Table 2 - uploaded by Rosamond Rhodes
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Over the past 15 years, medical schools have paid some attention to the importance of developing students' communication skills as part of their medical education. Over the past decade, medical ethics has been added to the curriculum of most U.S. medical schools, at least on paper. More recently, there has been growing discussion of the importance...
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... sum, rather than focusing on highly unusual issues or subjects that will be decided by the legislature, courts, or voters, medical- student ethics education should address issues that are common and relevant to situations that they are likely to encounter with some frequency. Some of these issues are listed in Table 2. ...
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In their practice, physicians and veterinarians need to resort to an array of ethical competences. As a teaching topic, however, there is no accepted gold standard for human medical ethics, and veterinary medical ethics is not yet well established. This paper provides a reflection on the underlying aims of human and veterinary medical ethics educat...
Citations
... Barriers against the integration of notions of medical legislation include overcrowded existing curricula, which lead to variable allocations of discrete courses and hours, financial constraints, lack of expertise and specific legal knowledge [17,24]. ...
The place of medical legislation in the university curriculum remains somehow uncertain and should be identified more clearly. A more robust knowledge base on the law is needed to enable medical students to develop sufficient legal competence to manage the challenges of future practice. Further research is needed to identify the most effective methods of teaching, learning and assessing legal knowledge and skills, during and after the completion of initial medical education. An in-depth analysis of resources shows that there is no robust evidence base that evaluates the impact in different curricular structures of the efficient methods in developing the knowledge, skills, attitudes, and behaviors needed in medical practice of student. Moreover, only a limited number of studies refer to the results and effectiveness of teaching and learning the elements of medical legislation.
... The courses designed need to be relevant and interesting to hold their attention and make a palpable difference in their practice. Several authors have noted that students have definite preference of topics they consider relevant [10][11][12][13][14]. Maturity of a curriculum would be when its' contents satisfy the needs of a learner and the end-beneficiaries -the patient. ...
ABSTRACT The last three decades have seen major strides being made in the introduction and promotion of medical ethics in the medical school curriculum. Efforts to hone faculty skills and knowledge have come to the forefront. More emphasis has been placed on discussions on ethical issues in addition to subject-related deliberations. In India, medical ethics teaching remains largely a part of the ‘hidden curriculum’ in most colleges. This study aims to know the circumstances and opportunities currently available for the ethics education of students, a reflection of how far we have travelled on this path of delivering to society empathic and ethical physicians. It is of great pertinence in view of the fact that the Medical Council of India has from this year, included the teaching of ethics into the formal curriculum. It contributes to identifying wherefrom we start and focus our renewed efforts. Inclusion of what was earlier ‘hidden’ in the formal curriculum and its’ implementation aim to ensure that the physicians of tomorrow acquire the knowledge and skills to recognize and handle ethical dilemmas in their practice.
Keywords: Ethics, medical students, medical, learning ethics, student uncertainty.
... Precise definition of the relationship will improve the implementation and protection of patients' rights and the rights of doctors and health personnel. Medical procedure, the iuridization of medical procedures, informed consent, consequences and expectations, are areas of health law, which must be precisely regulated for the purpose of exercising and protecting the rights of patients (10). ...
... Implementation of medical and health law, both in medical practice and law practice, we can recognize at, for example, organ transplantation. First of all, a doctor must discuss with their patients about this issue before the need of tissues and organs arise as a part of advance care planning (5,(9)(10)(11). Organ donation involves several issues. Of particular concern is to avoid any conflict between medical care of potential donor and needs of potential recipient (11). ...
... The answers, with respect to teaching medical ethics, will differ significantly. So, you have to be very specific about your course [7]. ...
Teaching bioethics has vast importance for medical student education, which is commonly delivered to undergraduate students using traditional didactic lectures and sometimes small group tutorials. Applying the theoretical knowledge on the daily medical practice and ward-based learning is a challenging task. 12 steps were formulated to help teachers develop their student's skills and attitudes necessary to practice according to ethical perspective, students should demonstrate sensitivity to ethical issues, analyse ethical issues and make ethical decisions in medical practice.
... It is important to identify deficiencies of students and/or professionals on ethical issues and arrange sensitization and at times, appropriate training [16][17] . However, implementation of medical ethics curriculum remains ambiguous 18 . ...
