Experience, education, and training impact on medicolegal knowledge, attitude, and practice

Ahmed Ibrahim Alyahya; Osama Said Ibrahim Elserafy; Faisal Mohammed Alzoubaidi; Osama Ahmed Abbas Moursi

doi:10.4103/sjfms.sjfms_4_18

ORIGINAL ARTICLE

Year : 2018 | Volume : 1 | Issue : 1 | Page : 1-4

Experience, education, and training impact on medicolegal knowledge, attitude, and practice

Ahmed Ibrahim Alyahya¹, Osama Said Ibrahim Elserafy², Faisal Mohammed Alzoubaidi¹, Osama Ahmed Abbas Moursi¹
¹ Department of Forensic Sciences, King Fahd Security College, Riyadh, KSA
² Department of Forensic Sciences, King Fahd Security College, Riyadh, KSA; Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Cairo University, Giza, Egypt

Date of Web Publication

25-May-2018

Correspondence Address:
Osama Said Ibrahim Elserafy
Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Cairo University, Giza

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/sjfms.sjfms_4_18

Abstract

Introduction: Medical practice is governed by four main principles: beneficence, nonmaleficence, autonomy, and justice. To achieve and sustain the best medical practice, these four principles should be emphasized and appreciated at continuous medical training and education. Aim of the Work: The aim of the study was to analyze the medicolegal knowledge, attitude, and practice (KAP) of the medical staff with the purpose of distinguishing the impact of experience, education, and training on medical practitioners' medicolegal KAP. Subjects and Methods: A self-structured questionnaire was prepared; 69 medical doctors and 16 nurses from different tertiary care hospitals in Riyadh province and various medical specialties participated in this survey. The survey incorporated demographic questions in addition to questions that specifically targeted the respondents' medicolegal KAP. Results: Statistically significant differences were found between years of experiences in relation to the individual parameters and the cumulative degree of KAP. When comparing KAP in relation to obtaining training and education on medicolegal issues, statistically significant difference was found between knowledge and their cumulative in relation to obtaining medicolegal training. On the other hand, no statistically significant differences were identified regarding attitude and practice in relation to obtaining medicolegal training. In addition, no statistically significant differences were found between KAP in relation to obtaining medicolegal education. Conclusion: The decline in the time resources provided for medicolegal training and education impacted negatively the medical staff medicolegal KAP. To develop medical staff medicolegal KAP, a structured educational and training programs on medicolegal issues should be integrated. Integrated continuous medical education and training programs will significantly increase the medical staff awareness levels and hence improve their KAP.

Keywords: Education, knowledge, attitude, practice, medico-legal, training

How to cite this article:
Alyahya AI, Elserafy OS, Alzoubaidi FM, Moursi OA. Experience, education, and training impact on medicolegal knowledge, attitude, and practice. Saudi J Forensic Med Sci 2018;1:1-4

How to cite this URL:
Alyahya AI, Elserafy OS, Alzoubaidi FM, Moursi OA. Experience, education, and training impact on medicolegal knowledge, attitude, and practice. Saudi J Forensic Med Sci [serial online] 2018 [cited 2023 Mar 24];1:1-4. Available from: https://www.sjfms.org/text.asp?2018/1/1/1/233185

Introduction

When reporting to medical practitioners' knowledge about the regulations that control the patient–doctor relationship, it is important to stress that the legislations are complex enough and their application could differ from one jurisdiction to the others.^[1]

Several clinical education methods can be applied in various settings; some of these methods can prompt best practice while others will give mixed results. Clinical education in higher education institutions has been well known and successfully applied in health-related disciplines for some time, but it has also become a focal point of formal education. In short, clinical education has evolved into multifaceted educational models adopted by multiple disciplines to create and implement experiential learning opportunities for students.^[2]

The formal postgraduate education in addition to other nonformal methods of sustainable medical education has an advantage over undergraduate education, as they do not only develop knowledge and skills but also they add positively to the clinical experience and enhance the decision-making strategies that will lead to better clinical outcomes.^[3],[4]

The current study aims to analyze the medicolegal knowledge, attitude, and practice (KAP) of the medical staff with the purpose of distinguishing the impact of experience, education, and training on medical practitioners' medicolegal KAP.

