129 students participated in our study. Descriptive data regarding personal information of the students are shown in Table 1. Mean age was 22.1 years (standard deviation: 3.5). 94 of the 129 respondents were female (73%) and 33 were male (26%), whereas 2 students did not specify their gender (1%). About one third of the participants (33%) were in first, second or third year of their medical studies, while two thirds (67%) were in fourth, fifth or sixth year, being the latter the one with the largest number of respondents (38).
Table 1
Characteristics of the students.
VARIABLE
|
CATEGORY
|
Total
|
Gender
|
Man
|
33 (25.6)
|
Woman
|
94 (72.9)
|
Other
|
2 (1.5)
|
Parents with college education?
|
One or none of your parents are college educated
|
59 (45.7)
|
Both your parents are college educated
|
70 (54.3)
|
Current academic year
|
From 1st to 3rd
|
42 (32.6)
|
From 4th to 6th
|
87 (67.4)
|
Subjects from previous academic years
|
No
|
102 (79)
|
Yes
|
27 (21)
|
Current average grade (qualifications in Spanish universities are graded from 0 to 10. 5 is the required qualification to pass the subject)
|
5 to 6.9
|
29 (22.5)
|
7 to 8.9
|
83 (64.3)
|
More than 9
|
6 (4.7)
|
Prefer not to reveal
|
11 (8.5)
|
Number of services you have rotated at
|
0 services
|
21 (16.3)
|
From 1 to 9 services
|
82 (63.6)
|
10 or more services
|
26 (20.1)
|
Age
|
Mean age
|
22.06 (3.46)
|
Students’ experience when rotating at hospital
Answers to questions about students’ experience when rotating at hospital are described in Table 2. Only 31% of 3rd -6th year students declared to have signed a “confidentiality commitment” document when starting their clinical practice (question 2 in Table 2). Furthermore, there is a significant difference between the results of 3rd -5th year students and 6th year students. Only 16% of 3rd -5th year students declared to have signed this “confidentiality commitment”, while the level of compliance among 6th year students was much higher (58%). Besides, the huge majority of 3rd -6th year students (77%) declared that their doctors had never provided them his/her username and password for the hospital’s internal network (question 3 in Table 2).
Table 2
Results about students’ experience when rotating at the hospital. Only students in 3rd − 6th years are included.
Question
|
Statements
|
Category
|
Number of students from 3rd to 6th year
|
Q1
|
During my clinical practice, I am constantly supervised and accompanied by my doctor.
|
Rarely
|
2 (1.9)
|
Sometimes
|
18 (16.7)
|
Quite often
|
57 (52.8)
|
Always
|
29 (26.9)
|
N/A
|
2 (1.9)
|
Q2
|
At the beginning of my medical rotations, I have signed a confidentiality commitment provided by the health center where I carry out the practice.
|
No
|
65 (60.2)
|
Yes
|
33 (30.6)
|
N/A
|
10 (9.3)
|
Q3
|
During my clinical practice, the doctor provides me his/her username and password for the hospital's internal network.
|
Always
|
2 (1.9)
|
Quite often
|
1 (0.9)
|
Sometimes
|
4 (3.7)
|
Rarely
|
16 (14.8)
|
Never
|
83 (76.9)
|
N/A
|
2 (1.9)
|
Q4
|
When I am at the hospital, I wear the identification card (name and surname, photograph and "student in training"), and carry it in a visible place.
|
Never
|
3 (2.8)
|
Rarely
|
12 (11.1)
|
Sometimes
|
6 (5.6)
|
Quite often
|
20 (18.5)
|
Always
|
66 (61.1)
|
N/A
|
1 (0.9)
|
Q5
|
The health-care center (not the medical school) takes charge of providing me the student identification card for the clinical practice.
|
No
|
52 (48.2)
|
Yes
|
52 (48.2)
|
N/A
|
4 (3.7)
|
Q6
|
When the academic year is finished, I am obligated to give the student identification card back.
|
No
|
86 (79.6)
|
Yes
|
2 (1.9)
|
N/A
|
20 (18.5)
|
Q7
|
When assigning the clinical rotations, the faculty informs me of what service is assigned to me. In addition, they also inform me of which doctor will be my responsible.
|
Never
|
1 (0.9)
|
Rarely
|
2 (1.9)
|
Sometimes
|
8 (7.4)
|
Quite often
|
31 (28.7)
|
Always
|
65 (60.2)
|
N/A
|
1 (0.9)
|
Q8
|
On the first day of each rotary, my assigned tutor already knew how many students we were and our names, our schedule and practice calendar, etc.
|
Never
|
32 (29.6)
|
Rarely
|
47 (43.5)
|
Sometimes
|
15 (13.9)
|
Quite often
|
12 (11.1)
|
Always
|
1 (0.9)
|
N/A
|
1 (0.9)
|
Q9
|
In preclinical years (mainly 1st and 2nd) we have used mannequins, simulated patients and/ or roleplays, in order to acquire skills for the “patient-student” relationship in subsequent clinical courses.
|
No
|
46 (42.6)
|
Yes
|
58 (53.7)
|
N/A
|
4 (3.7)
|
Q10
|
I have got nervous on some occasion during a health care process in my clinical practice, and I have missed not having practiced before with a mannequin, simulated patient, using roleplays, etc.
