THE KNOWLEDGE, ATTITUDE, PRACTICE AND STRESSORS OF MEDICO-LEGAL ISSUES AMONG MEDICAL STUDENTS, MEDICAL OFFICERS AND RESIDENTS: THE BOTSWANA EXPERIENCE

Abstract

Patients expect health professionals to be proficient and accountable in their clinical practice including applying medico-legal principles.  The knowledge, attitude, practice, and stressors related to medico-legal issues among medical students (MSs), medical officers (MOs), and residents have not been investigated in Botswana. A cross-sectional quantitative study was conducted. An online questionnaire was used to collect data on demographics, knowledge, attitude, practice and common stressors in medico-legal matters. Data were summarized and analyzed to demonstrate significant differences between study groups. All levels of MOs (including Medical Officer interns) and residents, and MSs at the end of their first and third clinical years at the Princess Marina Hospital were invited to participate in this study. The overall response rate was 54.9%. The 191 study participants included: 41.9% MSs, 23.0% MOs, and 35.1% residents. Males contributed 52.9% and females 47.1%. Knowledge of ‘dual loyalty’ conflicts and agencies who handle medico-legal issues was limited. In most cases, residents reported significantly higher levels of knowledge than MOs and MSs. There were no significant differences between the groups in the attitude items related to the medico-legal practice. Residents and MOs reported more frequent practice than MSs and, in several cases, significantly so; one exception being that residents report their medical errors significantly less often than MOs and MSs. Fear of legal consequences and lack or inadequacy of knowledge of medico-legal matters and policies were reported as the most important stressors, though not significantly different between the groups. The three groups reported reasonable levels of medico-legal knowledge and practice but with significant gaps. Participants expected that responsible authorities should provide more medico-legal training and resources. Fear of legal consequences and lack or inadequacy of knowledge of Botswana's medico-legal policies and laws are the leading causes of stress. Consequently, contextually appropriate and locally relevant medico-legal courses should be developed and taught as core courses.