Subjects and Methods

Subjects

This descriptive study was conducted after obtaining the Institutional Ethics Committee approval in Riyadh, KSA, within the framework of the specialized health-care centers: King Saud Medical City, King Fahd Specialist Hospital, Security Forces Hospital, King Khalid University Hospital, and King Fahd Medical City. The study involved physicians and nurses within the emergency, pediatrics, internal medicine, ENT, obstetrics, and gynecology departments. The survey targets of the questionnaire were 85 medical personnel (65 physicians and 16 nurses) with gender distribution of 63 males and 22 females, consisting of residents, specialists, consultant, and nurses (49, 13, 7, and 16 participants, respectively).

Method

A self-structured questionnaire consisted of overall 56 questions. The questionnaire prompted 12 questions to collect demographic data (age, gender, education background, specialty area, nationality, current employer, previous medicolegal education, and training) (Q1–Q12), 13 questions to assess the medicolegal knowledge (Q13–Q25), 13 questions for the assessment of professional attitude (Q26–Q38), and 8 questions to evaluate the current medicolegal practice (Q39–Q56).

The data collected were analyzed using IBM SPSS version 20.0 software (Statistical Package for the Social Sciences). The descriptive statistical analysis, t-test between two groups, and ANOVA test among several groups were done with the significance level at P < 0.05.

Results

The sample comprised 85 individuals with ages between 23 and 55 years and their mean 30.5 ± 6.9 years. Sixty-three males and twenty-two females participated in the study representing 74.1% and 25.9%, respectively, of the total participants, and their mean ages were 30.9 ± 7.4 and 28.9 ± 4 years, respectively [Table 1].

Table 1: Number, mean and percent of screened subjects' ages and gender

Click here to view

The study showed that 81.2% of the samples were exposed to medicolegal education either during their undergraduate (77.7%) or postgraduate education (3.5%), in comparison to only 21.2% who had been trained on medicolegal issues in their undergraduate (16.5%) or postgraduate education (4.7%) [Table 2].

Table 2: Number, percent and distribution of screened subjects according to exposure to Medico-legal Education and Training

Click here to view

The statistical comparison between the medicolegal knowledge of medical personnel in relation to obtaining previous medicolegal training showed statistically significant difference in the mean values of the following parameters 13a, 17, 18, 19, 20, 21, 22, and 25; P < 0.023, <0.0001, <0.0001, <0.047, <0.003, <0.005, <0.0001, and < 0.0001, respectively. There was no statistically significant difference regarding the other values in relation to previous medical education and training.

When comparing the medicolegal attitude and practice questions to previous medicolegal education and medicolegal training, no statistically significant difference was found among the groups.

In addition, a highly statistically significant difference was found between the medicolegal knowledge and previous medicolegal training in all groups (P< 0.0001). On the other side, no statistically significant difference was identified between previous medicolegal knowledge and education as well as between the attitude and previous medicolegal education or training along with practice and previous medicolegal knowledge and education [Table 3].

Table 3: The statistical comparison between medico-legal Knowledge, Attitude and Practice among Health Care Practitioners in relation to level of medico-legal education and medico-legal training

Click here to view

The professional distribution of participants was 69 medical physicians and 16 nurses representing 81.2% and 18.8% of the included participants, respectively. Residents, specialists, and consultant represented correspondingly 49 (57.7%), 13 (15.3%), and 7 (8.2%) participants of the included participants [Figure 1]. The participants' experience ranges between 1 and 30 years of medical practice [Figure 2].

Figure 1: Distribution of screened participants according to their medical profession

Click here to view

Figure 2: Distribution of screened participants according to the number of years of experience

Click here to view

The statistical comparison between the medicolegal KAP among health-care practitioners in relation to years of experiences showed highly statistically significant difference in the mean values of all individual parameters, P < 0.0001. As well, high statistically significant difference noticed in relation to the cumulative degree of KAP; P < 0.003, <0.005, and <0.0001, respectively [Table 4].

Table 4: The statistical comparison between medico-legal Knowledge, Attitude and Practice among health care practitioners in relation to years of experiences

Click here to view

Discussion

The professionalism within the medical field is governed by community morals, professional standards, code of ethics, and laws. The primary purpose of these regulations is to protect the patients from medical malpractice as well as to shield the medical personnel against lawsuits. These regulations should be applied across various workforces, specialties, work environment, and circumstances.

Doctors and nurses participated in the current study represented allied departments of tertiary care hospitals across Riyadh, the capital of Saudi Arabia. To the best of our knowledge, this is the first conducted study in Saudi Arabia to evaluate the impact of experience versus education and training on medical practitioners' KAP toward medicolegal cases.