|
Yes
|
81 (75)
|
No
|
25 (23.2)
|
N/A
|
2 (1.9)
|
Q11
|
During my clinical practice, I have access to the patient's medical history and I could modify it.
|
Always
|
11 (10.2)
|
Quite often
|
20 (18.5)
|
Sometimes
|
25 (23.2)
|
Rarely
|
26 (24.1)
|
Never
|
25 (23.2)
|
N/A
|
1 (0.9)
|
Q12
|
I do clinical interviews with patients and read their medical reports without the presence of my responsible doctor.
|
Always
|
3 (2.8)
|
Quite often
|
28 (25.9)
|
Sometimes
|
44 (40.7)
|
Rarely
|
22 (20.4)
|
Never
|
11 (10.2)
|
N/A
|
0 (0.0)
|
Q13
|
During my clinical practice, the doctor knocks at the door and greets the patients when entering their rooms.
|
Never
|
1 (0.9)
|
Rarely
|
2 (1.9)
|
Sometimes
|
8 (7.4)
|
Quite often
|
47 (43.5)
|
Always
|
49 (45.4)
|
N/A
|
1 (0.9)
|
Q14
|
We have been present more than 3 students at the same time in some health-care process of a patient.
|
Always
|
2 (1.9)
|
Quite often
|
29 (26.9)
|
Sometimes
|
49 (45.4)
|
Rarely
|
16 (14.8)
|
Never
|
12 (11.1)
|
N/A
|
0 (0.0)
|
Q15
|
I have sent a patient's medical history to my personal email, without expressly asking for permission.
|
Yes
|
3 (2.8)
|
No
|
104 (96.3)
|
N/A
|
1 (0.9)
|
Q16
|
I have used my personal mobile phone during a patient's care process for not related things with learning (WhatsApp, social networks, etc.)
|
Quite often
|
2 (1.9)
|
Sometimes
|
18 (16.7)
|
Rarely
|
33 (30.6)
|
Never
|
55 (50.9)
|
N/A
|
0 (0.0)
|
Q17
|
My assigned doctor informs me about patients' rights and corrects me in case of not acting correctly on issues of personal treatment, ethics, privacy, dignity, etc.
|
Never
|
15 (13.9)
|
Rarely
|
24 (22.2)
|
Sometimes
|
28 (25.9)
|
Quite often
|
20 (18.5)
|
Always
|
12 (11.1)
|
N/A
|
9 (8.3)
|
Q18
|
Before a patient's care process, my assigned doctor informs him/her (or his/her representative) of the presence of students and requests their verbal consent for the students to witness the clinical act.
|
Never
|
4 (3.7)
|
Rarely
|
25 (23.2)
|
Sometimes
|
33 (30.6)
|
Quite often
|
34 (31.5)
|
Always
|
12 (11.1)
|
N/A
|
0 (0.0)
|
Q19
|
If the doctor considers appropriate for me to carry out some type of exploration or procedure, he again requests the verbal consent of the patient (or his/her representative).
|
Never
|
3 (2.8)
|
Rarely
|
16 (14.8)
|
Sometimes
|
26 (24.1)
|
Quite often
|
37 (34.3)
|
Always
|
26 (24.1)
|
Q20
|
Some doctor told me private aspects about a patient without any clinical interest ("she is the mother of the mayor", "she is the sister of the hospital manager", "he likes to go to certain places", etc.).
|
Yes
|
63 (58.3)
|
No
|
38 (35.2)
|
N/A
|
7 (6.5)
|
Q21
|
The management of the health centers in which I carry out my training rotations (medical director, hospital manager, etc.) are responsible for explaining the ethical principles and basic rules of action in the patient care process.
|
Never
|
55 (50.9)
|
Rarely
|
25 (23.2)
|
Sometimes
|
16 (14.8)
|
Quite often
|
5 (4.6)
|
Always
|
3 (2.8)
|
N/A
|
4 (3.7)
|
Q22
|
During my clinical practice, the doctor introduces and identifies him/herself when entering the patients' rooms, as well as introduces me and identifies me as a student.
|
Never
|
4 (3.7)
|
Rarely
|
17 (15.7)
|
Sometimes
|
35 (32.4)
|
Quite often
|
39 (36.1)
|
Always
|
12 (11.1)
|
N/A
|
1 (0.9)
|
Q23
|
During my clinical practice, I have access to patients' identification data, such as name, surname, age, address, etc. (I see it in the report, my medical doctor tells me, etc.), not only purely clinical data.
|
Always
|
38 (35.2)
|
Quite often
|
38 (35.2)
|
Sometimes
|
25 (23.2)
|
Rarely
|
4 (3.7)
|
Never
|
2 (1.9)
|
N/A
|
1 (0.9)
|
Q24
|
The health-care centers in which I carry out my clinical practice have systems that allow students to read clinical reports about patients without being able to see their identification data (name, address, profession, etc.).
|
No
|
66 (61.1)
|
Yes
|
11 (10.2)
|
N/A
|
31 (28.7)
|
Most 3rd -6th year students (80%) referred they “always” or “quite often” carry their identification card when rotating at the hospital (question 4 in Table 2). Only 2% of the students declared to have returned their identification card when ending their rotations (question 6 in Table 2).
