Education of Medical Ethics in medicine

在日本，医学伦理是医学院的一项医学原则。但是，如何在实践中教授医学生涉及伦理困境的决策问题，目前尚不清楚。因此，我们对日本80所医学院进行了全国性的调查，以确定目前医学伦理学教学中的问题。我们询问了学生在医学院学习医学伦理学的方式和时间，以及一至六年级和研究生学习的目的、成就目标、内容和课程。对医学院教育事务的初步研究（回复率99%）表明，最低年级（一年级60.3%）教授医学伦理学的可能性最大，高年级（五至六年级分别为11%）教授医学伦理学的可能性较小。在讲授医学伦理学的讲师中，只有28%的人熟悉整个医学伦理学课程，只有15所医学院实行跨学院教学。教师对医学教学体系的满意度与“在床旁教学中引入医学伦理要素”有关。经讲师专业调整的logistic回归模型显示，医学伦理学教学内容的充分性与“与临床医生讨论”相关。指出医学伦理学教学的目标应该是为低年级学生提供一门学科，从小组讨论、案例研究和视觉教具中对医学伦理学产生兴趣开始，而不是仅仅听讲座。在高年级，引入更多的现实案例，培养医疗伦理意识，即临床伦理，对于建立医患信任关系，掌握沟通技巧，管理风险具有重要意义。尽管最近在实践中对医学伦理的认识有所提高，但医学院的教学人力资源仍然稀缺和不足。然而，日本应该更加重视医学伦理学的教学，特别是临床伦理学的教学，以及教师的教学和终身教育。少

Medical ethics is taught as a principle of medicine at medical schools in Japan. But it is not clear that how to teach decision making in practice which involves ethical dilemmas for medical students. Therefore, we conducted a national survey of 80 medical schools in Japan to identify the current issues in teaching medical ethics. We enquired how and when students learned medical ethics at medical school and also the objectives, achievement goals, contents and curricula for 1st to 6th grade and postgraduate studies.Preliminary study of educational affairs at the faculty of medicine (response rate 99%) showed that medical ethics is most likely to be taught in the lowest grade (1st year 60.3%) and less likely to be taught in the upper grades (5th-6th grade 11%,respectively). Only 28% of lecturers who teach medical ethics are familiar with the whole curriculum of medical ethics and only 15 medical schools had cross-faculty teaching. Lecturer's satisfaction for the system of teaching medic … More al ethics at medical school was related with 'introducing the element of medical ethics in bed-side teaching'. Sufficiency of contents for teaching medical ethics was associated with 'being discussed with clinicians' with logistic regression model adjusted by lecturer's specialty.It was indicated that teaching medical ethics should aim to have a discipline for the students in lower grades, starting from having an interest in medical ethics in group discussion, case study, and visual aids, rather than listening to lectures only. In the upper grades, introducing more realistic cases to cultivate the sense of ethics within healthcare, namely clinical ethics, is important to build relationship of trust between patients and doctors, acquire communication skill, and managing the risk. Despite the recent increased recognition of medical ethics in practice, the human resources for teaching at medical schools are scarce and insufficient. However, teaching medical ethics, especially clinical ethics should be more emphasized in Japan, along with teacher's teaching and career-long education. Less