Journal of Medical Ethics and History of Medicine最新文献

Professionalism is a core competency in the medical profession. In this paper, we aimed to confirm the validity, reliability and acceptability of the Professionalism Mini-Evaluation Exercise (P-MEX) instrument for the emergency medicine (EM) residency program. Twenty-two EM attending physicians completed 383 P-MEX forms (the Persian version) for 90 EM residents. Construct validity was assessed via structural equation modeling (SEM). The reliability coefficient was estimated by the generalizability theory, and acceptability was assessed using two researcher-made questionnaires to evaluate the perspectives of residents and assessors. There was a consensus among the participants regarding the content of P-MEX. According to the results of SEM, the first implementation of the original model was associated with a moderate fit and high item loadings. The model modified with correlated error variances for two pairs of items showed an appropriate fit. The reliability of P-MEX was 0.81 for 14 occasions. The perception survey indicated high acceptability for P-MEX from the viewpoint of the residents and increasing satisfaction with P-MEX among the assessors over time. According to the results of the research, P-MEX is a reliable, valid, and acceptable instrument for assessing professionalism in EM residents.

Today, role modeling is an essential component of medical education that facilitates the students' learning and affects their attitudes and behaviors. Hence, this study aimed to examine the characteristics of positive and negative role models using a mixed method approach. In the quantitative part, data were collected using a questionnaire with 24 items. The research population included medical students who were in their clinical period between May 2017 and December 2018 at Shiraz University of Medical Sciences (n = 750). A total of 282 questionnaires were completed by these students, and in the qualitative part, 26 semi-structured interviews were conducted with them. The most important components of role modeling for students included: individual characteristics, clinical skills and competence, teaching skills and professionalism, in that order. The qualitative analysis confirmed the results of the quantitative analysis. The findings showed that the characteristics of a negative role model can also be classified in four main components. The results demonstrated that 46.8% of the students identified one or more medical teachers as negative models. Students paid attention to not only the positive characteristics of their teachers, but also their negative features, stating that they had been influenced by both. Therefore, it can be concluded that clinical teachers should improve their performance as positive role models through reducing these negative effects and reinforcing positive characteristics.

Hinduism and Zoroastrianism have strong historical bonds and share similar value-systems. As an instance, both of these religions are pro-life. Abortion has been explicitly mentioned in Zoroastrian Holy Scriptures including Avesta, Shayast-Nashayast and Arda Viraf Nameh. According to Zoroastrian moral teachings, abortion is evil for two reasons: killing an innocent and intrinsically good person, and the contamination caused by the dead body (Nashu). In Hinduism, the key concepts involving moral deliberations on abortion are Ahimsa, Karma and reincarnation. Accordingly, abortion deliberately disrupts the process of reincarnation, and killing an innocent human being is not only in contrast with the concept of Ahimsa, but also places a serious karmic burden on its agent. The most noteworthy similarity between Zoroastrianism and Hinduism is their pro-life approach. The concept of Asha in Zoroastrianism is like the concept of Dharma in Hinduism, referring to a superior law of the universe and the bright path of life for the believers. In terms of differences, Zoroastrianism is a religion boasting a God, a prophet, and a Holy book, while Hinduism lacks all these features. Instead of reincarnation and rebirth, Zoroastrianism, like Abrahamic religions, believes in the afterlife. Also, in contrast with the concept of Karma , in Zoroastrianism, Ahura Mazda can either punish or forgive sins.

The present study was conducted to determine the relation between nurses' moral distress and the ethical climate in selected hospitals of the Iranian Social Security Organization (ISSO). This descriptive-analytical correlational study was conducted in 6 hospitals under the coverage of the Iranian Social Security Organization in 2016. Three hundred nurses were selected by convenience sampling method. Data were gathered using Corley's Standard Moral Distress and Olson's Hospital Ethical Climate Scales. Data were analyzed using SPSS software version 19. The mean score of the nurses' moral distress was 1.94 ± 0.66, which is considered moderate. The mean score of ethical climate was 88.97, indicating desirable ethical climate in these hospitals. The frequency score of moral distress had a unilateral reverse correlation with the total score of ethical climate as well as its dimensions, including colleagues, patients, hospitals and physicians. The score of the intensity of nurses' moral distress also had a unilateral reverse correlation with the total score of ethical climate and the scores of the hospital and physicians dimensions. These results emphasized the importance of creating a positive ethical climate to decrease moral distress as well as the need for professional interventions to increase support in moral issues.

The national guidelines for biomedical research ethics are approved by the "National Committee for Ethics in Biomedical Research" at the Iranian Ministry of Health and Medical Education as the regulatory body for biomedical research in the country. The focus of these guidelines should be on the ethical issues related to different stages of the research process, which would lead to increased research integrity and better supervision of research activities. The present study analyzed the contents of these national guidelines to clarify the ethical considerations connected to the five stages of a research process including 1) proposing, 2) approval, 3) operation, 4) documentation and 5) publishing. The findings showed that the assessed guidelines laid more emphasis on the ethical considerations related to the research operation stage rather than the proposal stage. In other words, activities such as identification of the research problem, formulation of hypotheses and questions, financial evaluation, data analysis and data interpretation did not receive adequate attention in these guidelines. Most of the guidelines presented subject categories such as the rights of participants and supervisory considerations in the "research operation stage", ethical considerations in the "evaluation and approval procedure stage", and editorial responsibilities in the "research review and publication stage". In general, despite noticeable content for guiding researchers for ethical conduction of research the national guidelines are not adequately developed to cover comprehensive and sufficient ethical considerations regarding all the activities of research.