In the current study, we observed a decline in obtaining training and education on medicolegal issues on the postgraduate level in comparison to the undergraduate level with relatively lower percentage of training than education. Our results were in agreement with several studies where they noticed a progressive decline of the total hours provided for postgraduate education and training in different medical specialties, countries, and work circumstances.^{[5],[6],[7],[8],[9]}

Several factors may play a role in this decreased trend of postgraduate training and education. Legislations have been developed by many countries to limit the working hours of doctors and nurses with the aim of enhancement of the medical staff performance and reduction of fatigue-induced patient care compromises.^[10],[11] In addition, the increased economic cost has been defended for the decline in the total hours provided for medical staff training and education.^[12]

To maintain the best medical practice, sustainable medical education and training are considered the leading tools for quality improvement of medical practice among medical professionals. Health and medical education institutions are the main sponsors concerned about providing optimum programs of continuous medical education for the medical staff.^[13]

In the present study, the results revealed that the current training methods influenced only the medical staff knowledge about medicolegal cases. On the other side, the current training methods did not impress the medical staff attitude and practice toward medicolegal cases. In addition, it was remarked that the current educational methods had no effectuation on the participants' medicolegal KAP. These findings are consistent with other observers who perceived poor levels of awareness among doctors and nurses about how to deal with the medicolegal cases in different work situations.^{[14],[15],[16],[17]}

These results could be attributed to the fact that the quality of medical education and training is negatively affected by the reduction of the total number of hours provided.^[18]

When comparing the participants KAP in relation to number of years of experience, the result demonstrated that the number of years of experience influenced all medical staff KAP as well as their cumulative. Our results were in agreement with Mehralian et al.,^[19] who found a growing relation between the participants' experience and their KAP. On the contrary, other studies noticed the predominant effect of education rather than their medical experience on the participants' KAP.^{[20],[21],[22],[23],[24],[25]}

The variability of the results in the previously mentioned studies could be contributed to the different applied educational and training strategies that vary among traditional and interactive learning techniques.^[26] Participant's feedback during the process of medical education and training is considered as the core component to guarantee the positive change in participants KAP.^[27] In addition, the integrated continuous medical education plays an essential role in the maintenance of professional competency and evidence-based medical practice.^{[28],[29],[30]}

