Descriptions of the characteristics of the respondents

A total of 391 out of 1,000 OB/GYN practitioners responded to the survey questions by email; therefore, the response rate was 39.1%. Participants responded from all provinces of Saudi Arabia. Female respondents totaled 257 (66.4%), which was almost double the rate of male respondents. The married respondents totaled 291 (75.6%), whereas 94 (24.4%) were unmarried.

The study included participants of all ages, with approximate percentages of the participants between 30 and 50years is more than 60%.

Saudi physicians accounted for 213 (55.9%) participants and 371 (94.8%) Muslims. Approximately 247(63.1%) of the respondents were working in a tertiary government teaching hospital, whereas government non-teaching and private hospitals accounted for 107 (27%) of the participants.

Fifty-five percent of the participants were OB/GYN Board certified under different types of boards. Most of the physicians were certified by the Saudi Arabian board (18.2%), followed by the Arab board and Egyptian board (10.5%) and (6.9%) respectively; however, physicians holding Western certificates from Canada, England, US, or Indian boards were minimal in numbers.

The participants had equal percentages in relation to their tier position. The consultants and registrars in the sample numbers were 119 (30.4%) and 126 (32.23%), respectively; the remaining were residents.

Around 192 (49%) physicians had more than 10years of experience in the field of OB/GYN. Currently, 61 (15.6%) of the practitioners face 110 ethical issues monthly in their practice, while the majority 309 (79.03%) face less than one issue per month (Table 1).

Approximately 85 (21.7%) of the participants received mixed ethics education (formal ethics education and informal bioethics education), whereas 74 (18.9%) received only formal ethics education and 85 (21.7%) received only informal ethics education. In addition, 78 (19.95%) did not have any type of bioethics education.

Approximately 75% of the respondents received different types of formal and informal bioethics education. Of the respondents, 25% had no bioethics education; 137(35%) of physicians received a formal education during medical school; however, only 46 (11.8%) throughout residency programs. Self-learning was the method used for informal bioethics education in 124 (31.7%) cohorts (see Table 2 & Fig.1).

Modes of formal and informal bioethics education

No differences relatedto genderor the type of ethics education received in medical school during residency programs, postgraduate programs, conferences, courses and workshops and daily practice were detected. However, male respondents, more so than female respondents, agreed to have received ethics education in sub-specialty programs. The same finding was true regarding self-learning and online training.

Regarding marital statusand type of ethics education, no significant differences during residency programs, sub-specialty programs, in conferences, online training, in courses and workshops were found. Single respondents agreed to receive an ethics education in medical school compared to married people. Married respondents received a greater degree of informal bioethics education through daily practice and self-learning, while others received it through self-learning. There exists a significant difference between marital status and medical school (P=0.00), postgraduate programs (P=0.009), daily practice (P=0.007) and self-learning (P=0.002).

Regarding age,no significant differences were found in ethics education,except in medical schools. Respondents under 30yearsof age showed higher results (57.9%), followed by people between 3039years old (37.1%) and people aged between 4049years (28.8%). Participants>50years of age received minimum ethics education at medical school (19.4%).

No significant statistical differences regarding nationality and the type of ethics education were found except in medical schools, whereSaudi Arabian physicians (41.3%) had a significant statistical difference (P=0.007) compared to non-Saudi Arabians (28%). However, in postgraduate programs, there was a significant statistical difference (P=0.002) between non-Saudi Arabians (11.9%) and Saudi Arabians (3.8%).

There was no significant statistical difference inrelation to positionor the type of ethics education, except that residents showed the highest agreement in relation to education in medical school (P=0.00), followed by registrar/specialists and then consultants. The statement is correct regarding ethics education during sub-specialty programs (P=0.00) too.

No significant statistical difference was found between thetype of board certificateandbioethics education, except for online training (P=0.029) and daily practice (P=0.01). The participants that received Westernsub-specialist certificateshad the highest agreement to learning from daily practice, while Saudi Arabian physicians had the least (Table 1).

Significant statistical difference was found in relation tothe current workplaceand bioethics education during residency programs (P=0.015), during sub-specialty programs (P=0.04), in postgraduate programs (P=0.025) and Online learning (P=0.004). Online learning had a higher percentage of physicians who worked in private hospitals.

There was no significant statistical difference in relationto experienceand the type of ethics education, except for education in medical schools (P=0.00) and during sub-specialty programs (P=0.005). Physicians having experience of<5years showed the highest positive agreement followed by participants of 510years, and then>10years. A high percentage of less experienced physicians had bioethics education in medical college, while those with more than 10years' experience were found to have a significant statistical difference from those who had bioethics education through subspecialty training.

There was a significant statistical difference between the number of ethical challenges per month and bioethics education in medical school (P=0.007), in courses and workshops (P=0.009) and daily practice (P=0.00). Most of the respondents with ethics education from medical school and in courses and workshops had faced more than 10 challenges per month (47.60% and 28.60% respectively), whereas respondents with ethics education from daily practice had a maximum of 110 challenges per month (39%) (Table 1).

There was no significant statistical difference in relationto sub-specialtyand the type of ethics education except for the general OB/GYN, which showed the least agreement compared to other types of subspecialties. The same finding is true regarding online training too.

No significant statistical difference was observed between the type of ethics education and ethical principles. Irrespective of the mode of ethics education, most of the respondents had a positive attitude towards various ethical principles. The highest positive attitude was towards respecting privacy of people and respecting confidentiality. Solidarity And Cooperation had the least positive attitude across all modes of ethics education (see Table 3).

The attitude of the OB/GYNs towards various ethical challenges in their daily practice were investigated. No statistical significance was observed between various forms of formal ethics education and ethical challenges, except there exists a significant statistical difference between post-graduate program and termination of pregnancy for non-medical (P=0.05) and between residency program and contraception issues (P=0.021). The respondents with postgraduate ethics education had a high positive response (agreed and strongly agreed, 31%) to the ethical challenge "Termination of pregnancy for a non-medical reason," and the respondents without residency program ethics education had a high positive response (agreed and strongly agreed, 46%) to the ethical challenge "contraception issues."

Pertaining to the informal mode of ethics education, significant statistical difference was observed between courses and workshops and paternity issues (P=0.006); female consent (P=0.004); breach of confidentiality (P=0.007). There also exists a significant difference between breach of confidentiality and conference and workshop (P=0.007) and daily practice (P=0.023). The respondents without courses and workshop mode of ethics education had agreed to the ethical challenges of paternity issues (33.92%), female consent (58%), and breach of confidentiality (33.6%). The respondents who did not have ethics education through conference (33%) and daily practice (33.8%) also agreed to the ethical challenge breach of confidentiality (Table 4).

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Ethics education among obstetrics and gynecologists in Saudi ... - BMC Medical Education