Abstract:

Background and Purpose:
The education of most health care professionals requires a combination of academic and clinical or workplace training. The internship experience may occur intermittently in the total educational experience or be placed at the end of the formal academic preparation. Ideally the formal academic experience and the clinical experience should complement each other especially in the recognition and response to ethical and legal issues. The purpose of this research was to investigate the frequency of ethical and legal violations as witnessed by students, their responses, and barriers they experienced in seeking remediation of the problem. The project was designed to capture student suggestions for improving the academic curriculum and clinical supervision relative to ethical and legal issues through an open discussion session post survey application.

Subjects and Methods:
An extensive review of the literature was the foundation for a survey to investigate six primary areas of concern through 33 questions. Those areas were: blatant wrongdoing, improper supervision, improper resource utilization, lack of respect for peers and patients, sexual harassment, and lack of veracity in multiple sources of communication. The surveys were distributed through two educational institutions to 70 students in Doctor of Physical Therapy programs and 69 were completed for a response rate of 98.5%. At the time of the survey students had experienced 16-24 weeks of clinical education.

Findings and Conclusion:
In many cases students identified ethical and legal issues and responded by reporting them to either their clinical supervisor or the academic clinical coordinator. However, there were multiple occasions where students witnessed ethical or legal wrongdoing and failed to take any action. In all six categories a minimum of 33% of the students reported witnessing or taking part in one of the six areas. In all categories only a small percentage responded appropriately by contacting a supervisor, colleague, or a representative from the academic unit. Most often they reported that the barrier to reporting was being in a “low position on hierarchy”. The second most frequent reported reason for not responding was that they failed to recognize the situation as illegal or unethical at the time. All students had been given the academic instruction prior to entering the clinical setting to identify all the potential violations as unethical or illegal. In conclusion based on student comments post survey application and our observations, we recommend a mandatory competency test prior to the clinical experience based on the laws and regulations of the state, earlier placement of instruction of ethical and legal issues in the curriculum so there is opportunity for repetition and exploration in multiple classes, and academic policy changes that both encourage reporting and punish failure to report.

This research will be reported in the Journal of Physical Therapy Education in fall, 2014. Permission for this submission was granted by the editor of the journal.

Keywords:

Ethical issues in education, Barriers to learning, Workplace learning.