| The Study of Ethics |
When they studied ethics
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54 (85.8%) reported the study at all levels of training: undergraduate, specialization, master’s degree, doctorate and post-doctorate; 3 (4.7%) reported not having studied; 6 (9.5%) think they did not, are not sure or do not remember. |
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Study of ethics in the specialization in Nephrology
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Only 6 (11.4%) reported having studied ethics during their specialization in Nephrology. 1 (1.8%) reports that they will have the content but have not yet had the module. All the remaining 46 (86.8%) denied the study. |
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Importance of the Content on ethics in training
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It was a very present speech. 47 (74%) interviewees mentioned the topic. The adjectives used to express this importance: extreme, very, relevant, primordial, necessary, interesting and fundamental. |
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How important the study of ethics was for the professional
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There is a description that was essential for the improvement in care. One statement summarized what was expressed by the others: “So, it is important for us to know how to deal with it, even with respect to the patient’s autonomy, what we offer, if there will be any benefit in their life, really?” (I60) |
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They do not know what would be important to study in ethics
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It was reported that the lack of knowledge is related to the lack of study of the topic and the lack of specific knowledge. The difficulty in formulating doubts on the subject also emerged. |
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Irrelevance of the content taught
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Statements emerged that learning was minimal, often in disciplines at the beginning of the course and, for this reason, the professional does not even remember the specific contents or what it is about. |
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They relate their training many years ago with not studying ethics
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3 (4.8%) deny the study of ethics and relate it to long-ago training: “At the time I studied Nephrology, this was not used. (laughs)” (I10 - graduated in 1987); “I graduated approximately 30 years ago and I have a very strict training in the medical part” (I17 - graduated in 1988); “as it was in the early 90s, this was not common” (I50 - graduated in 1996). |
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Ethics in current training
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2 (3.2%) reported that the content was in their training, as they went through “more modern curricula”. |
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Possibility of linking teaching, research and extension
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As they are professional training centers, 2 (3.2%) reported that there is the possibility of working on the teaching of bioethics together with the development of research in the service and in extension activities. |
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Lack of time to study ethics
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Despite the interest in the topic, there were reports from 3 (4.8%) interviewees about the difficulty of reconciling the study with the work routine. “I just didn’t have time in the face of the reality here of starting a job, right?” ... I find it interesting, but I haven’t had time yet” (I34); “I think that if I could, I would have more contact, you know, with this subject, yes” (I54);I, I try, I try to think about it, but I don’t, I never delved into it” (I63). |
| How and what professionals learn about ethics |
What they studied about ethics
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48 (76.2%) reported having studied the concepts of ethics or bioethics, especially in undergraduate studies. |
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Other ways of learning ethics reported
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The learning of contents was mentioned, such as: research in ethics; professional ethics; participation in professional council; Inclusion in the ethics committee. |
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Studied ethics in Nephrology in other places
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The professionals report contact with ethics in congresses, lectures, books, texts, independent study or in the discussion of cases in teams. |
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They studied ethics by working in other sectors
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There were reports of working in a non-oncological palliative care team by 2 (3.2%). An interesting statement was: “I left a year at the maternity to go to Nephrology and there are completely different characteristics, including our ethical position to work with each patient” (I35). |
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How Ethics Was Taught
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There was neglect when portraying how the content was taught: “But I think it’s very bad too. It’s very... poorly approached, not very didactic” (I13); Discussion is more in the classroom, not so much in dealing with the patient” (I32). |
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Deficiency in the content taught
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Terms such as; gap, little, I don’t even remember, little access, little knowledge, very loose, a deficiency, the course was very complete, but this part was not included, it is not the axis, and it does not guide, this is missing and lacking in medical courses. “I think this is something that we don’t have a determination and we don’t have adequate training to actually do this (laughs)” (I28) |
| Relevance of the Study of Ethics in Professional Training |
Why professionals seek to study Ethics
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To: do research; do the right thing; try to make as few mistakes as possible; be able to protect yourself too; doctor-patient relationship; to be able to treat better. In Nephrology specifically, it was quoted: “I stopped to think about it exactly when it is... recently, finally, this issue of the consideration of living donor transplantation was created” (I58) |
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Ethics as the basis of professional performance
