Journal of Medical Ethics and History of Medicine最新文献_第6页

The second strategic plan of medical ethics: a national report 医学伦理学第二次战略规划：国家报告

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Journal of Medical Ethics and History of Medicine Pub Date : 2021-12-02 DOI: 10.18502/jmehm.v14i17.8177

A. Parsapour, Ehsan Shamsi Gooshki, H. Malekafzali, F. Zahedi, B. Larijani

{"title":"The second strategic plan of medical ethics: a national report","authors":"A. Parsapour, Ehsan Shamsi Gooshki, H. Malekafzali, F. Zahedi, B. Larijani","doi":"10.18502/jmehm.v14i17.8177","DOIUrl":"https://doi.org/10.18502/jmehm.v14i17.8177","url":null,"abstract":"Medical ethics faces several challenges in different aspects of education, research, and treatment in medicine and healthcare practice. Design and implementation of a national strategic plan can pave the way for the development of a roadmap in various countries to strengthen ethics and address these challenges. To create a comprehensive plan compatible with the Iranian healthcare system, a multidisciplinary team of main stakeholders compiled a national strategic plan of medical ethics following several focus group discussion sessions and two workshops (2014-2017). Ultimately, the plan was confirmed by the Supreme Council for the Medical Ethics of the Ministry of Health and Medical Education. The current paper is a national report of the process and the medical ethics strategic plan in Iran. We have also tracked signs of progress and achievements in the country. In conclusion, this valuable effort has led to significant success in the implementation of medical ethics in clinical medicine, medical research, and education by using all the resources in our country. The participation of all the stakeholders, especially healthcare professionals in this way is required.","PeriodicalId":45276,"journal":{"name":"Journal of Medical Ethics and History of Medicine","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2021-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42852228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The impact of archaism discourse on Iranian medical historiography from the Achaemenid period 阿契美尼德时期古代话语对伊朗医学史学的影响

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Journal of Medical Ethics and History of Medicine Pub Date : 2021-12-01 DOI: 10.18502/jmehm.v14i16.8176

Masood Kasiri

引用次数: 0

Clarifying the concept of conscience in nurses' ethical performance in Iran: a concept analysis study. 澄清伊朗护士道德表现中的良心概念:一项概念分析研究。

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Journal of Medical Ethics and History of Medicine Pub Date : 2021-11-03 eCollection Date: 2021-01-01 DOI: 10.18502/jmehm.v14i14.7669

Kurosh Jodaki, Maryam Esmaeili, Mohammad Ali Cheraghi, Shahzad Pashaeypoor, Akram Sadat Sadat Hoseini

{"title":"Clarifying the concept of conscience in nurses' ethical performance in Iran: a concept analysis study.","authors":"Kurosh Jodaki, Maryam Esmaeili, Mohammad Ali Cheraghi, Shahzad Pashaeypoor, Akram Sadat Sadat Hoseini","doi":"10.18502/jmehm.v14i14.7669","DOIUrl":"https://doi.org/10.18502/jmehm.v14i14.7669","url":null,"abstract":"Although conscience, as an ethical concept, has emerged widely in the field of nursing, its functional meaning and its effects on nurses' performance are not clear. Therefore, the present study aimed to analyze the concept of conscience in the context of Iranian nurses' ethical performance. This study used a hybrid model including theoretical, fieldwork, and final analytic stages. In the theoretical phase, English and Persian articles published up to 2020 and indexed by scientific databases were analyzed. In the fieldwork phase, semi-structured in-depth interviews were conducted on nurse participants. The last two stages were jointly considered to draw the study's conclusions. In the theoretical phase, conscience was considered as a context-dependent concept, an inner voice, and a criterion for distinguishing right from wrong. The fieldwork phase' results were categorized into three themes: \"perception of conscience\", \"commands of conscience\", and \"obedience to conscience. The final definition was reached by merging the theoretical and field stages. This article aimed at investigating the relevance of conscience to ethical practice in the nursing field. Findings show that conscience is an inner feeling or voice that plays a vital role in providing ethical care by nurses.","PeriodicalId":45276,"journal":{"name":"Journal of Medical Ethics and History of Medicine","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2021-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c1/03/JMEHM-14-14.PMC8696592.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39939066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 4

Incivility toward nurses: a systematic review and meta-analysis. 对护士的不礼貌:一项系统回顾和荟萃分析。

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Journal of Medical Ethics and History of Medicine Pub Date : 2021-11-03 eCollection Date: 2021-01-01 DOI: 10.18502/jmehm.v14i15.7670

