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DOI: 10.24412/2707-6180-2022-64-173-181 УДК 37.025 МРНТИ 76.01.07
FORMATION OF ETHICAL AND DEONTOLOGICAL CULTURE IN PROFESSIONAL TRAINING OF A MEDICAL STUDENT
I.M. SALPYKOVA1, M.R. SHAMTIEVA1, S.G. ROZENTAL1, E.B. NURBAULINA 2, A.K. TOGAIBAYEVA3
'Kazan Federal University, Kazan, Russia 2 West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan 3 K.Zhubanov Aktobe Regional University, Aktobe, Kazakhstan
Salpykova I.M. - https://orcid.org/0000-0003-4036-6261; SPIN: 7118-0754
Shamtieva M.R. - https://orcid.org/0000-0003-0881-7915; SPIN: 7272-2000
Rozental S.G. - https://orcid.org/0000-0003-1843-4571; SPIN: 3698-6222
Nurbaulina E.B. - https://orcid.org/0000-0003-0124-2848; SPIN: 5898-6148
Togaibayeva A.K. - https://orcid.org/0000-0002-2071-9536; SPIN: 9471-6438
Citation/
библиографиялыщ сттеме/ библиографическая ссылка:
Salpykova IM, Shamtieva MR, Rozental SG, Nurbaulina EB, Togaibayeva AK. Formation of ethical and deontological culture in professional training of a medical student. West Kazakhstan Medical Journal. 2022; 64(3): 173—181. DOI: 10.24412/2707-6180-2022-64-173-181
Салпыщова ИМ, Шамтиева МР, Розентал СГ, Нурбаулина ЭБ, Тгайбаева AK. Этика-деонтологиялыщ мэдениетп ^алыптастыру медицина студенттерш кэаби о^ыту Yрдiсiнде. West Kazakhstan Medical Journal. 2022;64(3):173-181. DOI: 10.24412/2707-6180-2022-64-173181
Салпыщова ИМ, Шамтиева МР, Розентал СГ, Нурбаулина ЭБ, Тгайбаева AK. Формирование этико-деонтологической культуры в процессе профессиональной подготовки
студента-медика. West Kazakhstan Medical Journal. 2022;64(3):173-181. DOI: 10.24412/2707-6180-2022-64-173181
Formation of ethical and deontological culture in professional training of a medical student
I.M. Salpykova1, M.R. Shamtieva1, S.G. Rozental1, E.B. Nurbaulina2, A.K. Togaibayeva3
■Kazan Federal University, Kazan, Russia
2West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan 3K.Zhubanov Aktobe Regional University, Aktobe, Kazakhstan
Purpose: The article deals with the problem of forming the ethical and deontological culture of a medical student from the standpoint of methodological understanding, conceptual and essential justification, structural and substantive content, taking into account the main normative provisions based on new social realities. Considering that the influence of the social environment is stronger than the influence of the education system, the creation of an educational environment in medical universities is of particular importance.
Purpose: theoretical and methodological substantiation of ethical and deontological culture formation of a medical student in professional training. Methods: general theoretical - analysis of socio-philosophical, historical, psychological-pedagogical, scientific-methodical, reference-encyclopedic, ethical-deontological literature on the problem of the research, research and analysis of normative and program documentation, pedagogical experience of humanistic education of a medical student; comparison, classification and generalization of the material; data systematization. The methodological basis: axiological, competence-based, culturological approaches.
Results. The essence of familiarization with ethical and deontological culture is determined by the authors, which consists in organizing activities for the development and assimilation by students of ethical values and deontological norms that contribute to the development of empathy, the formation of a humanistic orientation of value orientations and significant qualities of students of future doctors. The necessity of substantial filling of the resource provision, the possibility of using the potential of humanitarian disciplines in the formation of the personality of the future doctor and his professional development as a specialist is substantiated. The conducted research made it possible to determine the vector in the development and implementation of organizational and pedagogical conditions for the formation of ethical and deontological culture of students in the educational process of the Institute of Fundamental Medicine and Biology of Kazan Federal University and within the framework of the study to test their effectiveness. The results of the research can be used in the process of developing curricula, work programs of disciplines, individual forms of organization of independent classroom and extracurricular work of students. Conclusions. The concepts of «personal culture», «professional culture», «ethical culture», «deontological culture» are considered based on the analysis of philosophical, psychological and pedagogical works; the content of the concept of «ethical and deontological culture» is determined and its structure is revealed; modern approaches
e
Шамтиева М.Р.
e-mail:mai'ina.rccmanovna0815@ yandex.ccm
Received/
Keaiu mycmi/ Паступпиа: 88.88.0800
Acceetee/ Басыаымга цабыаданды/ aрuняma к публикации: 8..8..0800
ISSN 2707-6180 (Print) © 2021 The Authors Published by West Kazakhstan Marat Ospanov Medical University
to ethical and deontological education are studied and to check their effectiveness in further research.
