Ethics education using documentary film for pharmacy students: Toward the creation of systematic ethical education for medical professionals

Ethics education using documentary film for pharmacy students: Toward the creation of systematic ethical education for medical professionals | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Ethics education using documentary film for pharmacy students: Toward the creation of systematic ethical education for medical professionals Yoshio Kusakabe, Yasuhiro Nakamura, Kazunari Tanigawa This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7286670/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background Ethics education is essential for pharmacy students to navigate complex clinical decisions involving patients’ diverse values and life perspectives. However, traditional approaches, such as lectures or paper-based case studies, often fail to cultivate empathy and deep ethical reflection. This study examined the effects of a documentary film-based ethics exercise and investigated the education year most suitable for such interventions. Methods We conducted an ethics exercise for first- and second-year pharmacy students (n = 566) using a documentary film portraying a terminally ill patient’s ethical dilemma. The exercise included a short ethics lecture, viewing the film, individual reflections, and small-group discussions (SGDs). To evaluate education outcomes, we used the Frommelt Attitude Toward Care of the Dying (FATCOD)-Form B-J scale in pre- and post-exercise surveys. Free-text responses were analyzed via text mining and inductive qualitative analysis. We investigated changes resulting from the exercise and any differences between the effects on first- and second-year students. Results Both first- and second-year students showed statistically significant improvements in multiple FATCOD-Form B-J items. Second-year students exhibited greater changes in questions related to family involvement and professional decision making. Text mining revealed that first-year students focused more on the patient, whereas second-year students considered broader contexts, including the family, caregivers, and ethical complexities. The proportion of students who believed the patient should attend their graduation ceremony decreased after SGDs, indicating more nuanced reasoning. First-year students had more difficulty reaching a group consensus, whereas second-year groups were more likely to reach clear decisions. Conclusions Documentary-based ethics education can enhance pharmacy students’ understanding of terminal care and ethical dilemmas. First-year students exhibited stronger emotional responses, whereas second-year students demonstrated broader perspectives and showed greater maturity in decision making. The exercise was beneficial for both education years, but deeper ethical reasoning was particularly evident among second-year students. These findings suggest that longitudinal, developmentally appropriate ethics education is important throughout pharmacy curricula. Documentary film ethical dilemma ethics education FATCOD narrative ethics pharmacy students small-group discussions Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 20 Nov, 2025 Reviews received at journal 13 Nov, 2025 Reviewers agreed at journal 05 Nov, 2025 Reviewers agreed at journal 03 Nov, 2025 Reviewers invited by journal 27 Oct, 2025 Editor invited by journal 21 Aug, 2025 Editor assigned by journal 07 Aug, 2025 Submission checks completed at journal 07 Aug, 2025 First submitted to journal 04 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7286670","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":539975175,"identity":"61eb1256-7fd6-41e0-a306-076951da4252","order_by":0,"name":"Yoshio 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Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Documentary film, ethical dilemma, ethics education, FATCOD, narrative ethics, pharmacy students, small-group discussions","lastPublishedDoi":"10.21203/rs.3.rs-7286670/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7286670/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eEthics education is essential for pharmacy students to navigate complex clinical decisions involving patients\u0026rsquo; diverse values and life perspectives. However, traditional approaches, such as lectures or paper-based case studies, often fail to cultivate empathy and deep ethical reflection. This study examined the effects of a documentary film-based ethics exercise and investigated the education year most suitable for such interventions.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe conducted an ethics exercise for first- and second-year pharmacy students (n\u0026thinsp;=\u0026thinsp;566) using a documentary film portraying a terminally ill patient\u0026rsquo;s ethical dilemma. The exercise included a short ethics lecture, viewing the film, individual reflections, and small-group discussions (SGDs). To evaluate education outcomes, we used the Frommelt Attitude Toward Care of the Dying (FATCOD)-Form B-J scale in pre- and post-exercise surveys. Free-text responses were analyzed via text mining and inductive qualitative analysis. We investigated changes resulting from the exercise and any differences between the effects on first- and second-year students.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eBoth first- and second-year students showed statistically significant improvements in multiple FATCOD-Form B-J items. Second-year students exhibited greater changes in questions related to family involvement and professional decision making. Text mining revealed that first-year students focused more on the patient, whereas second-year students considered broader contexts, including the family, caregivers, and ethical complexities. The proportion of students who believed the patient should attend their graduation ceremony decreased after SGDs, indicating more nuanced reasoning. First-year students had more difficulty reaching a group consensus, whereas second-year groups were more likely to reach clear decisions.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eDocumentary-based ethics education can enhance pharmacy students\u0026rsquo; understanding of terminal care and ethical dilemmas. First-year students exhibited stronger emotional responses, whereas second-year students demonstrated broader perspectives and showed greater maturity in decision making. The exercise was beneficial for both education years, but deeper ethical reasoning was particularly evident among second-year students. These findings suggest that longitudinal, developmentally appropriate ethics education is important throughout pharmacy curricula.\u003c/p\u003e","manuscriptTitle":"Ethics education using documentary film for pharmacy students: Toward the creation of systematic ethical education for medical professionals","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-05 13:14:03","doi":"10.21203/rs.3.rs-7286670/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-11-20T16:09:32+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-13T16:32:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"318135141240862575563565370505759518813","date":"2025-11-05T09:27:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"134073973130103282730980521326950989744","date":"2025-11-03T17:54:04+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-27T05:02:48+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-21T13:21:13+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-07T04:26:52+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-07T04:26:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-08-04T04:02:21+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"07c446ae-1409-4996-8cf0-27931af696f7","owner":[],"postedDate":"November 5th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-11-05T13:14:03+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-05 13:14:03","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7286670","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7286670","identity":"rs-7286670","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}