Response to Article: “Self-Assessment of Medical Ethics and Professionalism: Comparison Between Preclinical and Clinical Medical Students”

I am writing to express my appreciation for the original research article, “Self-Assessment of Medical Ethics and Professionalism: Comparison Between Preclinical and Clinical Medical Students,” by Naz Shaikh et al. This study highlights an essential aspect of medical education by evaluating the ethical and professional elements of medical students from their first to final years and further grouping them into preclinical (1–2 years) and clinical (3–5 years). While the findings provide us with valuable insights, I would like to suggest a few considerations that could enhance future research and deepen our understanding of this important topic.

One of the major limitations of the study is its reliance on self-assessment questionnaires which are inherently prone to bias, as the responses can be influenced by societal expectations. However, a well-structured researched questionnaire can be a robust tool in evaluating a program for which reliability and validity can be brought by undertaking a pilot study or a suitable cohort with the said questionnaire. ¹ Future research could benefit from a more comprehensive approach by combining self-assessments with peer feedback and supervisor evaluations. ²

The study would have a better outcome and result by incorporating a mentor-ship program from the first through final year which would provide a structured avenue for fostering professionalism through guidance from experts, which would help the medical professionals to foster and imbibe important attributes, knowledge, and professionalism from the beginning of their medical careers. ³ Programs such as the Attitude, Ethics, and Communication (AETCOM) module, which span from the first year to the final year of medical education are especially beneficial. ⁴ AETCOM case-based learning and simulated patient interactions offer a practical framework for assessing and improving professionalism in realistic scenarios. ⁵ By adopting a longitudinal study design, we could help us track the development of ethics and professionalism from preclinical stages to clinical years and through internships. Such a design would enable researchers to identify the key factors contributing to professional growth—whether through classroom learning, clinical exposure, mentorship, or systemic integration of modules such as AETCOM. A 4-dimensional approach to incorporate ethics and professionalism among students with the first dimension being the introduction of ethics in the early stages for incorporating a high degree of professionalism, the second dimension states the incorporation of ethics topics in modules in phases, the third dimension states incorporating of a condense ethics module in the early training phase and the fourth dimension is introduced during the internship stage where a practical and applied program for students is undertaken by patient interaction and the surroundings that they work. ⁶

While the study by Naz Shaikh et al provides significant insights into the field of medical education, future research would benefit from a broader and more integrative approach. A structured and validated questionnaire that is combined with peer and clinician review, the questionnaire should include quantitative and qualitative parts which will make the study more reliable and valid, fostering mentorship, aligning with frameworks such as AETCOM, and implementing longitudinal studies could offer a more nuanced understanding of how ethics and professionalism can be effectively introduced among medical students. The 4-dimensional approach has shown to be beneficial for students if it is introduced early in their medical education and is thoroughly followed up. These advancements could help medical educators better prepare students to meet professional and ethical standards, ultimately strengthening the healthcare system. Thank you to the authors for addressing this vital topic and to the editorial team for promoting a discussion that aims to enhance medical education.