Keywords: culture, ethical culture, deontological culture, student, medical education
Этика-деонтологиялык мэдениетт калыптастыру медицина студенттерш кэаби окыту урдкшде
И.М. Салпьщова1, М.Р. Шамтиева1, С.Г. Розентал1, Э.Б. Н^рбаулина2, A.K. Тогайбаева3
'^азан федералдьщ университета, ^азан, Ресей
2Марат Оспанов атындагы Батыс ^азакстан медицина университета, Актебе, ^азакстан
з^.Жубанов атындагы Актебе ещрлш унивеpситетi, Актебе, ^азакстан
Максаты. Макалада медицина студентшщ этикалык жэне деонтологиялык мэдениетгн калыптастыру YДеpiсiнщ проблемасы эдiстемелiк TYсiнiк, тужырымдамалык жэне мацыздылыгын негiздеу, курылымдык жэне мазмундык тольщтыру, негiзгi еpежелеpдi ескере отырып, жаца элеуметгж шындыкка негiзделген. Жогары медициналык бiлiм кузыретга мамандарды дайындауды камтамасыз етуi керек екенгн ескере отырып, медициналык университеттерде бiлiм беру ортасын куру ерекше мацызга ие. Жогарыда айтылгандарга CYЙене отырып, зерттеудщ максаты медициналык студенттщ кэсiби даярлыгы процесгнде этикалык жэне деонтологиялык мэдениеттi калыптастыру негiздеpiн теориялык жэне эдiстемелiк тургыдан негiздеу болып табылады. Эдктер: жалпы теориялык - элеуметгж-философиялык, психологиялык-педагогикалык, гылыми-эдастемелш, аныктамалык жэне энциклопедиялык эдебиеттерда, нормативтж-багдарламалык кужаттамаларды талдау; материалды салыстыру, жжтеу жэне жалпылау; деpектеpдi ЖYЙелеу.
Нэтижесi. Авторлар этика-деонологиялык мэдениетпен таныстыру процесшщ мэнiн аныжгады, студенттердщ к¥ндылык багдарларыныц гуманистiк багытын калыптастыруга ыкпал ететiн этикалык кундылыжгар мен деонтологиялык нормаларды дамыту жэне игеру бойынша гс-шараларды уйымдастырудан турады, болашак дэрггердщ шэюртшщ мацызды касиеттеpi. «Медицина мен биологиядагы этика жэне деонтология» пэнш дидактикалык камтамасыз ету мазмуныныц кажеттшт, цифрлык бiлiм беру ресурсы, болашак дэртердщ тулгасын калыптастыруда жэне маман pетiнде кэсiби дамуда гуманитарлык гылымдардыц элеуетiн пайдалану MYмкiндiгi. дэлелденген. Зерттеу ^азан федералдык университетгнщ ipгелi медицина жэне биология институтыныц оку процесшде студенттеpдiн этикалык жэне деонтологиялык мэдениетгн калыптастырудыц ¥й^1мдастыруш^1л^1к-педагогикал^1к шарттарын эзipлеу мен ЖYзеге асырудагы векторды аныщтауга мумкгндж беpдi. зерттеу шенбеpi, олардыц тшмдшггн тексеру. Зерттеу нэтижелеpi оку жоспарларын, пэндердщ жумыс багдарламаларын, студенттеpдiн езшдж аудиториялык жэне сыныптан тыс жумыстарын уйымдастырудыц жеке нысандарын жасау процесгнде пайдаланылуы мумкгн.