Lack of experience with mannequins, roleplays and simulated patients made 75% of 3rd -6th year students had got nervous when treating a real patient at least once (question 10 in Table 2).
Regarding the frequency with which the doctor informs the patient of the presence of students during the care process (question 18 in Table 2), the most frequent answer was “quite often” (31%), but still the majority of the students’ answers (57%) revealed that doctors “sometimes”, “rarely” or “never” notify the patient of their presence. In the same way, students declared to have been introduced to the patient by the doctor “quite often” (36%), while still most of the students’ answers (52%) reveal that doctors “sometimes”, “rarely” or “never” introduce the students and themselves when entering the patients’ rooms (question 22 in Table 2).
58% students reported that doctors have gossiped with students about patient’s private life issues -without any clinical interest- at some point of their clinical rotations (question 20 in Table 2).
Students’ opinion
Table 3 provides information about questions regarding students’ opinions on privacy issues. In general terms, most students answered correctly when asked about questions concerning medical secrecy and situations in which doctors are legally allowed to break it. 91% students knew they were subject to medical secrecy obligation (question 25 in Table 3), and 85% students were aware that medical secrecy remains after patients’ death (question 27 in Table 3). Results from questions 31 and 34 also go with this tendency, since students show general knowledge (85%) about breaking the medical secrecy in case of Disease Of Public Health Significance (DOPHS) and also in case of severe contagious diseases (68%).
Table 3
Results about students’ opinion in different situations.
Question
|
Statements
|
Category
|
Total
|
Current academic year
|
From 1st to 3rd
|
From 4th to 6th
|
Q25
|
Being a student and not a doctor, I am legally not subject to keep the medical secret.
|
Totally agree
|
4 (3.1)
|
2 (4.8)
|
2 (2.3)
|
Neither agree nor disagree
|
2 (1.6)
|
2 (4.8)
|
0 (0.0)
|
Partially disagree
|
5 (3.9)
|
3 (7.1)
|
2 (2.3)
|
Totally disagree
|
118 (91.5)
|
35 (83.3)
|
83 (95.4)
|
Q26
|
If a patient gives his/her consent, the doctor is legally allowed to “break” the medical secret.
|
No
|
77 (59.7)
|
25 (59.5)
|
52 (59.8)
|
Yes
|
30 (23.3)
|
8 (19.1)
|
22 (25.3)
|
N/A
|
22 (17.1)
|
9 (21.4)
|
13 (14.9)
|
Q27
|
If a patient dies, the medical secret disappears with him/her.
|
Yes
|
8 (6.2)
|
3 (7.1)
|
5 (5.8)
|
No
|
110 (85.3)
|
32 (76.2)
|
78 (89.7)
|
N/A
|
11 (8.5)
|
7 (16.7)
|
4 (4.6)
|
Q28
|
During my clinical practice in the hospital, a patient wants me not to be in his care process because I am a student. I refuse, since it is a "university hospital".
|
Totally agree
|
4 (3.1)
|
1 (2.4)
|
3 (3.5)
|
Partially agree
|
13 (10.1)
|
4 (9.5)
|
9 (10.3)
|
Neither agree nor disagree
|
12 (9.3)
|
7 (16.7)
|
5 (5.8)
|
Partially disagree
|
38 (29.5)
|
15(35.7)
|
23 (26.4)
|
Totally disagree
|
62 (48.1)
|
15 (35.7)
|
47 (54.0)
|
Q30
|
During your clinical rotation in Cardiology, a neighbor of yours gets hospitalized in your floor. When you get home, you tell your parents/friends about it.
|
Totally agree
|
8 (6.2)
|
5 (11.9)
|
3 (3.5)
|
Partially agree
|
21 (16.3)
|
3 (7.1)
|
18 (20.7)
|
Neither agree nor disagree
|
20 (15.5)
|
9 (21.4)
|
11 (12.6)
|
Partially disagree
|
23 (17.8)
|
10 (23.8)
|
13 (14.9)
|
Totally disagree
|
57 (44.2)
|
15 (35.7)
|
42 (48.3)
|
Q31
|
If a doctor diagnoses a patient with a Disease Of Public Health Significance or DOPHS (for example Cholera), the doctor is legally allowed to “break” the medical secret and report to health authorities.
|
No
|
7 (5.4)
|
4 (9.5)
|
3 (3.5)
|
Yes
|
110 (85.3)
|
29 (69.1)
|
81 (93.1)
|
N/A
|
12 (9.3)
|
9 (21.4)
|
3 (3.5)
|
Q32
|
I take a photograph of a patient's admission report, which will be useful for preparing some assignment. I will not share it with anyone, I will simply store it in the phone's photo gallery.
|
Totally agree
|
13 (10.1)
|
3 (7.1)
|
10 (11.5)
|
Partially agree
|
31 (24.0)
|
8 (19.1)
|
23 (26.4)
|
Neither agree nor disagree
|
20 (15.5)
|
5 (11.9)
|
15 (17.2)
|
Partially disagree
|
36 (27.9)
|
15 (35.7)
|
21 (24.1)
|
Totally disagree
|
29 (22.5)
|
11 (26.2)
|
18 (20.7)
|
Q33
|
During your clinical rotation in Psychiatry, a patient suspect for gender violence addresses you because he wants some medication to calm the headache. You are alone. You ignore it and don't tell your doctor.
