Association Between Medico-Legal Training and Competency in Ethical Reasoning and Risk Assessment Among Final Year Medical Students in Southwest Nigeria
Abstract
A multicentre study examining medico-legal training exposure, ethical reasoning and risk-assessment competency among final-year medical students in Southwest Nigeria.
Despite rising medical litigation and evolving patient rights, medico-legal training remains peripheral in sub-Saharan Africa. This leaves final-year medical students in Nigeria potentially unprepared for ethical and legal aspects of practice, with limited evidence on its association with ethical reasoning and risk assessment.
To assess the association between medico-legal training and competency in ethical reasoning and risk assessment among final-year medical students in Southwest Nigeria.
A multicentre cross-sectional study was conducted among 157 final-year medical students in Southwest Nigeria. Data were collected using a structured, expert-validated questionnaire assessing medico-legal training exposure, ethical reasoning, risk assessment and perceptions. Descriptive statistics, Pearson correlation and multiple linear regression were used, with statistical significance set at p < 0.05.
The mean age was 24.03 ± 2.11 years and 65.6% of participants were female. Overall, 73.9% had received medico-legal training, mainly through lectures (58.3%) and case-based discussions (26.0%). Mean scores were 21.06 ± 3.40 for ethical reasoning, 27.29 ± 4.86 for risk assessment and 27.74 ± 5.35 for perception. Ethical reasoning strongly correlated with risk assessment (r = 0.761, p < 0.001), while correlations with perception were moderate (r = 0.415–0.576, p < 0.001).
Medico-legal reinforcement demonstrated a small positive but statistically non-significant association with risk assessment (β = 0.116).
Although medico-legal training exposure was common, weak associations with competency outcomes suggest that current training approaches may benefit from greater emphasis on structured, practical and case-based methods. Nigerian medical schools should strengthen medico-legal curricula to better prepare future clinicians.
Final-year medical students.
MDCN-accredited medical schools.
116 of 157 participants.
Six-state geopolitical zone.
73.9% Received Training
A total of 116 of the 157 respondents reported having received some form of medico-legal training, while 26.1% reported no previous training.
58.3% School-Based Lectures
Lectures represented the most frequently reported form of medico-legal education, followed by case-based discussions at 26.0%.
74.2% Sometimes or Often
Among students who had received training, 74.2% reported that medico-legal concepts were reinforced either sometimes or often during clinical rotations.
21.06 ± 3.40
The mean ethical reasoning score among students who had received medico-legal training was 21.06 ± 3.40.
27.29 ± 4.86
Participants demonstrated generally positive self-perceived risk-assessment practices, with a mean risk-assessment score of 27.29 ± 4.86.
27.74 ± 5.35
Students held largely positive perceptions of their medico-legal education, with a mean perception score of 27.74 ± 5.35.
r = 0.761 · p < 0.001
Ethical reasoning demonstrated a strong positive correlation with risk-assessment competency.
β = 0.116
Regression analysis identified a small positive but statistically non-significant association between medico-legal reinforcement and risk assessment.
More Than 70%
More than 70% of trained students agreed or strongly agreed that they could readily identify ethical dilemmas and recognise clinical issues with both ethical and legal implications.
43.1%
Only 43.1% agreed or strongly agreed that they would disclose a medical error even when disclosure might have legal consequences.
94.0% Appropriate HIV Response
In the clinical vignette assessment, 94.0% selected the appropriate response when a patient requested non-disclosure of HIV status to a spouse.
81.9% Correct Response
Most respondents selected the appropriate response to an unreported medication error by a colleague where potential patient harm was involved.
69.0% Correct Response
Sixty-nine percent selected the correct initial clinical action when presented with a patient refusing a life-saving blood transfusion for religious reasons.
82.8%
Most trained respondents agreed or strongly agreed that medico-legal education had improved their awareness of medico-legal risks in clinical practice.
82.8%
A large majority reported that awareness of legal risk encouraged more thorough clinical documentation.
86.3% Want More Teaching
A strong majority expressed the need for increased medico-legal teaching within the undergraduate medical curriculum.
78.4% Prefer Practical Methods
Most respondents preferred more structured and practical, case-based medico-legal teaching rather than reliance on lectures alone.
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Multicentre Cross-Sectional Study
A descriptive cross-sectional quantitative study examining medico-legal training exposure and competency in ethical reasoning and risk assessment among final-year medical students.
157 Final-Year Medical Students
Participants were final-year medical students who had completed their core clinical rotations and were preparing for independent medical practice.
13 Medical Schools
The study included thirteen MDCN-accredited universities across Southwest Nigeria, representing federal, state-owned and private institutions.
Convenience & Voluntary Response Sampling
Participants were recruited using a combination of convenience and voluntary response sampling through class communication platforms, institutional mailing lists and permitted in-person sessions.
Cochran’s Formula
The study sample size was determined using Cochran’s formula for estimating proportions in descriptive cross-sectional studies. A total of 157 students participated.
Structured Questionnaire
A self-administered structured questionnaire was developed following literature review, adaptation of validated scales and contextual refinement for the Nigerian medical education setting.
Five Core Sections
The instrument assessed socio-demographic characteristics, exposure to medico-legal training and knowledge, ethical reasoning, risk assessment and clinical decision-making, and perceptions of training adequacy and effectiveness.
Cronbach’s α = 0.79–0.85
Internal consistency was α = 0.82 for the Ethical Reasoning scale, α = 0.79 for Risk Assessment and α = 0.85 for Perception of Training.
≥70%
Adequate competency was operationally defined as achieving at least 70% of the maximum possible score, based on expert consensus.
SPSS Version 27
Descriptive statistics, Pearson correlations and multiple linear regression were used. Model fit was assessed using R² and adjusted R², with statistical significance set at p < 0.05.
UNIMEDTH Research Ethics Committee
Ethical approval was granted by the UNIMEDTH Research Ethics
Committee.
Approval No.: UNIMED-HREC/Apv/2026/635
Electronic Informed Consent
Informed consent was obtained electronically before questionnaire completion. Participation was voluntary, no incentives were offered, and participants could withdraw without consequence. Data were anonymised and securely stored.
Strengthen Practical Medico-Legal Education
The findings support greater emphasis on structured, practical and case-based medico-legal teaching rather than reliance primarily on conventional lectures.
Collaborative Research Team
OOO conceived the study; OF, OTE, STA, EFO, AAD and AI contributed to study design and manuscript development; OOO conducted the analysis; OF synthesised the findings and drafted the conclusion; ID supervised the study. All authors reviewed and approved the final manuscript.
Conflict of Interest & Funding
Conflict of Interest:
No conflict of interest.
Funding:
No funding received.
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DOI: 10.64573/torgj2605003
Volume 2 · Issue 2 · Special Issue · 2026
The Operating Room Global Journal (TORGJ).
ISSN 3105-3262.
Original Research.
DOI: 10.64573/torgj2605003.
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