Е^орытынды. Философиялыщ, психологиялык-педагогикалык енбектеpдi талдау негiзiнде «тулга мэдениет», «кэаби мэдениет», «этикалык мэдениет», «деонтологиялык мэдениет» угымдары карастырылады; «этикалыщ-деонтологиялык мэдениет» угымыныц мазмуны айкындалып, курылымы ашылды; этикалык жэне деонтологиялык тэрбиенщ заманауи тэсiлдеpiн зеpттедi. Негiзгi свздер: мэдениет, этикалыц мэдениет, деонтологиялыц мэдениет, студенттж, медициналъщ бтш
ФОРМИРОВАНИЕ ЭТИКО-ДЕОНТОЛОГИЧЕСКОЙ КУЛЬТУРЫ В ПРОЦЕССЕ ПРОФЕССИОНАЛЬНОЙ ПОДГОТОВКИ СТУДЕНТА-МЕДИКА
И.М. Салпыкова1, М.Р. Шамтиева1, С.Г. Розенталь1, Э.Б. Нурбаулина2, А.К. Тогайбаеваз
'Казанский федеральный университет, Казань, Россия
2Западно-Казахстанский медицинский университет имени Марата Оспанова, Актобе, Казахстан
зАктюбинский региональный университет им. К. Жубанова, Актобе, Казахстан
Цель: В статье рассматривается проблема процесса формирования этико-деонтологической культуры студента-медика с позиций методологического осмысления, понятийно-сущностного обоснования, структурно-
содержательного наполнения с учетом основных нормативных положении, исходя из новых социальных реалий. Учитывая, что высшее медицинское образование должно обеспечивать подготовку компетентных специалистов, особую значимость приобретает создание в медицинских вузах образовательной среды. Исходя из вышеуказанного, целью исследования является теоретическое и методологическое обоснование основ формирования этико-деонтологической культуры в процессе профессиональной подготовки студента-медика. Методы: общетеоретические - анализ социально-философской, исторической, психолого-педагогической, научно-методической, справочно-энциклопедической, этико-деонтологической литературы по исследуемой проблеме, изучение и анализ нормативно-программной документации, педагогического опыта гуманистического воспитания студента-медика; сравнение, классификация и обобщение материала; систематизация данных. Результаты. Авторами определена сущность процесса приобщения к этико-деонтологической культуре, которая заключается в организации деятельности по освоению и присвоению студентами этических ценностей и деонтологических норм, способствующих формированию гуманистической направленности ценностных ориентаций и значимых качеств студента будущего врача. Доказана необходимость в содержательном наполнении дидактического обеспечения дисциплины «Этика и деонтология в медицине и биологии», цифрового образовательного ресурса, возможности использования потенциала гуманитарных дисциплин в формировании личности будущего врача и профессиональном становлении его как специалиста. Проведенное исследование позволило определить вектор в разработке и реализации организационно-педагогических условий формирования этико-деонтологической культуры студентов в образовательном процессе Института фундаментальной медицины и биологии Казанского федерального университета и в рамках исследования проверить их результативность. Результаты исследования могут быть использованы в процессе разработки учебных планов, рабочих программ дисциплин, индивидуальных форм организации самостоятельной аудиторной и внеаудиторной работы студентов.
Выводы. На основе анализа философских, психологических и педагогических трудов рассмотрены понятия «культура личности», «профессиональная культура», «этическая культура», «деонтологическая культура»; определено содержание понятия «этико-деонтологическая культура» и выявлена её структура; изучены современные подходы к этико-деонтологическому воспитанию. Ключевые слова: культура, этическая культура, деонтологическая культура, студент, медицинское образование
Introduction
According to the requirements reflected in regulatory documents as the Federal State Educational Standards of Higher Education, the Federal Law "Education in the Russian Federation", "The Concept of Spiritual and Moral Development and Education of the Personality of a Russian Citizen", high demands are placed not only on professional skills, at the same time on their moral and ethical qualities. The education of a medical student's sense of mercy, compassion, love for people, empathy, readiness to help the patient determines the further success of future medical activity. Moreover, in the process of interaction between a doctor and a patient or patient's relative, it is important and necessary to observe the basic moral principles.
At the same time, the realities of society and medicine are in a high contradiction. Nowadays, people do not pay enough attention to the values associated with a sense of responsibility, conscience, justice and duty. The researchers emphasize that modern Russian society is in a state of value-normative uncertainty. Modern education, make the main efforts to form a successful personality, does not pay enough attention to the development and
improvement of the theoretical and methodological foundations of ethical and deontological education.
