Short Report Rural Ethics Ward Rounds: Enhancing medical students’ ethical awareness in rural medicine Lisa Watts, MEd, 1 Lisa Parker, MBBS (Hons), MBioethics, 2 and Helen Scicluna, PhD 3 1 Rural Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia, 2 School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia, and 3 Medicine Education and Student Office, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia The success of the University of New South Wales (UNSW) Rural Clinical School (RCS) has led to an increase in the number of students who are developing their clinical skills in rural medicine. While medical students in both urban and rural settings face clinical ethical issues, the ethical issues faced in large metropoli- tan teaching hospitals can differ substantially from those faced in rural-based hospitals. 1 Like their urban counterparts, medical students on rural rotations might have limited opportunities for formal, dedicated clinical ethics instruction. A perceived barrier is the lack of specialist clinical ethics teachers, felt more acutely in the rural context. 2,3 To address this need, Rural Ethics Ward Rounds (REWRs) were piloted in the RCS in 2011, with the aim of encouraging stu- dents to recognise the ethical dimensions of ordinary clinical encounters, and to ask and discuss questions, rather than assume they should know the answers. The ‘teaching ward round’ concept 4 was used, with students asked to identify and present cases involving an ethical concern, particularly cases with a distinct rural compo- nent. This paper builds on our initial evaluation of this teaching innovation 5 by providing further analysis in relation to the rural context. Participants, methods and results REWRs were trialled in all four rural campuses of the RCS. Approximately 12 students met weekly in each campus for four ‘round table’ discussion sessions, with the facilitator participating by videoconference from the main campus of the university. A total of 60 medical students in year five or six attended at least one REWR, and 47 students attended three or four REWRs. The students were in a variety of clinical rotations, and there was a mix of rural and general entry students and two international students. Students were invited to complete a questionnaire before and after the REWR, with the data from those who attended three or four REWRs included in final results. Three particular findings relating to rural issues are worthy of note here. Students indicated that after participation in the REWRs, they were more frequently aware of rural ethical issues (mean 3.3 pre versus 4.0 post; P < 0.01; Likert scale 1 = never, 2 = rarely, 3 = sometimes, 4 = frequently, 5 = very frequently); students found the openness of the sessions beneficial (91.7% strongly agreed/agreed) and were positive about the use of videoconferencing (86.6% strongly agreed/agreed). In rural medical education the use of external teachers is not uncommon. However, we were particularly inter- ested in the opinions of the students regarding our teaching format in this sensitive and highly nuanced clinical subject. The ability to speak openly was viewed positively by students and does not appear to have been hindered by the use of videoconferencing. Indeed some students specifically valued the use of a non-local facili- tator. In response to our survey question, ‘What were the best features of the sessions?’ student responses included: The opportunity to discuss ethical issues with someone outside the relatively small local community. One can be much more candid. Ability to speak openly; video-conferencing worked surprisingly well. The ability to speak my mind in the sessions without any later impact, plus the ability to take their ideas away. Comment Participation in the REWRs improved students’ ability to recognise and discuss the ethics of health care in rural contexts. Medical students learn about ethics in rural health in the preclinical years. However, by discussing Correspondence: Ms Lisa Watts, Rural Clinical School, Sydney Campus, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, 2052, Australia. Email: l.watts@ unsw.edu.au Aust. J. Rural Health (2013) 21, 128–129 © 2013 The Authors Australian Journal of Rural Health © National Rural Health Alliance Inc. doi: 10.1111/ajr.12016