A cross cultural journey through ethics education Medical ethics teaching during the clerkship in Indonesia and the Netherlands

Previous studies have discussed the wide range of ethical problems faced by medical students during their training, as well as differences in goals and scope of medical ethics education. We wondered if there is a tension between what students expect or need to learn and what teachers think students should learn. Therefore, we explored the experiences and perceptions of both medical students and teachers on ethics teaching during the clerkship. Since ethics is about values and influenced by culture, we decided to explore medical ethics teaching in two countries, Indonesia and the Netherlands. The study used qualitative methods with a phenomenological approach. We participated in group discussions and conducted in-depth interviews with students and teachers. We found that students in both settings had different perceptions of what an ethical problem is and encountered cases that were close to their daily work and often quite different from the cases discussed in the literature. Students also shared negative emotions and experienced moral distress. We found similar goals between Dutch and Indonesian teachers, but also goals that were specific to the respective countries. Teachers in both countries received reports of alarming cases from students during ethics classes and were uncertain on whether or not to intervene. We suggest that ethics education should prepare students for both their clinical training as well as clinical practice. Ethics group discussions should remain a free and safe place for students and all parties involved. Initiating cross-cultural discussions may be beneficial to broaden students’ and teachers’ perspectives.