|
Totally agree
|
2 (1.6)
|
0 (0.0)
|
2 (2.3)
|
Partially agree
|
4(3.1)
|
0 (0.0)
|
4 (4.6)
|
Neither agree nor disagree
|
4 (3.1)
|
4 (9.5)
|
0 (0.0)
|
Partially disagree
|
8 (6.2)
|
3 (7.1)
|
5 (5.8)
|
Totally disagree
|
111 (86.1)
|
35 (83.3)
|
76 (87.4)
|
Q34
|
If a doctor diagnoses a patient with a severe contagious disease, the doctor is legally allowed to “break” the medical secret and tell it to the patient's partner, even if the patient does not want, in order to avoid potential damage of partner's health.
|
No
|
21 (16.3)
|
5 (11.9)
|
16 (18.4)
|
Yes
|
88 (68.2)
|
25 (59.5)
|
63 (72.4)
|
N/A
|
20 (15.5)
|
12 (28.6)
|
8 (9.2)
|
Q35
|
During my clinical practice, I see a patient with a Fournier's Gangrene. It is a pathology that is not seen every day, so I send a photo of the perineal necrosis to a WhatsApp group with class friends, without informing the patient, but without giving information about his identity.
|
Totally agree
|
1 (0.8)
|
1 (2.4)
|
0 (0.0)
|
Partially agree
|
11 (8.5)
|
3 (7.1)
|
8 (9.2)
|
Neither agree nor disagree
|
7 (5.4)
|
4 (9.5)
|
3 (3.5)
|
Partially disagree
|
23 (17.8)
|
12 (28.6)
|
11 (12.6)
|
Totally disagree
|
87 (67.4)
|
22 (52.4)
|
65 (74.7)
|
Q36
|
In case of a patient who a priori is going to spend a long stay in the plant (> 15 days), if the doctor has already requested the patient's verbal consent for me to be present at the clinical events and even perform physical examinations, it is not necessary to request his verbal consent again during the rest of his stay.
|
Totally agree
|
16 (12.4)
|
8 (19.1)
|
8 (9.2)
|
Partially agree
|
33 (25.6)
|
11 (26.2)
|
22 (25.3)
|
Neither agree nor disagree
|
19 (14.7)
|
6 (14.3)
|
13 (14.9)
|
Partially disagree
|
34 (26.4)
|
9 (21.4)
|
25 (28.7)
|
Totally disagree
|
27 (20.9)
|
8 (19.1)
|
19 (21.8)
|
Q37
|
During your emergency clinical rotation, a patient in the waiting room does not stop shouting and insulting the staff because he has been waiting his turn for quite some time. For this reason, you assist earlier other patients who came later than him.
|
Totally agree
|
1 (0.8)
|
0 (0.0)
|
1 (1.2)
|
Partially agree
|
7 (5.4)
|
4 (9.5)
|
3 (3.5)
|
Neither agree nor disagree
|
15 (11.6)
|
4 (9.5)
|
11 (12.6)
|
Partially disagree
|
25 (19.4)
|
7 (16.7)
|
18 (20.7)
|
Totally disagree
|
81 (62.8)
|
27 (64.3)
|
54 (62.1)
|
Q38
|
During your clinical rotation through the Internal Medicine plant, you perform a physical examination of a terminally ill patient. When finished, you go with your doctor to the hallway to continue passing floor. However, when you leave you realize that you have exposed the intimate parts of the patient and you tell the doctor. The patient has dementia and has no family / friends who could complain. The doctor tells you "it is not necessary; nobody comes to see him".
|
Neither agree nor disagree
|
3 (2.3)
|
2 (4.8)
|
1 (1.2)
|
Partially disagree
|
2 (1.6)
|
2 (4.8)
|
0 (0.0)
|
Totally disagree
|
124 (96.1)
|
38 (90.5)
|
86 (98.9)
|
Q39
|
If a judge requests a doctor to testify at a trial, the doctor is legally allowed to “break” the medical secret regarding that patient.
|
No
|
36 (27.9)
|
11 (26.2)
|
25 (28.7)
|
Yes
|
64 (49.6)
|
14 (33.3)
|
50 (57.5)
|
N/A
|
29 (22.5)
|
17 (40.5)
|
12 (13.8)
|
Q40
|
I upload to Instagram a photograph in which I am auscultating a patient. I do not expressly ask for permission. The patient has a characteristic tattoo on the sternum area (visible in the photograph), but his face cannot be seen.
|
Neither agree nor disagree
|
1 (0.8)
|
1 (2.4)
|
0 (0.0)
|
Partially disagree
|
7 (5.4)
|
5 (11.9)
|
2 (2.3)
|
Totally disagree
|
121 (93.8)
|
36 (85.7)
|
85 (97.7)
|
Q41
|
I upload to Instagram a photograph in which I am auscultating a patient. I do not expressly ask for permission, but its face cannot be seen, and in this case, there is no way to know its identity.