Taking into account all the above mentioned issues, our study dedicated to the problem of students' ethical and deontological culture formation - future doctors, so the following research is extremely relevant. It can be noted that in the Federal State Educational Standard of Higher Education of the third generation, the requirements for the graduate are clearly indicated as requirements for the results of mastering the main educational program. So, in the name of the category (group) of general professional competencies "Ethical and legal foundations of professional activity" in medical specialties, deontological competence is considered in the first place. As a result of mastering the specialty program, the graduate "is able to implement moral and legal norms, ethical and deontological principles in professional activities" (31.05.01 "Medicine"; 31.05.03 "Dentistry"); "is able to comply with the principles of medical ethics and deontology while working with patients (their relatives/ legal representatives), colleagues" (30.05.01 "Medical Biochemistry").
Modern ethical philosopher R.G. Apresyan claims that
in addition to professional training, higher education has to systematically and comprehensively promote fundamental moral values, explain their meaning and their effectiveness in professional activities [1]. Additionally, "moral and ethical content should be integrated into the most different parts of the curriculum," since ethical education is one of the most important components in forming the personality of a future doctor.
The personality of a modern student, particularly a medical student, is formed while there is some "blurring" of the value system in society. The values which are promoted by the media are often the opposite of those that have traditionally been inherent in the best representatives of domestic medicine. Considering that the influence of the social environment is stronger than the impact of the education system, the creation of an educational environment in medical universities that contributes to the formation of the ethical and deontological culture of the future doctor has great importance.
In domestic and foreign literature devoted to the issues of ethical and deontological training in a medical university, it is emphasized that deontological education should be carried out within the framework of each academic discipline from the first year until the full formation of deontological moral stereotypes in the minds of future doctors. According to researchers, exactly the interdisciplinary integration can have the greatest impact on the formation of ethical values [2; 3; 4; 5; 6; 7].
The above mentioned information allows us to speak about a number of existing contradictions at the socio-pedagogical level, at the scientific and pedagogical level, at the scientific and methodological level:
- at the socio-pedagogical level, a contradiction has been established between the society's need for specialists with a general and professional culture, and the emerging trend towards a decrease in the level of ethical and deontological culture of medical workers;
- at the scientific and pedagogical level, a contradiction was revealed between the need to form a professional ethical and deontological culture among students of a medical university and the insufficiency of modern scientifically based developments in the following area in the theory of pedagogy and psychology;
- at the scientific and methodological level, a contradiction has been established between the need to use the potential of interdisciplinary disciplines taught at a medical university to familiarize students with ethical and deontological culture.
Generally, all the identified contradictions allowed us to consider the problem of the process of formation of the ethical and deontological culture of a medical student from the standpoint of methodological understanding, conceptual and essential substantiation, structural and content, taking into account the main regulatory provisions, based on new social realities.
The purpose of the following study is the theoretical and methodological substantiation of the foundations of the formation of ethical and deontological culture in the process of professional training of a medical student.
The following tasks were solved in the given study: to carry out an analysis of socio-philosophical, historical, psychological-pedagogical, scientific-methodical,
reference-encyclopedic, ethical-deontological literature concerned the problem of study in order to clarify the essence of the concept of "ethical-deontological culture".
Methods of the research
The theoretical basis of the research: theories of humanization in medical education; concepts of ethical and moral education; theoretical provisions of the pedagogy of vocational education, ideas of medical ethics and deontology, theories of culture and ethics.
The methodological basis of the research: the provisions of the cultural (V.S. Bibler, E.V Bondarevskaya,
0.5. Gazman, S.I. Gessen, A.S. Zapesotsky, N.B. Krylova, etc.), axiological (N.A. Astashova, V.A. Karakovsky, A.V. Kiryakova, I.B. Kotova, E.N. Shiyanov, N.E. Shchurkova, E.A. Yamburg and others) and competency-based (V.I. Baidenko,
1.A. Zimnyaya, V.S. Meskov, Yu.G. Tatur, G.S. Trofimova, A.V. Khutorskoy, etc.) approaches.
In order to rich the above mentioned goals, a set of complementary methods were used: theoretical analysis of socio-philosophical, historical, psychological-pedagogical, scientific-methodical, reference-encyclopedic, ethical-deontological literature dedicated to the problem of the research, study and analysis of normative and program documentation, pedagogical experience of humanistic education of a student -physician; comparison, classification and generalization of the material; data systematization.
Results
The research was conducted from November 2021 to February 2022 years.