Foroozan Atashzadeh Shoorideh, Soolmaz Moosavi, Abbas Balouchi

{"title":"Incivility toward nurses: a systematic review and meta-analysis.","authors":"Foroozan Atashzadeh Shoorideh, Soolmaz Moosavi, Abbas Balouchi","doi":"10.18502/jmehm.v14i15.7670","DOIUrl":"https://doi.org/10.18502/jmehm.v14i15.7670","url":null,"abstract":"One important part of a nurse's job is to create and help maintain a safe work environment. Evidence shows that negative behaviors such as incivility are not uncommon in the nursing profession. This systematic review and meta-analysis aimed to examine the prevalence of incivility toward nurses. For this purpose, all observational studies that primarily investigated the rate of incivility toward nurses were selected. The electronic databases PubMed, Embase, Web of Sciences, Magiran, IranDoc, and Scopus were searched for studies published during the period of January 1, 1996 to December 31, 2019. The quality of studies was assessed using Hoy's Critical Assessment Checklist. The study was undertaken using the random effects model, and data were analyzed using STATA14. Data on 60 articles, including data on 30801 individuals, published between 1997 and 2019, entered the study. The findings showed the prevalence of incivility to be 55.10% (95%, CI: 48.05, 62.06). Due to the high prevalence of uncivil behavior, especially of the verbal type, nursing managers should identify risk factors in the workplace. Planners should develop programs to increase workplace safety, especially in centers that are most exposed to these behaviors. It is also recommended that future studies focus on implementation of effective evidence-based interventions based on organizational culture.","PeriodicalId":45276,"journal":{"name":"Journal of Medical Ethics and History of Medicine","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2021-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f7/5a/JMEHM-14-15.PMC8696574.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39939519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 7

Ethical considerations for clinicians faced with patients lacking the capacity to form reasoned judgments regarding COVID-19 tests and isolation. 临床医生面对患者缺乏对COVID-19检测和隔离做出合理判断的能力时的伦理考虑。

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Journal of Medical Ethics and History of Medicine Pub Date : 2021-11-03 eCollection Date: 2021-01-01 DOI: 10.18502/jmehm.v14i13.7668

Jeffrey Yuk-Chiu Yip

{"title":"Ethical considerations for clinicians faced with patients lacking the capacity to form reasoned judgments regarding COVID-19 tests and isolation.","authors":"Jeffrey Yuk-Chiu Yip","doi":"10.18502/jmehm.v14i13.7668","DOIUrl":"https://doi.org/10.18502/jmehm.v14i13.7668","url":null,"abstract":"Dealing with patients suffering severe mental health problems during the Coronavirus disease 2019 (COVID-19) pandemic have raised several, complex, clinical and ethical questions (1). Such patients may need to be treated within secure facilities where many patients and staff live in close proximity, increasing the risk of disease transmission. In February 2020, in the Daenam hospital in South Korea, an infection cluster was found in the psychiatric ward, with 101/103 patients testing positive (2). In this pandemic’s unprecedented circumstances, psychological pressure on medical staff has been severe (3). Clinical staff have been significantly at risk when dealing with psychiatric inpatients, especially in areas where high infection levels have led to shortfalls in personal protective equipment supply. Several strategies are required to reduce infection risks for psychiatric inpatients and their caregivers. Such strategies may include a comprehensive test program, mask-wearing, and social distancing. However, psychiatric patients would frequently not possess the capacity to make reasoned judgments regarding the refusal of testing or noncompliance with anti-infection protocols. Because of psychiatric illness, such patients may refrain from being tested or following protocols such as mask-wearing or isolation. Thus, clinicians have faced with serious ethical problems when dealing with psychiatric inpatients during this pandemic, in that they must balance the requirements of respecting patient autonomy and allowing them as much freedom of self-determination as is appropriate, against the need to protect the patient from infection and prevent them from infecting others. This commentary aimed at assisting clinicians facing with such ethical dilemmas.","PeriodicalId":45276,"journal":{"name":"Journal of Medical Ethics and History of Medicine","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2021-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/70/01/JMEHM-14-13.PMC8754172.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39861928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Developing and validating an instrument to measure: the medical professionalism climate in clinical settings. 开发和验证测量工具：临床环境中的医学职业精神氛围。

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Journal of Medical Ethics and History of Medicine Pub Date : 2021-11-03 eCollection Date: 2021-01-01 DOI: 10.18502/jmehm.v14i11.7666

Fariba Asghari, Zahra Shahvari, Abbas Ebadi, Fateme Alipour, Shahram Samadi, Maryam Bahreini, Homayoun Amini

