Demographic characteristics, including anticipated length to graduation, age, gender, race and ethnicity, undergraduate major and previous ethics education of respondents are displayed in Table 1 based on respective educational program. The majority of respondents were female (333, 59.3%), white (326, 58.0%), mid–20s in age (340, 60.5%) and with 2–3 years (297, 52.8%) remaining in their respective degree program prior to graduation. A notable majority of nursing students (32, 40.5%) were over 33 years of age, while all BS/(D)MD students (70, 100%) were under 22 years of age. A large majority of the BS/(D)MD students (63, 90.0%) indicated an Asian race.
Table 1 Demographic characteristics of respondents across all educational programs (n = 562)
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The majority of students indicated an undergraduate major in biological sciences (329, 58.5%). Students across educational programs reported a varying amount of previous ethics coursework or training, with almost half of the respondents (267, 47.5%) reporting no prior ethics education or training. A large percentage of SOM (168, 49.4%), BS/(D)MD (46, 65.7%) and DPT (31, 42.5%) students reported no previous bioethics or medical ethics education, while a majority of nursing students (57, 72.2%) indicated they had some form of previous ethics training or coursework.
Perceived Need for Medical Ethics Education
Most respondents (340, 60.6%) across all degree programs endorsed interest in a more formalized medical ethics education curriculum in addition to the medical ethics currently integrated into their respective degree program coursework. Expressed interest was highest among BS/(D)MD undergraduate students (59, 84.3%) and lowest among DPT students (38, 52.8%).
Respondents were asked to rate the importance of understanding fundamental principles of medical ethics and bioethics to their future careers from 1 “not important at all” to 5 “very important”. The majority of students (522, 92.9%) across all degree programs reported an understanding of ethics as somewhat (172, 30.6%) or very important (350, 62.3%) to their future career as displayed in Figure 1. The BS/(D)MD undergraduate students [4.89 (0.32)] placed more importance on understanding of ethics to their future career when compared to all other groups (p <.001), whereas the DPT graduate students [4.34 (0.84)] displayed the lowest level of importance of ethics understanding to their future career (p <.001). While there were no statistically significant differences between medical students in preclinical versus clinical years, the perceived importance of ethics to future medical students declined across progressive cohorts [SOM students in preclinical years, 4.52 (0.89) and SOM students in clinical years, 4.36 (0.89)].
Figure 1 Importance of medical ethics to participants’ future career by educational program (n = 562)
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While assessing respondent interest in a graduate-level medical ethics curriculum from 1 “very unlikely” to 5 “very likely”, 161 (28.6%) respondents showed interest as being somewhat likely (117, 20.8%) or very likely (44, 7.8%) to pursue graduate level training. As outlined in Table 2, interest in graduate level training was highest among BS/(D)MD undergraduate students [3.19 (1.04)] and lowest among medical students in clerkship years [2.49 (1.25)] and DPT graduate students [2.21 (1.11)]. A significant portion of BS/(D)MD undergraduate students (29, 41.4%, p <.001) reported that they were somewhat likely or very likely to pursue graduate level ethics education, compared to 10 (13.7%) DPT students and 37 (22.6%) medical students in their clerkship years.
Table 2 Respondent interest in pursuing graduate level medical ethics training by educational program (n = 562)
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Preferences for Medical Ethics Curriculum
Of the respondents (n = 161) who reported that they were somewhat likely or very likely to pursue graduate level ethics training, the top motivational factors for interest are illustrated in Figure 2. Importance to career (130, 80.7%) and desire to help others (124, 77.0%) were among the top two motivational factors reported across all programs. Enjoyment of learning (104, 64.6%) and desire to provide healthcare ethics consultation (81, 50.3%) were additional motivational factors for over half of all respondents.
Figure 2 Motivational factors for interest in graduate level ethics training across all educational programs (n = 161)
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In regard to preferred curricular format, respondents across all programs interested in pursuing graduate level training favored interest in the graduate certification program. Majority of respondents (141, 90.3%) were at least somewhat interested in a graduate certificate program (n = 156), and 49 (31.0%) respondents were at least somewhat likely to pursue a master’s degree program (n = 158, p <.01). CON students preferred a fully online program, whereas SOM, BS/(D)MD and DPT students preferred a hybrid learning format.
The top educational components desired among respondents interested in pursuing graduate level training in a medical ethics curriculum are illustrated in Figure 3. Ethics case-based discussions (130, 80.7%) and ethics guest lectures (126, 78.3%) were among the top two components desired in the curriculum across all respective degree programs. Ethics discussions in small peer groups (101, 62.7%), an introductory course in foundations of bioethics (100, 62.1%), faculty-student mentorship sessions (99, 61.5%), palliative care/hospice clerkship rotation (94, 58.4%) and healthcare ethics consultation review committee exposure (89, 55.3%) were additional educational components desired by over half of the respondents.
Figure 3 Educational components desired in graduate level ethics training across all educational programs (n = 161)
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