The first stage (preparatory) was devoted to the theoretical understanding of the problem in order to determine the general strategy and guidelines for the research:
1. At this stage, the following activities were carried out: the study and analysis of socio-philosophical, historical, psychological-pedagogical, scientific-methodical, reference-encyclopedic, ethical-deontological literature on the research problem, study and analysis of normative and program documentation, pedagogical experience of humanistic education of a medical student, studying the experience of international and Russian colleagues.
2. The essence of the concept of "ethical and deontological culture" was determined, which consists in organizing activities for the development and appropriation of ethical values and deontological norms by students, contributing to the development of empathy, the formation of a student's humanistic orientation and deontological significant personality traits of the future specialist; correction and clarification of the conceptual apparatus.
In our opinion, medicine in all ages has not been developed as a simple technology. It is known that since ancient times it contained strict moral, ethical and legal prescriptions of the doctor's duties in relation to
the patient, his responsibility for the wrong results of treatment. Additionally, the term "ethics" was used by the ancient Greek philosopher Aristotle for the first time. Ethics as a science means the discipline that studies questions of morality and morality. The ancient Indian book "Ayurveda" gives us the first provisions of medical ethics, it is further developed in the oath of Hippocrates of Kos in ancient Greece.
In the Middle Ages, Paracelsus has played a key role in the development of the principles of medical ethics. The development of medical ethics as a science finds its expression in the oaths, oaths and codes of doctors of ancient Tibet, set forth in the treatise "Judshi", the oaths of doctors of ancient India, the code of Chinese doctors. The achievements about this matter of the Salerno Medical School (founded in 1213) are interesting. Of the more than 50 emblems of medicine used over the centuries, and, based on modern archeological data, it was first used as early as the 2nd millennium BC. in ancient Babylon, there remains a snake - a symbol of caution, knowledge, wisdom, goodness. The formation of the moral principles of medicine was also influenced by Islam in the person of medieval Arab thinkers and doctors like Ibn Sina (Avicenna) (X-XI centuries), Ar Razi (X century), Ibn Al-Talmid (XII century) and others. In addition, we will mention about the Western European models of medical ethics of Paracelsus (XV-XVI centuries) and Kant (XVIII century).
We have established that medical ethics is a methodological concept and considers general issues of medical activity. Deontology is a methodological concept that considers the issues of fulfillment by medical personnel of their duty to patients, colleagues, and society. It is an applied part of medical ethics and is closely related to the diagnosis, treatment, prevention of diseases, the performance of various medical procedures, the basic rules of conducting for medical workers and indicating the necessary moral qualities of physicians.
The term "deontology" (Greek deontos - due, proper; logos - teaching) was introduced by the English philosopher Jeremy Bentham for the first time in order to denote the theory of morality in general. The totality of ethical norms and principles of behavior of medical workers in the performance of their professional duties is the concept of medical deontology. This term was introduced into the Russian medical literature by the outstanding oncologist-surgeon N.N. Petrov in the book "Issues of Surgical Deontology" (1944), speaking of deontology as "the principles of behavior of medical personnel ... to maximize the amount of usefulness of treatment." The very first code of medical ethics can be recognized as the Hippocratic Oath. It became a model for creating medical oaths throughout the world and in all eras. However, it is outdated in some positions, nevertheless, it is always modern. The requirements that a doctor should be guided by while fulfilling his professional duty are formulated in the works of Hippocrates, Galen, Celsus, Avicenna and other ancient scientists. Its provisions were the basis of the Geneva Declaration of the World Medical
Association (1948-1994). Foreign scientist R. Moore notes that medical ethics is a universal ethics relating to medical activity, without any special principles, methods or rules. It is "an old ethic trying to find its place in new, often in difficult circumstances." Most of its provisions are reflected in the Russian Federation.
So, ethical codes, norms and rules of communicating for a medical specialist are developed on the basis of the principles of deontology. The World Medical Assembly has adopted a number of statements and declarations on particular issues of medical ethics:
1. "Declaration on the abuse of the elderly and the elderly" (1989-1990);
2. Statement on Teenage Suicide (1991);
3. Statement on Parental Neglect and Child Abuse (1990-1992);
4. "Statement on the complicity of doctors in suicides" (1992), etc.
