Development Strategies in Medical Education

Introduction
Ethics affects most fields of study that are at the forefront of providing services to humans [1]. Ethics is a knowledge that explains the principles and values that govern human behavior and voluntary attributes and differentiate between good and bad, worthiness and unworthiness, and goodness and ugliness [3, 4]. Professional ethics is a set of principles and standards of human behavior that determine the behavior of individuals and groups in a business environment. Medical ethics is a branch of professional ethics that describes the ethical and professional standards of medical specialists, including midwifes. The international Code of Ethics for Midwives, prepared by the International Confederation of Midwives, include the four dimensions of Midwifery Relationships, Professional Responsibilities of Midwives, Practice of Midwifery, and Advancement of Midwifery Knowledge and Practice. Midwives are required to fully observe ethical principles such as justice, beneficence, non-maleficence, avoiding harm to others, self-sacrifice, confidentiality, respect for autonomy in their profession [10, 11]. 
Non-observance of professional ethics in midwifery will lead to harmful risks, including increased maternal and newborn mortality, decreased satisfaction with the midwifery community, decreased public trust in midwives, and decreased success in childbirth and newborn care [12]. Therefore, midwives should have sufficient knowledge of the professional ethics principles and theor responsibilities in caring for women [13]. Any obstacles that somehow affect the failure of midwives to comply with the professional ethics should be removed. The present study aims to find barriers to complying with professional ethics in midwifery according to viewpoints of midwives in obstetrics and gynecology hospitals of Jahrom city in Iran.

Methods
This is a descriptive cross-sectional study that was conducted in 2023. Participants were 51 midwifery experts working in a obstetrics and gynecology hospital in Jahrom city in Iran in 2023. The data collection tool was a questionnaire that included two sections of demographic information (age, educational level, work experience, marital status, employment status, and place of service) and barriers to complying with professional ethics with 33 items in three areas: environmental (5 items), managerial (14 items), and personal/care (14 items). The items were rated on a five-point Likert scale from completely agree to completely disagree. The validity and reliability of this questionnaire have been confirmed in the studies by Dehghani et al., and Rezaian et al. [14, 15]. To analyze the data, descriptive statistics (mean and standard deviation) and inferential statistics (Kolmogorov-Smirnov test, independent t-test) were used in SPSS software, version 21.

Results
Most of participants (50.98%) were in the age group of 20-30 years. In the environmental domain, 53.8% of the participants disagreed with the lack of necessary education in the field of ethical issues during education, while 15.4% had no idea. In the managerial domain, 32.7% completely agreed and 46.2% disagreed with lack of moral and legal support from managers. In the personal/care domain, 38.8% completely disagreed and 36.7% disagreed with the lack of time. Also, 29.4% completely disagreed with lack of knowledge and skills in performing tasks for the first time. Regarding the lack of critical thinking or moral decision-making ability, 35.3% completely disagreed and 25.5% completely agreed.

Conclusion
The results of the study showed that there are many barriers to complying with professional ethics in midwifery in the hospitals of Jahrom city. In the personal/care domain, the first barrier was the lack of time for midwifery personnel, which indicates the need to optimize work plans and facilitate the allocation of optimal time. Also, there is need to strengthen and update the training and skills of midwives, especially when faced with new duties. Moreover, challenges such as inappropriate behavior of patients with midwifery personnel, negative attitude towards professional ethics standards, worry about dealing with infectious patients, and lack of critical thinking ability indicate the need to increase awareness and skills of and midwives develop safety and health measures in the department. In the managerial domain, the ability and skills of the personnel during the division of work was reported as a main challenge which indicates the need to pay attention to the skills and capabilities of the personnel. Ineffective crisis management was another barrier, which needs improvement. In the environmental domain, the barriers included the lack of necessary training and the need for moral and legal support by managers.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the ethics committee of Jahrom University of Medical Sciences (Code: IR.JUMS.REC.1402.101).

Funding
This study was funded by Jahrom University of Medical Sciences.

Authors' contributions
The authors contributed equally to preparing this article

Conflicts of interest
The authors declare no conflict of interest.

Acknowledgments
The authors would like to thank the Clinical Research Development Unit of Peymanie Hospital in Jahrom city for their cooperation.

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