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The statements portray that ethics is the basis of professional performance, not only in Nephrology, but in all areas, and that there is no way to act without this knowledge; It is necessary to be aware that the focus of care is the patient and pay attention to doing the best for them. It is necessary to be ethical with: the team, the user and their family. |
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Ethics in the professional’s routine
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It was one of the most present categories. There are reports that it is practiced daily, without realizing it; it “moves” the professional and their commitment. From this perspective, there is improvement in conducts as the experience increases, favoring the care provided and self-protection. Routine issues that can generate conflicts: different user needs and the presence of the industry. |
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When the professional practices ethics
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The practice of ethics in Nephrology was cited: “when we allow the patient, you know, to make their choice of therapy... when we guide them in relation to the treatment” (I1); “so that I can have respect for the patient, so that I can have a good, a good development of my work, it’s... so that I can also respect the work of the other professional” (I12);to deal with the patient, and with the suffering of others” (I17); On the other hand, it was emphasized that: “the environment, the institution you live in and the specialty... it will limit you or not in the exercise of your ethics” (I24). |
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Professional habitus / example of another professional
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The way you learned to use ethics: “But, in fact, you end up taking a lot of examples, right?” ... “the day-to-day, observing the other professionals, the way they acted” (I3); “because we see a lot of things like this talking to the staff, in the evolution of the cases” (I32); “It’s a little bit of the experience, right? so I put mine there, my speech with the patient is always very similar, right? it’s like that, let’s say so much talking, right? we already have more or less one, something in our heads like how we approach, how we talk, trying, as much as possible, you know, to particularize it like this for each patient, right?” (I49). |
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Studying opens horizons
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The importance of training and how much it has contributed to the growth of the professional was reported: “And this has, I have learned a lot, I have opened, opened my horizons a lot, right?” (I25); “Yeah, for sure right? we always want to learn more, right? aaa...this, the things change too” (I50) |
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Importance of Ethics dissemination
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The professionals portrayed that the disclosure of ethics can be the differential for the performance: “I think that ethics today should be more disseminated ... But this ethics focused on bioethics aimed at patients, I think it should be more disseminated, not studied as any specific topic” (I1); “Not with Nephrology itself, but with general medical training... But this is important for care, right? But this is not related to nephro, it is general patient care, you know?” (I63). |
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Importance of ethics for life
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There was a consensus on the importance of ethics not only for professional training, but for life and for society as a whole: “Everything always has bioethics and ethics” (I22);in the treatment, most obviously, better, right? of any human being it is fundamental” (I50); “it is mainly related to personal and, sometimes, cultural decision... like, religious” (I41). And that after the study of ethics, the professional was able to understand how wrong some human attitudes and actions are. However: “I think that society unfortunately does not understand what ethics is and when we transport the problem of society to the focal problem within Medicine, this is another conflict... What in my view today is the structure of society is very bad. Because people don’t know what ethics is, right?. These, here and there, we are faced with very complicated situations, right?” (I25). |
| Study of ethics in nephrology |
Nephrology training is complete, but there was no ethics study
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During the training “in residency the workload, it is small, it is more practical, right? then there was nothing in this sense” (I50); “you had the rotation period and then it’s no more... And you should do it, right?” (I32); “because this course there is already a complete course, so ethics and bioethics specifically, no” (I25). |
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They are interested in studying ethics in Nephrology
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The interest in studying ethics content in Nephrology was reported by almost half of the participants, and 10 (15.9%) are interested, but do not report a specific topic; 2 (3.2%) think about several topics; 34 (4.7%) had never thought about the subject; 17 (26.9%) are not interested or do not think about anything specific. 5 (7.9%) mentioned specific topics, according to the topics presented below. |
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What they would like to study about ethics and nephrology
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When asked about the topics that professionals would like to learn: expanded criteria in kidney transplantation, end-of-life care for kidney patients, confidentiality, social media, palliative nephrology, approach to patients who refuse dialysis, professional attitude, embracement, when to interrupt dialysis in the elderly or cancer patient, indication of dialysis in elderly people with degenerative diseases. However, some professionals did not know how to answer: “Only in nephro itself... I found bioethics very boring” (I13); “Hum... Nothing very specific to Nephrology that comes” (I41); “Specifically, nothing that comes to my mind right now” (I55). |
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There should be a space in residency/training to discuss ethics
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Suggestions from the interviewees: “That, I don’t know, but bioethical issues should be, we should have a space in the residency to discuss this, you know” (I32);So, yes. But I don’t know what exactly” (I61);is managing to specialize in specific things, of each of these, of these service areas, because it is very diverse, right?” (I35) |
