PURPOSE: To assess medical students' perceptions of the ethical environment across four years of medical school. METHOD: In the spring of 1996, the authors distributed a questionnaire to all four classes at the Wake Forest University School of Medicine. The students provided demographic information and information about their exposures to or participation in unethical situations. Results were analyzed using multiple analysis of variance, univariate analysis of variance, Pearson correlation, and cross-tabulations. RESULTS: The response rate was 71%. The students reported that exposures to unethical behavior started early and continued to increase with each year in school. For example, 35% of the first-year students reported observing unethical conduct by residents or attending physicians. This percentage rose to 90% of the fourth-year students. The authors found no significant relationship between demographic variables other than the year in school and the ethical dilemma variables. CONCLUSION: Medical students face perceived ethical dilemmas beginning as early as the first year of medical school. Thus ethics instruction must begin in the freshman year. In addition, there must be changes to the environment in which clinical education is conducted to enhance the positive enculturation of students into the medical profession.
(C) 1998 Association of American Medical Colleges