|
Totally agree
|
2 (1.6)
|
0 (0.0)
|
2 (2.3)
|
Partially agree
|
8 (6.2)
|
5 (11.9)
|
3 (3.5)
|
Neither agree nor disagree
|
8 (6.2)
|
4 (9.5)
|
4 (4.6)
|
Partially disagree
|
32 (24.8)
|
11 (26.2)
|
21 (24.1)
|
Totally disagree
|
79 (61.2)
|
22 (52.4)
|
57 (65.5)
|
Q42
|
During your surgical rotary in Traumatology, the surgeon photographs with her personal mobile phone the preoperative area of patients with large cosmetic defects. After the operation, she photographs the area again to make a comparison. In order to know which patient belongs each image, she labels its medical record number to the image.
|
Totally agree
|
21 (16.3)
|
4 (9.5)
|
17 (19.5)
|
Partially agree
|
26 (20.2)
|
6 (14.3)
|
20 (23.0)
|
Neither agree nor disagree
|
33 (25.6)
|
15 (35.7)
|
18 (20.7)
|
Partially disagree
|
22 (17.1)
|
9 (21.4)
|
13 (14.9)
|
Totally disagree
|
27 (20.9)
|
8 (19.1)
|
19 (21.8)
|
Q43
|
In case of an under-18 patient, the doctor must request verbal consent (about my presence as a student in the care process) from the patient's legal representative.
|
Totally disagree
|
3 (2.3)
|
2 (4.8)
|
1 (1.2)
|
Partially disagree
|
8 (6.2)
|
3 (7.1)
|
5 (5.8)
|
Neither agree nor disagree
|
5 (3.9)
|
3 (7.1)
|
2 (2.3)
|
Partially agree
|
31 (24.0)
|
11 (26.2)
|
20 (23.0)
|
Totally agree
|
82 (63.6)
|
23 (54.8)
|
59 (67.8)
|
Q44
|
In the same previous case (under-18 patient), once verbal consent has been requested from the legal representative, the latter decides on his own, and has no obligation to listen to what the minor thinks about what has been reported.
|
Totally agree
|
1 (0.8)
|
1 (2.4)
|
0 (0.0)
|
Partially agree
|
4 (3.1)
|
2 (4.8)
|
2 (2.3)
|
Neither agree nor disagree
|
10 (7.8)
|
6 (14.3)
|
4 (4.6)
|
Partially disagree
|
41 (31.8)
|
13 (31.0)
|
28 (32.2)
|
Totally disagree
|
73 (56.6)
|
20 (47.6)
|
53 (60.9)
|
Q45
|
In case of a patient with limited decision-making capacity, the doctor must request verbal consent (about my presence as a student in the care process) from the family/partner/legal representative of the patient.
|
Totally disagree
|
5 (3.9)
|
1 (2.4)
|
4 (4.6)
|
Partially disagree
|
4 (3.1)
|
0 (0.0)
|
4 (4.6)
|
Neither agree nor disagree
|
9 (7.0)
|
4 (9.5)
|
5 (5.8)
|
Partially agree
|
36 (27.9)
|
14 (33.3)
|
22 (25.3)
|
Totally agree
|
75 (58.1)
|
23 (54.8)
|
52 (59.8)
|
Q46
|
In case of an incapacitated patient (with a judicial sentence), the doctor must request verbal consent (about my presence as a student in the care process) from the family/partner/legal representative of the patient.
|
Totally disagree
|
7 (5.4)
|
2 (4.8)
|
5 (5.8)
|
Partially disagree
|
3 (2.3)
|
0 (0.0)
|
3 (3.5)
|
Neither agree nor disagree
|
12 (9.3)
|
7 (16.7)
|
5 (5.8)
|
Partially agree
|
31 (24.0)
|
10 (23.8)
|
21 (24.1)
|
Totally agree
|
76 (58.9)
|
23 (54.8)
|
53 (60.9)
|
Only 23% students knew that doctors can legally break the patient’s medical secrecy if the patient gives his or her consent (question 26 in Table 3). About 50% students knew that doctors are legally allowed to break the patient’s medical secrecy obligation if a judge calls them to testify in a trial concerning that patient (question 39 in Table 3). In case of question 32, about taking a picture of a patient’s hospitalization report which would be useful for an assignment, students’ answers were quite diverse.
Students were asked about uploading a picture auscultating two patients to Instagram, not asking for the patient’s consent in any case. Patient in question 40 had a characteristic tattoo on his sternum area, even though his face was not shown in the picture, while patient in question 41 had no characteristic physical aspects and his face was not shown in the picture, so he could not be identified. About 94% students totally disagree on taking and uploading that picture in question 40, buy only 61% totally disagree in question 41.
We analyzed all these results according to several variables to see if there were differences between various groups of students.
Association between academic year and knowledge about ethical issues
We compared the results between two groups, being the first group 1st to 3rd academic year students, and the second group students from subsequent years (4th to 6th ). Results regarding this variable are shown in Table 4a. Please note that, although 3rd year students are not pre-clinical students, they had barely rotated when surveyed
In regard to the question 25, concerning medical secrecy and situations in which doctors are legally allowed to break it, results suggest that being a 4th to 6th year student increases 4.15 times the probabilities of giving the correct answer (p = 0.031, CI 1.14–15.08). The same happens in question 40 about uploading a picture to Instagram auscultating a patient who has a characteristic tattoo, not asking for his consent but being his face not shown in the picture. In this case, results suggest that being a 4th to 6th year student increases 7.08 times the probabilities of giving the correct answer (p = 0.02, CI 1.36–36.78). Question 28 deserves special mention, where students were presented a situation in which a patient prefers them not to be present during his care process. Results suggest that being a 4th to 6th year student increases 2.12 times the probabilities of answering correctly (p = 0.053, CI 0.99–4.52).
