Background: The education of medical students concerning ethical issues focuses mainly on critically ill hospitalized patients. However, in the outpatient setting physicians encounter many problems that require ethical decision making. The present study is an assessment of medical students' awareness and understanding of ethical issues commonly encountered in the ambulatory setting.
Methods: A questionnaire was designed to evaluate general knowledge of medical ethics using 12 clinical vignettes. These vignettes depict situations in the ambulatory setting which involve ethical problems. The questionnaire was distributed to medical students who were asked to state whether an ethical issue was present, its significance, and what the specific issue was.
Results: Students' abilities to identify that an ethical issue was involved in each vignette ranged from 34.2% to 96.4%. A majority of students identified the presence of an ethical dilemma in seven out of 12 vignettes. The significance rating varied from 2.8 to 4.4 on a scale of 1 to 5. The results indicate that traditional education in medical ethics does not necessarily prepare students to recognize these problems in the clinical setting.
Conclusions: The medical students surveyed for this study seem to be variably prepared to recognize obvious ethical dilemmas in the ambulatory setting. Medical education must prepare students to recognize and appropriately manage these commonly encountered situations.