All these documents are about the basic moral principles and rules that future doctors are required to follow in their activities and that are currently guided by medical workers around the world. In many countries ethical commissions on bioethics have been created and are successfully functioning nowadays. There are numerous of bioethical associations, including ethical committees, are being organized, and more and more specialists in this field are being trained, which, of course, indicates the demand for this scientific field for medical practice in the Russia.
Nevertheless, the problem of unpreparedness of specialists in the field of medicine, in particular, communication with patients, relatives of the patient and colleagues (especially with junior medical personnel) still remains unresolved due to the fact that this training is not given enough attention, both at the university and within the system of advanced training of specialists.
We have noted that the concept of "deontological culture of the future doctor" is rarely found in scientific publications. Issues related to the development of deontological culture were developed in the study by G.A. Karakhanova in relation to the professional training of a teacher as a result of morally oriented training through the requirements of professional duty, which is manifested in behavior and professional activity (the content of professional ethics, moral ideals, humanistic values of activity) [8].
M.L. Kropacheva claims deontological competence as a humanistic orientation of a doctor's value orientations, as well as a set of learned ethical and deontological norms and the formation of deontologically significant qualities of a specialist's personality that are realized in professional activity [9].
The study of some works related to the problems of the medical professional ethical culture showed that they are based on the consideration of ethics in the context of professional specialization in relation to a particular area of medical practice (deontology in surgery, obstetrics and gynecology, pediatrics, etc.). Therefore, our research required the study of the theoretical aspects of medical ethics and deontology. The analysis of the numerous
literature revealed the lack of a unified point of view on the relationship and content of the concepts of "medical ethics" and "medical deontology".
The analysis of the content of concepts shows that they are perceived by specialists in an inseparable unity. This allowed us to substantiate the use of the term "ethical-deontological culture" in relation to one of the components of the professional culture of a medical worker.
In the following study, we define ethical and deontological culture as a humanistic orientation of the doctor's value orientations, as well as a set of learned ethical and deontological norms and the formation of deontologically significant qualities of a specialist's personality that are realized in professional activities.
We have analyzed several publications from the several international databases like Scopus, WOS, and Russian journals. In publications devoted to medical ethics and deontology, it is emphasized that demonological education should become "total" in all disciplines from the first year until the full formation of deontological moral stereotypes in the minds of future doctors. This opinion can be supported by the data of American experts who note that although ethics courses have been introduced in virtually all medical schools in North America over the past 20 years, during the same period there has been an increase in dissatisfaction with the behavior of doctors and a noticeable drop in professionalism. Among a number of factors that explain the insufficient influence of the course of medical ethics on the formation of professional values, we can highlight the following:
- courses often focus on making difficult decisions in situations on the verge of life and death and pay little attention to the values that are in demand in the daily practice of every doctor: empathy, compassion, attentiveness. In addition, these values are difficult to form in the bustle of an overworked clinic, where there is not enough time for interaction, reflection, and feedback. According to the researchers, courses devoted to the study of literature, religion, cinematography, in which much attention is paid to analysis, reflection, and the development of self-awareness, can have a much greater influence on the formation of these values. It is believed that literature, art, philosophy develop the ability to communicate with patients, to understand deeper into what is happening with the patient, to find more ways to help the patient and alleviate his condition. Therefore, for example, in the UK, the General Medical Council encourages the introduction of the liberal arts into the curricula, and a number of organizations, including the Institute of Medical Ethics and the American Society for Bioethics and the Humanities, support the inclusion of literature and the arts in the US medical curriculum.
In the foreign practice of teaching in medical universities from the beginning 70s XX centuries literary texts are used as a teaching material. Prose, drama, poetry, autobiographies and feature films are used as a texts. There are a large number of methodological materials: anthologies, bibliographies, special periodicals, electronic databases and websites.
The important role of literature and art in the professional training of a doctor has been repeatedly noted by domestic researchers (E.A. Wagner, A.A. Grando, etc.). According to E.A. Wagner, good literature teaches one of the main principles of deontology: to understand other people and find a common language with them.
Russian universities already have experience of using such literature texts, for example, at the First Moscow State Medical University named after I.M. Sechenov (Moscow), Altai State Medical University (Barnaul), Northern State Medical University (Arkhangelsk), students make analysis and discussion in the classroom on ethics and deontology, stories of writers-doctors. It should be noted the Kirov State Medical University (Kirov), which introduced the elective course "History of Mercy". The course materials are designed in order to connect bridge between morality and medicine, thereby "inspiring future healers that acts of mercy are not some kind of abstract high matter."