In general terms, we found that students in the last years of medical school (4th -6th grade) showed a tendency to respond more correctly than those in the first years (1st -3rd grade).
Association between gender and knowledge about ethical issues
We compared the results between two groups according to the gender of the students (male or female). Results regarding this variable are shown in Table 4b.
In general terms, results show a tendency among women to answer more incorrectly compared to the male group. Results from question 26, where students were asked if doctors can legally break the patient’s medical secrecy if the patient gives his or her consent, show that being a female student multiplies by 0.22 the probabilities of answering correctly when compared to the male group (95%CI: 0.086–0.56, p = 0.002). The same happens in question 30, where the students were presented a situation in which their neighbor had just been hospitalized at the floor they were rotating at. Students had to decide if they told their family/friends about it. Results show that being a female student multiplies by 0.39 the probabilities of answering correctly when compared to the male group (95% CI: 0.17–0.87, p = 0.022).
Association between age and knowledge about ethical issues
We compared the results according to the age of the students. Results regarding this variable are shown in Table 4c.
In general terms we found that elder students tend to answer more correctly than the younger ones. An example of this is question 35, about sending a picture of a Fournier’s gangrene via WhatsApp without the patient’s consent, where results indicate that the probability of answering correctly this question increases 1.30 times per year of age (95% CI 1.05–1.60, p = 0.017). Results from question 40 (OR = 1.75, 95% CI: 1.09–2.80, p = 0.021) and question 41 (OR = 1.25, 95% CI: 1.03–1.52, p = 0.023) go with the same tendency. In this questions students were asked about uploading a picture auscultating two patients to Instagram, not asking for the patient’s consent in any case.
Association between parents’ educational level and knowledge
We made a comparison between two groups according to the level of studies reached by the students’ parents. 70 out of 129 students reported that both of their parents had reached college education studies, which means 54% of all the students. Results are shown in Table 4d.
According to results from question 31, about breaking the medical secrecy in case of Disease Of Public Health Significance (DOPHS), being a medical student whose parents were college-graduated multiplies by 9 times the probabilities of answering correctly when compared to the non-both college-graduated parents group (OR = 9, 95% CI: 1.05–77.35, p = 0.045). The same happens when analyzing results from question 37, where students were presented a situation in which an angry patient was shouting at them because he or she had been waiting for medical attendance for a long time. Students had to decide whether to delay his/her medical care or not due to his/her bad manners. According to our results, being a medical student whose parents were college-graduated multiplies by 2.26 times the probabilities (odds) of answering correctly (95% CI: 1.09–4.68, p = 0.028).
Table 4.
Association between questions regarding students’ experience and academic year (Table 4a), gender (Table 4b), age (Table 4c) and parents’ educational background (Table 4d).
(4a)
Question
|
Category
|
Correct/Total
|
OR (95% CI)
|
P value
|
Q25
|
1st-3rd
|
35/42
|
1(ref.)
|
.
|
4th-6th
|
83/87
|
4.15 (1.14-15-38)
|
0.031
|
Q26
|
1st-3rd
|
8/42
|
1(ref.)
|
.
|
4th-6th
|
22/87
|
1.32 (0.52-3.38)
|
0.560
|
Q27
|
1st-3rd
|
32/42
|
1(ref.)
|
.
|
4th-6th
|
78/87
|
1.46 (0.33-6.48)
|
0.617
|
Q28
|
1st-3rd
|
15/42
|
1(ref.)
|
.
|
4th-6th
|
47/87
|
2.11 (0.99-4.52)
|
0.053
|
Q30
|
1st-3rd
|
15/42
|
1(ref.)
|
.
|
4th-6th
|
42/87
|
1.68 (0.79-3.59)
|
0.180
|
Q31
|
1st-3rd
|
29/42
|
1(ref.)
|
.
|
4th-6th
|
81/87
|
3.72 (0.79-17.65)
|
0.098
|
Q32
|
1st-3rd
|
11/42
|
1(ref.)
|
.
|
4th-6th
|
18/87
|
0.74 (0.31-1.74)
|
0.484
|
Q33
|
1st-3rd
|
35/42
|
1(ref.)
|
.
|
4th-6th
|
76/87
|
1.38 (0.49-3.87)
|
0.538
|
Q34
|
1st-3rd
|
25/42
|
1(ref.)
|
.
|
4th-6th
|
63/87
|
0.79 (0.26-2.38)
|
0.672
|
Q35
|
1st-3rd
|
22/42
|
1(ref.)
|
.
|
4th-6th
|
65/87
|
2.69 (1.24-5.83)
|
0.012
|
Q36
|
1st-3rd
|
8/42
|
1(ref.)
|
.