{"title":"Developing and validating an instrument to measure: the medical professionalism climate in clinical settings.","authors":"Fariba Asghari, Zahra Shahvari, Abbas Ebadi, Fateme Alipour, Shahram Samadi, Maryam Bahreini, Homayoun Amini","doi":"10.18502/jmehm.v14i11.7666","DOIUrl":"10.18502/jmehm.v14i11.7666","url":null,"abstract":"This study was conducted to develop and validate an instrument to measure the medical professionalism climate in clinical settings. The item pool was developed based on the Tehran University of Medical Sciences Guideline for Professional Conduct. The items were distributed between two questionnaires, one for health-care providers and the other for patients. To assess the construct validity of the questionnaires, 350 health-care providers and 88 patients were enrolled in the study. The reliability of the questionnaires was evaluated by calculating Cronbach's alpha and ICC. At first a 74-item pool was generated. After assessing and confirming face and content validity, 41 items remained in the final version of the scale. Exploratory factor analysis revealed the three factors of \"personal behavior\", \"collegiality\" and \"respect for patient autonomy\" in a 25-item questionnaire for service providers and a single factor of \"professional behavior\" in a 6-item questionnaire for patients. The three factors explained 51.775% of the variance for service providers' questionnaire and the single factor explained 63.9% of the variance for patients' questionnaire. The findings demonstrated that from the viewpoints of patients and service providers, this instrument could be applied to assess the medical professionalism climate in hospital clinical settings.","PeriodicalId":45276,"journal":{"name":"Journal of Medical Ethics and History of Medicine","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2021-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/43/dc/JMEHM-14-11.PMC8696557.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39939064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Moral distress among Iranian neonatal intensive care units' health care providers: a multi-center cross sectional study. 伊朗新生儿重症监护病房卫生保健提供者的道德困扰:一项多中心横断面研究

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Journal of Medical Ethics and History of Medicine Pub Date : 2021-11-03 eCollection Date: 2021-01-01 DOI: 10.18502/jmehm.v14i12.7667

Saleheh Tajalli, Somayeh Rostamli, Nazi Dezvaree, Mamak Shariat, Maliheh Kadivar

{"title":"Moral distress among Iranian neonatal intensive care units' health care providers: a multi-center cross sectional study.","authors":"Saleheh Tajalli, Somayeh Rostamli, Nazi Dezvaree, Mamak Shariat, Maliheh Kadivar","doi":"10.18502/jmehm.v14i12.7667","DOIUrl":"https://doi.org/10.18502/jmehm.v14i12.7667","url":null,"abstract":"Due to the unique nature of the neonatal intensive care unit (NICU) and its moral distress, this study aimed to investigate moral distress in the NICU. This cross-sectional study was conducted on 234 physicians and nurses working in the neonatal wards of eight hospitals. The Corley's Moral Distress Scale was used to collect data. Findings showed that 25 of the participants were physicians and 209 were nurses. The intensity and frequency of distress among physicians and nurses were assessed as moderate. The mean intensity and frequency of moral distress among nurses and physicians were 48.3%, 41.5% and 46.46%, 15.62% respectively. The results showed that the mean intensity and frequency of distress were higher, however not significantly, among nurses. The intensity and frequency of moral distress had a statistically significant and direct correlation with the intention to leave and the number of staff in each working shift among the nurses. Moral distress in the NICU practitioners was moderate, so addressing this issue and trying to alleviate it was important. Identifying the causes behind moral distress can help adopt appropriate measures to prevent and reduce them.","PeriodicalId":45276,"journal":{"name":"Journal of Medical Ethics and History of Medicine","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2021-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/54/c6/JMEHM-14-12.PMC8696547.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39939065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 3

Medical students' perception of professionalism climate in clinical settings. 医学生对临床专业氛围的感知。

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Journal of Medical Ethics and History of Medicine Pub Date : 2021-08-31 eCollection Date: 2021-01-01 DOI: 10.18502/jmehm.v14i10.7238

Saba Hoobehfekr, Fariba Asghari, Azadeh Sayarifard, Maliheh Kadivar, Shayan Kashefinejad

{"title":"Medical students' perception of professionalism climate in clinical settings.","authors":"Saba Hoobehfekr, Fariba Asghari, Azadeh Sayarifard, Maliheh Kadivar, Shayan Kashefinejad","doi":"10.18502/jmehm.v14i10.7238","DOIUrl":"https://doi.org/10.18502/jmehm.v14i10.7238","url":null,"abstract":"Medical professionalism has a crucial role in educating medical students. The role of professionalism in the clinical environment is therefore an important factor in medical education. This study attempts to evaluate the opinions of medical students in the teaching hospitals of Tehran University of Medical Sciences (TUMS) about the professionalism environment in this university. A sample of 165 students filled out the Persian translation of UMKC-SOM (Climate of Professionalism Survey) questionnaire. This instrument evaluates students' perspectives on the degree of adherence to professionalism by faculty, residents and other students. The results of the study revealed that the total score of professionalism climate was 53.9 for faculty, 42.09 for residents, and 50.76 for students and the difference between these three groups was statistically significant (p-value < 0.01). Results of further analysis through post-hoc tests for multiple comparisons among the groups revealed that the students found their fellow students and faculty more professional than residents. The study also showed that the medical ethics course had no impact on perceptions observations (p-values > 0.05). The study results also revealed that the students found their fellow students and faculty more professional than residents. This finding demonstrates the importance of teaching professionalism to residents since they serve as role models for students. Further multicenter studies are needed to improve the professionalism climate in the medical teaching environment.","PeriodicalId":45276,"journal":{"name":"Journal of Medical Ethics and History of Medicine","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2021-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e7/34/JMEHM-14-10.PMC8696550.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39939063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 2