In addition, from our point of view, the introduction of interdisciplinary courses, of course, contributes to an increase in the ethical and deontological culture of the future medical student, however it can lead to the increasing in the teaching load of students, which is already quite large in a medical university. Therefore, a promising and relevant direction, in our opinion, is the inclusion of this potential in the disciplines already available in the curriculum.
The most common option for the implementation of ethical and deontological training is teaching the basics of ethics and deontology within a separate discipline.
The Russian system of medical education traditionally supports this model, by offering the discipline "Medical Bioethics" as the main source of learning about ethical standards in the medical field. Some authors criticize the given model in connection with the limited content of the discipline, aimed at solving a rather narrow range of problems, in particular, only at acquiring knowledge about ethics as a science, about fundamental issues of ethics, about normative documents regulating the legal relationship between a doctor and a patient.
Some studies note that such a study of biomedical ethics is only the first level of general theoretical training. Together with the first level, it is necessary to introduce a second one, which would specify the application of the previously obtained general theoretical provisions and would have an applied character, corresponding to the realities of practical activity.
For instance, medical universities in North America, where over the past decades, almost all medical universities have implemented a program to introduce courses in medical ethics, we noticed that the problem of dehumanization of medicine and the professional activities of doctors is still acute, as evidenced by the huge number of lawsuits filed from patients. So V. Gushchin, Director of the Department of Surgical Oncology at the Mercy Clinic (Baltimore, USA), notes the need to train the communication skill, which is a component of professionalism, which, in our opinion, cannot be done within the framework of a theoretical discipline.
Despite the fact that the discipline "Medical Bioethics" certainly expands the horizons of students and provides the study of the basics of medical ethics, this discipline as an independent unit, limited in time to study one semester or a year, does not have sufficient potential for the practical application of this knowledge. So,it is necessary to search for new models for the formation of professional and ethical culture of university students, which take into account the specifics of their professional activities.
In order to familiarize future doctors with professional ethical and deontological culture, we relied on Professor I.E. Yarmakeyeva's point of view, according to which the solution of the problem of realizing the potential of the academic discipline goes through three stages:
1) careful study and identification of the potential of the discipline;
2) determination of a set of conditions for updating this potential;
3) design, construction and testing of the scientific and pedagogical system.
In our opinion, one of the most successful models for the implementation of ethical and deontological training is the integration of the classical model of study at the Institute of Fundamental Medicine and Biology of the Kazan Federal University "Ethics and deontology in medicine and biology." This model does not only ensure the assimilation of fundamental ethical knowledge, however also the application of this knowledge in the practical activities of a student of the future doctor.
The discipline is included in the section of the main professional educational program "General Medicine", "Dentistry", "Medical Biochemistry" and belongs to the basic (general professional) part, is mastered in the 2nd year in the 3rd semester. The total labor intensity of the discipline is 2 credit(s) unit(s) for 72 hours(s). Referring to the Federal State Educational Standards in the specialties: 31.05.01 "General Medicine", 31.05.01 "Dentistry", we note in the list such graduate competencies as "able to analyze and take into account the diversity of cultures in the process of intercultural interaction", "able to implement moral and legal norms, ethical and deontological principles in professional activity"; in the specialty 30.05.01 "Medical Biochemistry" competence is presented - "is able to comply with the principles of medical ethics and deontology in working with patients (their relatives / legal representatives), colleagues" [10]. These competencies form the basis of ethical and deontological competence, which in turn includes an extensive set of knowledge about medical ethics and deontology, including cultural ones, readiness and ability to implement ethical standards in communication with patients, patient relatives, and work colleagues.
Furthermore, an important component of ethical and deontological competence is the presence of deontologically significant personality traits, such as empathy, compassion, mercy, etc. Lecturer S.G. Rosenthal (co-author of the study) introduces deontological principles into the learning process during lectures, practical classes, work of students in scientific circles.
The structure and thematic plan of contact and independent work on the discipline in each 13 lecture traces the importance of the main material for the future specialist, the need for a deep understanding of the problem by students in order to form their clinical thinking, interest in constant replenishment of knowledge for successful implementation in further work for the benefit of the patient.
Table 1.
Thematic design of the training modules of the course "Ethics and Deontology in Medicine and Biology"
№ Sections of the discipline / module
1. Topic 1. The subject of bioethics. Features of the development of modern scientific knowledge and the history of the formation of the subject area of bioethics.