|
4th-6th
|
19/87
|
1.19 (0.47-2.99)
|
0.715
|
Q37
|
1st-3rd
|
27/42
|
1(ref.)
|
.
|
4th-6th
|
54/87
|
0.91 (0.42-1.95)
|
0.807
|
Q38
|
1st-3rd
|
38/42
|
1(ref.)
|
.
|
4th-6th
|
86/87
|
9.05 (0.98-83.71)
|
0.052
|
Q39
|
1st-3rd
|
14/42
|
1(ref.)
|
.
|
4th-6th
|
50/87
|
1.57 (0.62-3.96)
|
0.338
|
Q40
|
1st-3rd
|
36/42
|
1(ref.)
|
.
|
4th-6th
|
85/87
|
7.08 (1.36-36.78)
|
0.020
|
Q41
|
1st-3rd
|
22/42
|
1(ref.)
|
.
|
4th-6th
|
57/87
|
1.73 (0.82-3.66)
|
0.153
|
Q42
|
1st-3rd
|
8/42
|
1(ref.)
|
.
|
4th-6th
|
19/87
|
1.19 (0.47-2.99)
|
0.715
|
Q43
|
1st-3rd
|
23/42
|
1(ref.)
|
.
|
4th-6th
|
59/87
|
1.74 (0.82-3.71)
|
0.151
|
Q44
|
1st-3rd
|
20/42
|
1(ref.)
|
.
|
4th-6th
|
53/87
|
1.71 (0.82-3.69)
|
0.155
|
Q45
|
1st-3rd
|
23/42
|
1(ref.)
|
..
|
4th-6th
|
52/87
|
1.23 (0.58-2.58)
|
0.589
|
Q46
|
1st-3rd
|
23/42
|
1(ref.)
|
.
|
4th-6th
|
53/87
|
1.29 (0.61-2.71)
|
0.506
|
(4b)
Question
|
Category
|
Correct/Total
|
OR (95% CI)
|
P value
|
Q25
|
Male
|
31/33
|
1(ref.)
|
.
|
Female
|
85/94
|
0.61 (0.12-2.98)
|
0.540
|
Q26
|
Male
|
14/33
|
1(ref.)
|
.
|
Female
|
15/94
|
0.22 (0.09-0.57)
|
0.002
|
Q27
|
Male
|
26/33
|
1(ref.)
|
.
|
Female
|
82/94
|
9.46 (1.80-49.76)
|
0.008
|
Q28
|
Male
|
20/33
|
1(ref.)
|
.
|
Female
|
42/94
|
0.53 (0.23-1.18)
|
0.118
|
Q30
|
Male
|
20/33
|
1(ref.)
|
.
|
Female
|
35/94
|
0.39 (0.17-0.87)
|
0.022
|
Q31
|
Male
|
29/33
|
1(ref.)
|
.
|
Female
|
79/94
|
0.45 (0.05-3.93)
|
0.474
|
Q32
|
Male
|
12/33
|
1(ref.)
|
.
|
Female
|
15/94
|
0.33 (0.14-0.82)
|
0.016
|
Q33
|
Male
|
29/33
|
1(ref.)
|
.
|
Female
|
80/94
|
0.79 (0.24-2.59)
|
0.695
|
Q34
|
Male
|
23/33
|
1(ref.)
|
.
|
Female
|
63/94
|
0.46 (0.12-1.70)
|
0.242
|
Q35
|
Male
|
28/33
|
1(ref.)
|
.
|
Female
|
57/94
|
0.28 (0.10-0.78)
|
0.015
|
Q36
|
Male
|
8/33
|
1(ref.)
|
.
|
Female
|
18/94
|
0.74 (0.29-1.91)
|
0.534
|
Q37
|
Male
|
17/33
|
1(ref.)
|
.
|
Female
|
62/94
|
1.82 (0.82-4.08)
|
0.144
|
Q38
|
Male
|
31/33
|
1(ref.)
|
.
|
Female
|
91/94
|
1.96 (0.31-12.26)
|
0.473
|
Q39
|
Male
|
21/33
|
1(ref.)
|
.
|
Female
|
41/94
|
0.39 (0.14-1.09)
|
0.071
|
Q40
|
Male
|
33/33
|
1(ref.)
|
.
|
Female
|
86/94
|
1.00 (1.00-1.00)
|
/
|
Q41
|
Male
|
25/33
|
1(ref.)
|
.
|
Female
|
52/94
|
0.40 (0.16-0.97)
|
0.042
|
Q42
|
Male
|
7/33
|
1(ref.)
|
.
|
Female
|
18/94
|
0.88 (0.33-2.34)
|
0.798
|
Q43
|
Male
|
22/33
|
1(ref.)
|
.
|
Female
|
58/94
|
0.81 (0.35-1.86)
|
0.612
|
Q44
|
Male
|
16/33
|
1(ref.)
|
.
|
Female
|
55/94
|
1.50 (0.68-3.32)
|
0.320
|
Q45
|
Male
|
21/33
|
1(ref.)
|
.
|
Female
|
53/94
|
0.74 (0.33-1.67)
|
0.468
|
Q46
|
Male
|
23/33
|
1(ref.)
|
.
