in the residency training, and systematized continuous medical ethics training and monitoring should be given to the residents. Level of satisfaction should be addressed by different ways of motivation, incentives as well as improving the working environment. As the work experience increases, good practice of ethics decreases, therefore the hidden curriculum shouldn’t be taken as granted.

Practice of code of ethics would have been better if done by observing at actual physician patient encounter than using self-administered questionnaire to decrease subjectivity. Factors that could affect the KAP of residents at a system (institutional) level were not assessed in this study. Online questionnaire has risk of being repeatedly filled by single person.

AAU Addis Ababa University

BMJ British Medical Journal

CHS College of Health Sciences

EMA Ethiopian Medical Association

JME Journal of Medical ethics

KAP Knowledge, Attitude, Practice

MCQ Multiple Choice Questions

SPSS Statistical Package for Social Sciences

WMA World Medical Association

Ethics approval and consent to participate

All the methods of this study were conducted strictly according to the applicable guidelines (of Declaration of Helsinki). Ethical approval was obtained from the Research Ethics Committee of the Department of Surgery in Addis Ababa University. Informed consent was taken from all the study participants using a consent form. The study was a web-based survey done using Google Form where the first page contained the consent form. Below the statement, a question asking the participants if they agreed to participate was placed. Participants willing to participate could proceed to the questionnaire by clicking “Next.” Data protection was ensured by storing the data in a password protected google drive accessible to investigators only. The consent form stated the purpose of the study, the investigators involved, and the voluntary nature of participation, with no benefits from participation mentioned. The informed consent form is attached along with the questionnaire (see Supplementary files 1 and 2). The confidentiality of the participants was assured by the use of unique codes and no personal identifiers were collected.

Consent for publication

Not applicable

Availability of data and materials

The datasets collected during this study will be available from the corresponding author on reasonable request.

Competing interests

The authors have no any conflicting interests to declare.

Funding

This study was partially funded by Addis Ababa University.

Authors' contributions

Abebe Mihret Hailu: made data collection, analysis and writing of this manuscript.

Berhanu Nega and Adamu Addissie: supervised the study process and reviewed this manuscript.

Acknowledgments

Our acknowledgements go to the department of surgery at Addis Ababa University and to all the study participants/surgery residents/.

Beauchamp TL, Childress JF. Principles of Biomedical Ethics, 5th Ed. New York: Oxford University Press; 2001.
World Medical Association, Medical Ethics Manual, 3rd ed. 2015
Reddy C: Medical Ethics. Indian Journal of Dent Res August 13, 2009, 18(2):47
Kalantri S. Ethics in medical education. Indian J Anaesth. 2003;47(6):435–6.
Ethiopian Medical Association: Medical Ethics for Doctors in Ethiopia. Addis Ababa, Ethiopia: Ethiopian Medical Association (EMA); April 2010
Hafferty FW, Franks R. The hidden curriculum, ethics teaching, and the structure of medical education. Acad Med. 1994;69(11):861–71.
Norman SW, Christophor JB, Ronan OC, Bailey and Love Short Practice of Surgery, 26th ed. Pp 155-57
Daniel EH, Peter A, Geoffrey PD, Daniel BH, and Timothy MP. Ethics, Palliative Care, and Care at the End of Life: Schwartz’s Principles of Surgery 10th ed. Pp 1941-45
McCullough L B, Jones J W and Brody B A, Surgical Ethics, New York, Oxford University Press, 1998
Biruk L, Mesafint A, Yeweyenhareg F, Abiy H, Yeneneh G: Analysis of Medical Malpractice Claims and Measures Proposed by the Health Professionals Ethics Federal Committee of Ethiopia: Review of the Three Years Proceedings. Ethiopian Medical Journal 2015, 53(Supp 1)
Tiruneh MA, Ayele BT (2018): Practice of code of ethics and associated factors among medical doctors in Addis Ababa, Ethiopia. PLoS ONE 13(8): e0201020. https://doi.org/10.1371/ journal.pone.0201020
Getu Gamo Sagaro, Alemayehu Worku Yalew, Mengistu Meskele Koyira. Patients' Satisfaction and Associated Factors among Outpatient Department at Wolaita Sodo University Teaching Hospital, Southern Ethiopia: A Cross Sectional Study. Science Journal of Clinical Medicine.Vol. 4, No. 5, 2015, pp. 109-116. doi: 10.11648/j.sjcm.20150405.16
Samaj A, Kumar P, Arja RA, TB, Adhikari,BK and Shiva RM: Knowledge, attitude and practice of healthcare ethics among resident doctors and ward nurses from a resource poor setting, Nepal, BMC Med Ethics. 2016
Shiraz B, Shamim MS, Shamim MS, Ahmed A: Medical ethics in surgical wards: knowledge, attitude and practice of surgical team members in Karachi, Indian Journal of Medical Ethics [01 Jul 2005, 2(3):94-96]
A.M. Mohamed, M.A. Ghanem and A.A. Kassem: Knowledge, perceptions and practices towards medical ethics among physician residents of University of Alexandria hospitals, Egypt, EMHJ Vol. 18 No. 9 2012

Chart 1 is available in the Supplementary Files section.

No competing interests reported.

Download PDF

Version 1

posted

You are reading this latest preprint version

Assessment of Knowledge, Attitude and Practice of Medical Ethics and Associated Factors Among Surgery Residents in Addis Ababa University: a Cross Sectional Study

Status:

Version 1

Abstract

Introduction

Methodology

Study settings

Study Population

Questionnaire and Variables

Operational Definitions

Sampling procedure and data collection

Data analysis

Ethical approval

Results

Discussion

Conclusions and Recommendations

Limitations

Abbreviations

Declarations

References

Chart

Additional Declarations

Supplementary Files

Status:

Version 1