2. Topic 2. Doctor and patient Ethical aspects of relationships
3. Topic 3. Ethics of biomedical research
4. Topic 4. Obligations and rights of medical workers
5. Topic 5. Medical (medical) errors
6. Topic 6. The rights of citizens in the field of health protection
7. Topic 7. Ethical problems of abortion, contraception, sterilization.
8. Topic 8. Euthanasia as a bioethical problem
9. Topic 9. Ethical problems of psychiatry
10. Topic 10. Venereal diseases and AIDS: ethical and legal problems
11. Topic 11. Ethical and legal problems of clinical transplantation and transfusiology
12. Topic 12. Ethical and legal problems of medical genetics and genetic engineering
13. Topic 13. Principles of ethical treatment of animals
Final results in deontology is achieved by solving situational problems, test tasks, working on abstracts on the proposed topic under the guidance of a teacher, as well as preparing for speeches at student scientific and practical conferences.
We have identified the following pedagogical conditions which ensure the effectiveness of the process of familiarization with professional ethical and deontological culture in the classroom in the discipline "Ethics and deontology in medicine and biology", a digital educational resource:
- involvement of students in activities related to their future profession;
- the use of dialogue as the main means of mastering ethical values and deontological norms in the classroom;
- orientation of students to mastering ethical standards and humanization of the educational process.
Discussion
Taking into account the specified conditions, aimed at the formation of the ethical and deontological culture of the student, it is planned to create competence-oriented didactic materials, using works of art as texts, excerpts from the books of famous doctors, stories from the life of prominent figures in medicine, cases from real medical practice, opinions reasoning will be selected famous doctors about medicine and their profession, pedagogical
maxims, addition of cases, etc.
Taking into account above mentioned conditions, aimed at the formation of the ethical and deontological culture of the student, it is planned to create competence-oriented didactic materials, consisted of texts, excerpts from the books of famous doctors, stories from the life of prominent figures in medicine, cases from real medical practice, reasoning will be selected famous doctors about medicine and their profession, pedagogical maxims, addition of cases, etc. The main tool for preparation will be dialogue, which is realized in the form of a conversation or discussion of the problem under discussion. In this regard, this approach is most significant for the development of a culture of moral feelings: the manifestation of empathy, the formation of attitudes towards ethical and deontological norms and rules.
We plan to continue our study in the new 2022-2023 academic year, in which second-year students, future general practitioners (district general practitioner), dentists, biochemists, will take participation.
At the ascertaining stage of the experimental study, primary diagnostics of the level of ethical and deontological culture of the student in the experimental (EG) and control (CG) groups will be carried out. In accordance with the identified structural components of ethical and deontological culture, the indicators of the severity of each of the components are determined:
- the level of the cognitive component - the criterion of its formation is the presence of a system of knowledge about professional duty, ethical principles and deontological norms, students' ideas about deontologically significant personal qualities of a doctor and self-assessment of the formation of these qualities;
- the level of the emotional and value component - the definition of empathy and the humanistic orientation of the individual, interest in activities in the field of "person - person";
- the level of the activity component - an orientation towards ethical professional behavior with the help of content analysis of activity products.
At the formative stage, an experimental program will be implemented in order to introduce future doctors to professional ethical and deontological culture.
At the control stage of the pilot study, repeated diagnostics will be performed, aimed at identifying the degree of familiarization with the professional ethical and deontological culture.
Conclusion
In conclusion, we want to note that the process of forming the ethical and deontological culture of a medical student cannot be limited by the curriculum of the discipline "Ethics and deontology in medicine and biology". Ethical and deontological training involves the creation of a set of didactic conditions. The need for the content of the didactic support of the discipline "Ethics and Deontology in Medicine and Biology", a digital educational resource, the possibility of using the potential of the humanities in shaping the personality of the future doctor and professional development as a specialist is proved. Finally, our study allowed us to determine the benchmark in the development and implementation of didactic conditions for the formation of ethical and deontological culture of students in the educational process of the Institute of Fundamental Medicine and Biology of Kazan Federal University and, as part of further research, to check their effectiveness.
Acknowledgment. This paper has been supported by the Kazan Federal University Strategic Academic Leadership Program (PRIORITY-2030).
Conflict of Interest. The authors declare no possible conflicts of interest.
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