Experience of Indonesian medical students of ethical issues during their clinical clerkship in a rural setting

Raditya Bagas Wicaksono; Miko Ferine; Diyah Woro Dwi Lestari; Arfi Nurul Hidayah; Amalia Muhaimin

doi:10.18502/jmehm.v14i6.6750

Raditya Bagas Wicaksono Lecturer, Department of Bioethics and Humanities, Faculty of Medicine, Universitas Jenderal Soedirman, Purwokerto, Indonesia.
Miko Ferine Lecturer, Department of Bioethics and Humanities, Faculty of Medicine, Universitas Jenderal Soedirman, Purwokerto, Indonesia.
Diyah Woro Dwi Lestari Lecturer, Department of Bioethics and Humanities, Faculty of Medicine, Universitas Jenderal Soedirman, Purwokerto, Indonesia.
Arfi Nurul Hidayah Lecturer, Department of Bioethics and Humanities, Faculty of Medicine, Universitas Jenderal Soedirman, Purwokerto, Indonesia.
Amalia Muhaimin Lecturer, Department of Bioethics and Humanities, Faculty of Medicine, Universitas Jenderal Soedirman, Purwokerto, Indonesia; Researcher, Department of Ethics, Law, and Humanities, Amsterdam University Medical Centres, University of Amsterdam, The Netherlands.

DOI: https://doi.org/10.18502/jmehm.v14i6.6750

Keywords: Ethical issue; Medical students; Clinical clerkship; Indonesia.

Abstract

Although ethics is an essential part of medical education, little attention has been paid to ethics education during the clerkship phase, where medical students observe how physicians make decisions regarding various ethical problems. Specific nuances and cultural contexts such as working in a rural setting can determine ethical issues raised. This phenomenology study aimed to explore ethical issues experienced by Indonesian students during clinical clerkship in a rural setting. In-depth interviews were used to explore students’ experiences. Participants were ten students, selected on gender and clerkship year variations. Data saturation was reached after eight interviews, followed by two additional interviews. Thematic analysis was used in this study, and trustworthiness was ensured through data and investigator triangulation, member checking, and audit trail.

Three main themes found in this study were limited facilities and resources, healthcare financing and consent issues, as well as unprofessional behavior of healthcare providers. Many ethical issues related to substandard care were associated to limited resources and complexities within the healthcare system in the rural setting. Early exposure to recurrent ethical problems in healthcare can help students prepare for their future career as a physician in a rural setting.