|
Female
|
51/94
|
0.52 (0.22-1.20)
|
0.125
|
(4c)
Question
|
OR per year (95% CI)
|
P value
|
Q25
|
1.36 (0.90-2.05)
|
0.140
|
Q26
|
0.86 (0.68-1.09)
|
0.212
|
Q27
|
1.00 (0.80-1.25)
|
1.000
|
Q28
|
1.14 (0.97-1.35)
|
0.115
|
Q30
|
1.17 (0.98-1.38)
|
0.079
|
Q31
|
1.38 (0.89-2.13)
|
0.146
|
Q32
|
1.12 (0.97-1.31)
|
0.122
|
Q33
|
1.25 (0.95-1.65)
|
0.115
|
Q34
|
0.95 (0.84-1.06)
|
0.365
|
Q35
|
1.30 (1.05-1.60)
|
0.017
|
Q36
|
1.15 (0.97-1.35)
|
0.102
|
Q37
|
0.96 (0.86-1.07)
|
0.435
|
Q38
|
2.33 (1.16-4.69)
|
0.018
|
Q39
|
1.20 (0.97-1.49)
|
0.097
|
Q40
|
1.75 (1.09-2.80)
|
0.021
|
Q41
|
1.25 (1.03-1.52)
|
0.023
|
Q42
|
1.08 (0.95-1.21)
|
0.234
|
Q43
|
1.02 (0.91-1.15)
|
0.727
|
Q44
|
1.14 (0.96-1.35)
|
0.142
|
Q45
|
1.01 (0.90-1.12)
|
0.912
|
Q46
|
1.06 (0.92-1.21)
|
0.423
|
(4d)
Question
|
Category
|
Correct/Total
|
OR (95% CI)
|
P value
|
Q25
|
Non both college education
|
54/59
|
1(ref.)
|
.
|
Both college education
|
64/70
|
0.99 (0.29-3.42)
|
0.984
|
Q26
|
Non both college education
|
16/59
|
1(ref.)
|
.
|
Both college education
|
14/70
|
0.66 (0.28-1.53)
|
0.330
|
Q27
|
Non both college education
|
47/59
|
1(ref.)
|
.
|
Both college education
|
63/70
|
2.23 (0.51-9.82)
|
0.287
|
Q28
|
Non both college education
|
27/59
|
1(ref.)
|
.
|
Both college education
|
35/70
|
1.19 (0.59-2.37)
|
0.631
|
Q30
|
Non both college education
|
24/59
|
1(ref.)
|
.
|
Both college education
|
33/70
|
1.30 (0.65-2.62)
|
0.462
|
Q31
|
Non both college education
|
44/59
|
1(ref.)
|
.
|
Both college education
|
66/70
|
9.00 (1.05-77.35)
|
0.045
|
Q32
|
Non both college education
|
18/59
|
1(ref.)
|
.
|
Both college education
|
11/70
|
0.42 (0.18-0.99)
|
0.048
|
Q33
|
Non both college education
|
51/59
|
1(ref.)
|
.
|
Both college education
|
60/70
|
0.94 (0.35-2.56)
|
0.906
|
Q34
|
Non both college education
|
36/59
|
1(ref.)
|
.
|
Both college education
|
52/70
|
1.59 (0.61-4.13)
|
0.342
|
Q35
|
Non both college education
|
36/59
|
1(ref.)
|
.
|
Both college education
|
51/70
|
1.71 (0.82-3.60)
|
0.154
|
Q36
|
Non both college education
|
10/59
|
1(ref.)
|
.
|
Both college education
|
17/70
|
1.57 (0.66-3.76)
|
0.310
|
Q37
|
Non both college education
|
31/59
|
1(ref.)
|
.
|
Both college education
|
50/70
|
2.26 (1.09-4.68)
|
0.028
|
Q38
|
Non both college education
|
55/59
|
1(ref.)
|
.
|
Both college education
|
69/70
|
5.02 (0.55-46.19)
|
0.154
|
Q39
|
Non both college education
|
28/59
|
1(ref.)
|
.
|
Both college education
|
36/70
|
0.92 (0.40-2.10)
|
0.840
|
Q40
|
Non both college education
|
54/59
|
1(ref.)
|
.
|
Both college education
|
67/70
|
2.07 (0.47-9.04)
|
0.335
|
Q41
|
Non both college education
|
31/59
|
1(ref.)
|
.
|
Both college education
|
48/70
|
1.97 (0.96-4.04)
|
0.064
|
Q42
|
Non both college education
|
13/59
|
1(ref.)
|
.
|
Both college education
|
14/70
|
0.88 (0.38-2.07)
|
0.777
|
Q43
|
Non both college education
|
40/59
|
1(ref.)
|
.
|
Both college education
|
42/70
|
0.71 (0.34-1.47)
|
0.360
|
Q44
|
Non both college education
|
36/59
|
1(ref.)
|
.
|
Both college education
|
37/70
|
0.72 (0.35-1.45)
|
0.352
|
Q45
|
Non both college education
|
34/59
|
1(ref.)
|
.
|
Both college education
|
41/70
|
1.04 (0.52-2.10)
|
0.914
|
Q46
|
Non both college education
|
34/59
|
1(ref.)
|
.
|
Both college education
|
42/70
|
1.10 (0.55-2.23)
|
0.785
|