Value-rich exposures in medical education: phenomenology of practice according to the lived experiences of medical students in Iran. 医学教育中价值丰富的暴露:基于伊朗医学生生活经验的实践现象学。

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Journal of Medical Ethics and History of Medicine Pub Date : 2021-07-13 eCollection Date: 2021-01-01 DOI: 10.18502/jmehm.v14i9.6753

Hakimeh Sabeghi, Shahram Yazdani, Seyed Abbas Foroutan, Seyed Masoud Hosseini, Leila Afshar

{"title":"Value-rich exposures in medical education: phenomenology of practice according to the lived experiences of medical students in Iran.","authors":"Hakimeh Sabeghi, Shahram Yazdani, Seyed Abbas Foroutan, Seyed Masoud Hosseini, Leila Afshar","doi":"10.18502/jmehm.v14i9.6753","DOIUrl":"https://doi.org/10.18502/jmehm.v14i9.6753","url":null,"abstract":"Values predispose people to make the right and especially ethical decisions, and are important for good performance in medical sciences. Students' lived experiences and the value-rich exposures during their education are some effective means of achieving professional values that help them build their own value frameworks. In this phenomenology of practice study, we aimed to explore and describe the lived experiences of a sample of medical students in Shahid Beheshti University of Medical Sciences regarding their value-rich exposures. In-depth interviews, students' written stories, recorded video interviews related to past trips and photographs were used to collect data. The data was analyzed based on Van Manen's thematic analysis method. Five themes emerged from the data: \"in the shadow of a supportive mentor\", \"a well-orchestrated, value-rich program\", \"human interactions in a value system\", \"acquiring values in a real-life environment\", \"and seeking values in oneself\". Our study identified different dimensions of value-rich exposure based on the lived experiences of medical students and pointed out some issues that medical education planners can consider to improve the quality of value-based education for medical students.","PeriodicalId":45276,"journal":{"name":"Journal of Medical Ethics and History of Medicine","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2021-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6c/6e/JMEHM-14-9.PMC8696577.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39939062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 2

Teaching professionalism in cadaver dissection: medical students' perspective. 尸体解剖专业教学:医学生的视角。

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Journal of Medical Ethics and History of Medicine Pub Date : 2021-07-13 eCollection Date: 2021-01-01 DOI: 10.18502/jmehm.v14i7.6751

Mahboobeh Khabaz Mafinejad, Mohammad Taherahmadi, Fariba Asghari, Kobra Mehran Nia, Saeeid Reza Mehrpour, Gholamreza Hassanzadeh, Parisa Farahani, Reza Hosseini Dolama

{"title":"Teaching professionalism in cadaver dissection: medical students' perspective.","authors":"Mahboobeh Khabaz Mafinejad, Mohammad Taherahmadi, Fariba Asghari, Kobra Mehran Nia, Saeeid Reza Mehrpour, Gholamreza Hassanzadeh, Parisa Farahani, Reza Hosseini Dolama","doi":"10.18502/jmehm.v14i7.6751","DOIUrl":"https://doi.org/10.18502/jmehm.v14i7.6751","url":null,"abstract":"This study was designed to facilitate freshman medical students' adaptation to the dissection room and familiarize them with the related ethical codes. Single-group post-test design research was conducted at Tehran University of Medical Sciences in 2018 - 2019. The program began with a brief explanation of the necessity of the subject, and after a documentary film was shown, the principles of professional and ethical behaviors in the dissection room were discussed by a panel of experts. In the end, a valid and reliable evaluation questionnaire (Cronbach's alpha coefficient = 0.89) was distributed among the students. A total of 129 questionnaires were completed and returned. Overall, 94.4% of the students believed that the program provided an excellent opportunity to reflect on professional behaviors during practical anatomy sessions. In addition, 92.8% of the students believed that they would use the ethical points mentioned in the program in the future. Content analysis of the open questions produced three main categories: \"motivating learning\", \"application of theory in practice\" and \"changing the attitude toward responsibility\". The results indicate that adequate preparation for cadaver dissection sessions and learning about professional behavior codes in the first exposure can help medical students to better understand the principles of professional behaviors.","PeriodicalId":45276,"journal":{"name":"Journal of Medical Ethics and History of Medicine","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2021-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/61/55/JMEHM-14-7.PMC8696593.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39702405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 3