An emphasis on ethics is crucial in medical training, explains Alastair Campbell

As medical students look to their future practice, they must wonder how many more demands will be placed on them. Scientific knowledge, especially in genetics, is expanding at an exponential rate, leading to a total change in diagnosis and treatment options. At the same time, what a Bristol student recently described as "tree hugging," seems to be on the increase. Future doctors are now to be not only knowledgeable and competent, but ace communicators too … and really nice people. We need only add the exhortation of the Prince of Wales in his recent Reith lecture to be suspicious of science and listen to ancient harmonies, to leave us wondering whether the 20th century style of medical education is bound to fail to produce the doctors wanted by the patients of the 21st century.

Those of us who teach ethics in medical schools could be seen as yet another source of burden and limitless demand. Backed up by the insistence of the GMC that ethics is an integral part of medical practice and therefore of medical education, the ethics teachers' group has agreed a very substantial list of core topics in medical ethics, which should be included in every curriculum. Moreover, ethics is now examined in many schools at several points in the curriculum and final year students can now expect to be confronted by ethical dilemmas, not merely clinical conundrums, in OSCE stations.

Recent UK government policy on the "modernisation" of the NHS, however, will make this new emphasis on ethics in training a crucial preparation for future practice. All the institutions of the NHS, at both primary and secondary level, will have to adopt procedures for clinical governance and by doing this will have to show that they are genuinely monitoring all aspects of the quality of practice. There will be no place in this reformed NHS for the medical "lone ranger", the consultant who is a law unto himself/herself or the GP whose decisions are never scrutinised. Since ethics teaches both critical self reflection and constructive discussion of dilemmas with colleagues, it should help rather than hinder the practitioners of the future to meet this new demand.

At Bristol Medical School, students have the chance to reflect in small groups on the ethical problems they encounter in their clinical attachments, and there is currently also a qualitative study of the experiences of the group who recently became PRHOs. What we have uncovered are students and young doctors who face major ethical conflicts. These are not provoked, as the public imagines, by the dramas of "high tech" medicine. Instead, it is the stresses and uncertainties of their role, confusion about how their ethical qualms are to be addressed without seeming to speak out of turn, and sometimes a sense of betrayal of their own integrity by carrying out instructions they believed to be ethically wrong.

In the midst of this confusion, a genuinely critical and reflective ethics training can equip future doctors to be not just survivors but real agents of change. It all depends how we understand the function of professional ethics. If we look to the past, there is no question that the professions have used ethics simply as a way of distinguishing themselves from mere technicians or tradespeople. It has been a mode of gaining status and power. But the ethics that can help with clinical governance goes back to the commitment of Socrates, whose assertion, "the unexamined life is not worth living" has been the motto of moral philosophy ever since.

The final year students at Bristol two years ago helped devise an oath to be said at graduation, in which they promise not only to put the good of patients first but also to serve " the public wellbeing." This is far removed from using ethics for professional advantage. Oaths, of course, can be mere empty formulas, but they need not be. The best of our graduates are reflective, self critical, and (initially at least) not willing to be bound by a tribal loyalty to colleagues to the detriment of patients. They really do want to work, as their oath also states, "with conscience and integrity." Clinical governance will be more than mere jargon if it gives genuine support and encouragement to this kind of young practitioner. If not, the NHS and other healthcare systems are heading for the rocks.