Altruism, an attitude of unselfish concern for others – an analytical cross sectional study among the Medical and Engineering students in Bangalore (2024)

Abstract

Keywords: Altruism, empathy, professional ethics

Introduction

Altruism is disinterested and selfless concern for the well-being of others. Intentional and voluntary actions that aim to enhance the welfare of another person in the absence of any external reward.[1] The term “altruism” was introduced as a term opposite to “egoism” by a French philosopher Auguste Comte as a guide to working in the interests of others.[2] The concept of altruism is an inherent part of Medical professions and it is a long-standing tradition since the days of Hippocratic Oath or even before.[3] It is been said that medicine was conceived in sympathy and was born out of necessity. While Medicine is a vocation, altruism is a definite pre-requisite for the same. No other professional course requires such a pre-requisite. The unquestioning status and gratitude given to healers in olden times has been replaced by increasing demands and expectations from doctors. These days, medicine has become increasingly accountable; patient-centeredness is a priority thus doctors are subjected to commercial drivers and performativity metrics.[4] In recent times medical profession has assumed a consumer–provider model. As doctors are making an appraisal of cost and benefit of medical profession and growing cases of medical malpractice. There is a growing feeling that altruism in medicine, if not dying is at least declining.[5] With the background of increasing mistrust between the medical profession, media and the public and increasing incidents of violence against doctors in India, understanding the roots of altruism in medicine becomes essential.[6] It is important to assess, does an altruistic attitude still exists among medical students who are training to be professionals in our country. And is altruistic attitude of our medical students comparable with that of their contemporaries is an interesting question.[7] In India very little research has been done on altruism in college students and no studies have been conducted to compare medical student's altruism with any other professional course students. Hence this study will be conducted with the objective of assessing Altruistic attitudes among medical students and to compare them with engineering students who are the next most popular professionals in our society.[8]

Methodology

An analytical cross-sectional study was conducted in a Medical college and an Engineering college situated in Bangalore. This Medical College admits 150 students per year. Admission happens from Karnataka state merit list, linguistic minority colleges merit list and few through management quota. Students from all over India are studying in this medical college. A total of 600 medical students from first year to fourth year were available in this medical college. Fifty students from each year (1^st to 4^th) were included in the study and they were selected randomly using random number table. A total of 200 medical students were included in the study. The Engineering College admits around 200 students per year including all the branches of engineering. Majority of the Admission happens from Karnataka state merit list and very few management quota students are studying in this college. A total of 800 students were available in this college. Among them 50 students from each year (1^st to 4^th) were included in the study randomly using random number table. A total of 400 students participated in the study.

Result

Among the 400 students who participated in the study 200 were medical students and the rest 200 from engineering courses. The response rate was 100%. Among them 100 (25%) were first year students, 100 (25%) were second year students, 100 (25%) were third year students, and the remaining 100 (25%) belonged to the fourth year. The age range of the students was 18–24 years. Out of the 400 students who participated 200 (50%) were women. The characteristics of the study population are shown in Table 1.

The responses of the students to each items in the Altruistic Personality Scale are shown in Table 2.

In our study we found that simple acts, such as “helped carry a strangers things, delayed lift for a stranger, pointed out at a clerks error” were more frequent than “donating blood, donating to charity, giving lift to a stranger”. The frequency of most altruistic behaviors was reported as “never, once or more than once”. With respect to factors influencing altruism, 31.8% of the respondents mentioned that their parents often donated to charity and 31% agreed that they learnt altruism from their parents whereas only 13.3% mentioned that their friends frequently organized charitable events and donations. About 19.5% mentioned that their role models often practiced altruistic acts. The five factors, representing groups of altruistic behaviors, included simple acts of altruism, limited acts of altruism, recognized acts of charity, grater acts of altruism, and humanitarian acts. The items that loaded in the five factors and their factor loadings are shown in Table 3.

Hierarchical cluster analysis using the factor scores revealed that the sample could be optimally divided into three clusters. Cluster 1 (risk-taking altruists) consists of students who predominantly perform greater acts of altruism and simple acts of altruism, but score less in recognized charitable activities and humanitarian acts. Cluster 2 (limited altruists), comprises students who score high in humanitarian acts, but negatively in all other acts of altruism. The final cluster, Cluster 3 (simple altruists) includes students who perform recognized acts of charity, humanitarian acts, and simple acts of altruism, but score negatively in greater acts of altruism. Among our study population, it was observed that 89.49% were simple altruists, 67.07% belonged to risk taking altruists group, and about 45.41% were limited altruists. Various factors influencing the altruistic behavior of students are shown in Table 4. In our study it was seen that with increasing age the students increasingly become limited altruists. Male respondents were risk taking altruists when compared to females who were predominantly simple altruists. No other demographic data such as native place, type of school or religion had any significant influence on the respondents nature of altruism. Parents frequently donating to charity and friends frequently organized altruistic and charitable events and role models donating to charity had positive influence on altruistic behavior of the students.

