Impact of a Novel Approach for Undergraduate Medical Ethics Education in The Middle East and South Asia

Abstract

Background Complexities of ethics education, combined with socio-cultural issues specific to the medical curricula of the developing country context, have created resource constraints that impact medical ethics education delivery in countries like Pakistan and Saudi Arabia. These constraints include the dearth of contextually relevant texts, shortage of trained teachers and confines in institutional regulations in the regions. Focused strategies are required to address these constraints. Workbook-based ethics learning (WBEL) is one such strategy based on a contextually relevant ethics education model. Purpose This study aimed to evaluate the effectiveness of ethics education, delivered through the WBEL strategy, on students’ learning and satisfaction in medical colleges of Pakistan and Saudi Arabia. Methods A pre-post-test intervention study was conducted in two medical colleges, Jinnah Sindh Medical University, Pakistan and King Abdulaziz University, Saudi Arabia. An ethics course was structured using the WBEL strategy and delivered to early clinical years medical students. The impact on student learning was measured by pre-and-post administration of a set of Key Feature Questions (KFQ) and a Script Concordance Test (SCT). A twenty-eight-item course feedback questionnaire was developed to collect students’ perceptions regarding the WBEL strategy. Results Of the total 125 students who consented, 90 (72%) completed the pre-and post-test measures, and 103 returned the feedback forms at the two sites. The post-test scores in KFQs were significantly higher than pretest scores in both Pakistani and Saudi students (p-value < 0.001). There was no significant pre-to-post difference in overall SCT scores (p = 0.057). The majority of participants considered the overall course to be valuable. They provided positive feedback on the Workbook’s usefulness and the enhancement of critical thinking within the course. Ethics case discussions, classroom quizzes, and reflective writing were considered most effective for learning during the course. Conclusion The findings suggest that the WBEL is a promising way forward in medical ethics education as it resulted in a notable increase in participants’ knowledge and ethical decision-making skills. The study also provides evidence of feasibility for using the WBEL strategy for teaching ethics in resource-limited regions.