Conclusion

The decline in the time resources provided for medicolegal training and education impacted negatively the medical staff medicolegal KAP. To develop medical staff medicolegal KAP, a structured educational and training programs on medicolegal issues should be integrated. Continuous medical education and training programs will significantly increase the medical staff awareness levels and hence improve their KAP.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Willmott L, White B, Close E, Gallois C, Malcolm P, Graves N, et al. Futility and the law: Knowledge, practice and attitudes of doctors in end of life care. QUT Law Rev 2016;16:55.
2.	Cantatore F, Crane L, Wilmoth D. Defining clinical education: Parallels in practice. Aust J Clin Educ 2016;1:2.
3.	Bennett NL, Davis DA, Easterling WE Jr., Friedmann P, Green JS, Koeppen BM, et al. Continuing medical education: A new vision of the professional development of physicians. Acad Med 2000;75:1167-72.
4.	Smits PB, Verbeek JH, de Buisonjé CD. Problem based learning in continuing medical education: A review of controlled evaluation studies. BMJ 2002;324:153-6.
5.	Moonesinghe SR, Lowery J, Shahi N, Millen A, Beard JD. Impact of reduction in working hours for doctors in training on postgraduate medical education and patients' outcomes: Systematic review. BMJ 2011;342:d1580.
6.	Fernandez E, Williams DG. Training and the European working time directive: A 7 year review of paediatric anaesthetic trainee caseload data. Br J Anaesth 2009;103:566-9.
7.	Maxwell AJ, Crocker M, Jones TL, Bhagawati D, Papadopoulos MC, Bell BA, et al. Implementation of the European working time directive in neurosurgery reduces continuity of care and training opportunities. Acta Neurochir (Wien) 2010;152:1207-10.
8.	Schneider JR, Coyle JJ, Ryan ER, Bell RH Jr., DaRosa DA. Implementation and evaluation of a new surgical residency model. J Am Coll Surg 2007;205:393-404.
9.	Roedling S, Robinson A, Lough-White C, Miller R. Impact of a European working time directive-compliant working pattern on delivery of medical specialty teaching for senior house officers in a teaching hospital. Clin Med (Lond) 2008;8:116-7.
10.	Holzman IR, Barnett SH. The bell commission: Ethical implications for the training of physicians. Mt Sinai J Med 2000;67:136-9.
11.	Iglehart JK. Revisiting duty-hour limits – IOM recommendations for patient safety and resident education. N Engl J Med 2008;359:2633-5.
12.	Patton DV, Landers DR, Agarwal IT. Legal considerations of sleep deprivation among resident physicians. J Health Law 2001;34:377-417.
13.	Peyman N, Alipour Anbarani M. The effect of training diabetes prevention behaviors on promotion of knowledge, attitude and practice of students for prevention of diabetes in Mashhad city. Int J Pediatr 2015;3:501-7.
14.	Pinto M, Varun R, Wanasinghe W, Jayasinghearachchi TM, Herath H, Kumarasiri P. A cross-sectional study of knowledge and attitudes of medical professionals towards end-of-life decisions in teaching hospitals of Kandy district (Sri Lanka). Anaesth Pain Intensive Care 2013;17:40-4.
15.	Hildén HM, Louhiala P, Palo J. End of life decisions: Attitudes of Finnish physicians. J Med Ethics 2004;30:362-5.
16.	Ramírez-Rivera J, Cánova-Díaz C, Hunter-Mellado R. Knowledge and implementation of the DNR in internal medicine teaching programs. P R Health Sci J 2010;29:96-101.
17.	Junod Perron N, Morabia A, De Torrenté A. Evaluation of do not resuscitate orders (DNR) in a Swiss community hospital. J Med Ethics 2002;28:364-7.
18.	Ganesan S, Sandhiya S, Reddy KC, Subrahmanyam DK, Adithan C. The impact of the educational intervention on knowledge, attitude, and practice of pharmacovigilance toward adverse drug reactions reporting among health-care professionals in a tertiary care hospital in South India. J Nat Sci Biol Med 2017;8:203-9.
19.	Mehralian G, Yousefi N, Hashemian F, Maleksabet H. Knowledge, attitude and practice of pharmacists regarding dietary supplements: A Community pharmacy- based survey in Tehran. Iran J Pharm Res 2014;13:1457-65.
20.	Jain M, Dogra V, Mishra B, Thakur A, Loomba PS. Knowledge and attitude of doctors and nurses regarding indication for catheterization and prevention of catheter-associated urinary tract infection in a tertiary care hospital. Indian J Crit Care Med 2015;19:76-81. [PUBMED] [Full text]
21.	Apisarnthanarak A, Thongphubeth K, Sirinvaravong S, Kitkangvan D, Yuekyen C, Warachan B, et al. Effectiveness of multifaceted hospitalwide quality improvement programs featuring an intervention to remove unnecessary urinary catheters at a tertiary care center in Thailand. Infect Control Hosp Epidemiol 2007;28:791-8.
22.	Drekonja DM, Kuskowski MA, Johnson JR. Internet survey of Foley catheter practices and knowledge among Minnesota nurses. Am J Infect Control 2010;38:31-7.
23.	Fakih MG, Dueweke C, Meisner S, Berriel-Cass D, Savoy-Moore R, Brach N, et al. Effect of nurse-led multidisciplinary rounds on reducing the unnecessary use of urinary catheterization in hospitalized patients. Infect Control Hosp Epidemiol 2008;29:815-9.
24.	Mahdaviazad H, Keshtkar V, Emami MJ. Osteoporosis guideline awareness among Iranian family physicians: Results of a knowledge, attitudes, and practices survey. Prim Health Care Res Dev 2018:1-7.
25.	Kaushal G, Doke P, Shah A, Verma V. An analysis of knowledge, attitude and practices regarding standard precautions of infection control and impact of knowledge and attitude of ICU nurses on self-reported practices of infection control. Int J Res Found Hosp Healthc Adm 2015;3:79-85.
26.	Brannan JD, White A, Bezanson JL. Simulator effects on cognitive skills and confidence levels. J Nurs Educ 2008;47:495-500.
27.	Issenberg SB, McGaghie WC, Petrusa ER, Lee Gordon D, Scalese RJ. Features and uses of high-fidelity medical simulations that lead to effective learning: A BEME systematic review. Med Teach 2005;27:10-28.
28.	Suchitra JB, Lakshmi Devi N. Impact of education on knowledge, attitudes and practices among various categories of health care workers on nosocomial infections. Indian J Med Microbiol 2007;25:181-7. [PUBMED] [Full text]
29.	Cant RP, Cooper SJ. Simulation-based learning in nurse education: Systematic review. J Adv Nurs 2010;66:3-15.
30.	Kaushal G. Impact of training on knowledge, attitude and practices scores of ICU nurses regarding standard precautions of infection control in a super speciality hospital of Delhi. Paripex Indian J Res 2015;4:282-5.