Discussion

With its sense of service and self-sacrifice, altruism is often thought to be an integral factor of medical professionalism. What distinguishes a craftsman from a professional is the latter's “devotion to the public good.[11] Swick states unequivocally that altruism is a necessary part of the medical profession. “Values such as compassion, altruism, integrity, and trust worthiness are so central to the nature of the physician's work…. that no physician can truly be effective without holding deeply such values”.[12]

No studies have attempted to understand the altruistic motivations of medical students or the medical professionals especially in the Indian context. In our study, we have made an attempt to quantify altruism among medical students and compare them with students of another profession.

The previously validated altruistic personality scale which we have been used does not mention any medical scenarios and is not specific to the practice of medicine, but it makes attempts to capture the general altruistic attitudes of the all students.

This study found that overall frequency of altruistic behaviors among all the students was low. Even among those who showed altruistic behavior, majority (45%) emerged as simple altruists.

To define Simple altruism as acts of altruism, they are which do not involve any high level risk to the self, physical, mental, social, or emotional, like giving someone directions to an address or giving a person their place in a queue. Risk-taking altruism included acts of altruism which require a higher level of risk to the self like donating blood, pushing someone's car. Whereas limited altruism was defined by acts which are a matter of basic etiquette, like offering their seat in the bus to an elderly or pregnant woman.

In our study women were found to be more risk-taking altruist compared to men majority of who belonged to limited altruism group. This observation was in contrast to the observations made in a study in Chennai in which they found women were more likely to be simple altruists than men, who were more likely to be risk-taking altruists.[13] Previous studies in the West have shown that expensive altruistic behaviors (e.g., donating expensive goods) are more common among women and inexpensive altruistic behaviors are more common among men. Men are more likely to be “all or none” type of altruists, whereas women tend to be more egalitarian in their approach.[14,15]

“It is the claim of altruism that allows the medical profession to claim moral superiority. Certainty of goodness leads to complacency and worse”.[16] The traditional image of doctors is of selfless individuals prepared to “go the extra mile” for their patients at all hours of the day or night. But the medical profession should ask itself how far this image remains relevant in today's conditions[17] A survey of medical trainees linked to a RCP working party found that 69% of 2175 medical trainees agreed or strongly agreed with the statement “medical practice requires altruism”.[18] In our study when we compared altruistic behavior of medical students with their contemporary engineering students we found that majority of the medical students belonged more to the simple altruism group compared to risk taking behavior exhibited by the engineering students though this result is not statistically significant it endorses the fact that altruism if not dying at least declining in the medical profession. Another study conducted by Nasrina Siddiqi illustrates that behavioral sciences students were significantly higher on altruism as compared to those studying engineering.

Studies have shown that parental and environmental influences have a significant role in promoting pro-social behaviors among children. In our study parents donating to charity had significant influence on the altruistic behavior of the student compared to friends and role model influence on altruism our results were very much similar to study conducted by Sanjai S in Chennai where they found that the parents and peer influence was limited to simple altruistic acts, such as giving change to a stranger and allowing somebody to pass ahead in a queue, which do not expose the individual to much risk.[13]

In the same study another finding was as the students progressed through medical college, their altruistic behaviors became less frequent.[13] where as in our study as the students progressed through the course risk-taking altruism increased and simple altruism decreased in our study population. This could largely be due to clinical training of medical students in our traditional settings subjects students to a lot of stress, huge volumes of information, a scenario of uncertainty, high levels of responsibility, and heavy competition. A midst this atmosphere, medical students go through a change that has been called “traumatic De-idealization.”[11] Studies of medical students' attitudes which show decline in altruism during medical school has convinced many educators that “traditional medical education even brings about increased cynicism and loss of compassionate attitudes.”[5,12] In this setting, maintaining altruism, which is a desirable physician trait, seems to be difficult.

Conclusion

Altruism has always been an integral part of medicine from the olden days. And like shown by this study and other studies, parents, peers, and role models can significantly influence most of the altruistic tendencies. Good medicine always stands on the basis of good interactions between people.

Few changes in the existing curriculum for medical professionalism which should emphasize on skills such as empathy towards patients, communication, good doctor patient relationship, emotional intelligence and professional ethics and values is desired. Introducing special teaching programs such as Problem-based learning (PBL), Case based learning (CBL) Attitude and communication module (AETCOM), including medical ethics in curriculum and early introduction to clinical medicine for the medical students is of at most importance.

Provision and emphasize on participating in organized altruistic acts, such as voluntary blood donation, participation in rural health education activities and humanitarian activities in disaster struck areas in the undergraduate curriculum for both medical and engineering students could motivate students to enhance their altruistic tendencies, which, in a long run would improve their professionalism.

Doing this study in a medical and engineering college setting helps introduce the topic of altruism among the students and give them a chance to self-analyze their altruistic nature and bring about positive changes towards human altruism.

References