The ethics of increasing medical student numbers in a resource constrained setting
Date
2019
Authors
Menezes, Colin Nigel
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Abstract
Background:
There is an urgent need to increase the number of doctors in South Africa. This study provides a local context where it specifically examines the ethical implications of patients’ rights being affected in medical education in a South African setting and sets out to provide empirical evidence for optimum student to patient ratios to substantiate solutions for this dilemma.
Methods:
Empirical studies contribute to the field of ethics and therefore, this study includes both a normative and a descriptive component. For the empirical study, 118 patients were interviewed and 120 students were invited to complete a self-administered questionnaire. These participants were approached from four Departments - Surgery, Internal Medicine, Obstetrics & Gynaecology and Paediatrics in an academic teaching hospital in Johannesburg.
Results:
The Constitution, National Health Act (NHA) and Patients’ Rights Charter advocate for access to healthcare. The State’s ethical obligations conflict with its utilitarian policy attempts that allow for medical education to achieve healthcare at the cost of violating patients’ rights and accepts that certain actions are imperative to achieve a better healthcare system, in line with the spirit of Ubuntu. On the other hand, Principlism and Kantism, together with the Constitution and NHA focus on maintaining patients’ autonomy, right to
privacy and dignity, informed consent and confidentiality whether they accept or refuse healthcare choices. The roles of students are not formally discussed in these documents.
The empirical aspect of the study revealed that a third of patients were unaware that they were admitted to a teaching hospital and half of them were unaware of their right to refuse interaction with students. The majority of patients and students preferred smaller groups of no more than eight students per tutorial. Most patients wanted supervision during an encounter. The majority of patients said they never refused consent to students, while a third of students said at least up to three patients refused consent to be examined by them. The common reason cited by students for refusal of consent by patients was the exposure to excessive numbers of students and healthcare professionals.
Conclusion:
Patients need to be educated on their role in medical education. Institutions need to take cognisance of numbers of students that patients can tolerate. This highlights the urgent need for guidelines on the student-patient interaction including student to patient ratios by the Health Professions Council of South Africa (HPCSA) and medical schools.
Description
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, in partial fulfilment of the requirements for the degree of Master of Science in Medicine in Bioethics and Health Law