This baseline study was conducted to find out the knowledge, attitudes and practices of medical ethics among the undergraduate medical interns who did not have structured ethics curriculum in their course. A descriptive, cross-sectional study was carried out using a self-administered structured questionnaire among the medical undergraduate interns of Maharajgunj Medical Campus, the pioneer medical college of Nepal which enrols 60 students in a year. A total of 46 interns participated in the study. The most common source of knowledge on ethics was lectures/seminars (35.7%) followed by experience at work (24.5%), training (21.4%) and own reading (17.3%). The main contents of Hippocratic Oath were known to 98.8% while 60.9% knew the main contents of Nepal Medical Council (NMC) code of ethics. Great majority (91.3%) regard ethics as very important in medical profession. “Doctors know the best irrespective of patients’ opinion” was disagreed by only 39.1% indicating the paternalistic attitude. However, 78.3% were in favour of adhering to the patient’s wish. None of the participant agreed to abandon confidentiality. Only about one-fourth (26.1%) claim to encounter ethical dilemma every day while the highest number (43.5%) had once in a month. To deal with the situation of ethical dilemma, majority approached to immediate supervisor followed by head of the department and colleagues. Eighty-seven percent of participating interns were involved in research activities involving human subjects. Only one of the participants had encountered the ethical issue on end-of-life and it was do-not-resuscitate consent in a terminally ill patient. On implementation of the curriculum on medical ethics focus should be - principles of biomedical ethics, sensitive ethical dilemmas like end-of-life care and practical experiences with participation in deliberations of the ethics committee.
... This is further explicated in Hegel's sociocultural philosophy [4] where, although personal identity is not given a short or simple definition, it can be understood in terms of social struggles to become recognized as a social agent within a shared culture. Medical ethicists are increasingly taking the view that medical identity and knowledge are intricately related [5] and Hegel's philosophy is an attempt to show how being and knowing are deeply connected. Medical education researchers might focus empirically on the verbal interactions, physical sites and discourses that produce medical selves [6]. ...
Purpose: To examine philosophical stances underpinning medical identity and assess the conceptual relationship between physician, medical practice and culture. Argument: Medical identity is about the ideals and moral positions that physicians take when justifying themselves. Medical identity is the study of the sociocultural paragons that conceptually underlie the phenomenology of physicians' coming to take themselves as autonomous social agents. The paper relies on Hegel's Phenomenology of Spirit and investigates dilemmas pertaining to first objectivist versus subjectivist views and second hedonistic versus sentimentalist approaches to medical identity. The sociocultural philosophical analysis of medical identity can shed light on what it means conceptually for a physician to harbor beliefs associated with him/her being taken to be an autonomous professional. It is important because it touches on the meaning of being a compassionate, good and skilled physician, making its relevance to person-centered medicine self-evident. Conclusion: Medical identity should be analyzed with reference to literature, philosophy and medical practice in order for the physician to exercise a reflective position in the care of the individual patient which is both scientifically rational and subjectively meaningful.
... Largely the same appears to be the case with the IME core curriculum (despite the reference to 'virtuous doctors' above). (Stirrat et al, 2010: 55, quoting Rhodes andCohen, 2003) (emphasis added). Moreover, the authors of the core curriculum clearly stipulate that next to critically reflective understanding of 'a necessary core of knowledge, skills, attitudes and behaviour', medical students should 'be able to demonstrate in practice an understanding of' a number of additional attitudes and practical skills (Stirrat et al., 2010: 56). ...
This project investigated the place of character and virtues, training and professional practice in medicine in the UK. The project aimed to identify which personal virtues medical students and experienced doctors hold and to investigate how these could influence their professional life, as compared to other values and factors. Specifically, it examined how an understanding of the virtues influences doctors' moral thinking and possible conduct, and how the environment in which doctors train and work can influence them in becoming good doctors.
... All doctors have experienced for good or ill the pervasive influence of this 'hidden curriculum' in their training. [29][30][31] 'Without careful and explicit attention to character, students are likely to absorb unacceptable habits and attitudes through the silent curriculum of observing medical misconduct and mistakenly adopting that as the norm'. 31 'Teaching the teachers' is one means by which the positive effects of this hidden curriculum can be accentuated and the negative effects reduced. ...
... [29][30][31] 'Without careful and explicit attention to character, students are likely to absorb unacceptable habits and attitudes through the silent curriculum of observing medical misconduct and mistakenly adopting that as the norm'. 31 'Teaching the teachers' is one means by which the positive effects of this hidden curriculum can be accentuated and the negative effects reduced. 21 Further enabling our graduates to 'do good medical ethics' ...
The development of learning, teaching and assessment of medical ethics and law over the last 40 years is reflected upon with particular reference to the roles of the London Medical Group, the Society for the Study of Medical Ethics, its successor Institute of Medical Ethics; the Journal of Medical Ethics and the General Medical Council. Several current issues are addressed. Although the situation seems incomparably better than it was 40 years ago, the relatively recent events in Mid Staffordshire National Health Service (NHS) Foundation Trust show we cannot be complacent. Whatever role we have in the NHS or medical education, we must all strive to make sure it never happens again.
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
... Rhodes and Cohen note that the "nature and content of these fields [medical ethics and professionalism] and their relationship to one another remains confused and vague". 57 During the last two years of medical education, students rotated through different clinical settings and participated with supervising physicians in making decisions with significant impact on the patient and the patient's family. Kohlberg theorized that interaction with the environment, in concert with cognitive prerequisites, would provide the catalyst for change in the individual's perspective of the self and the other, impacting moral perspective. ...
The goal of this study was to determine differences in moral judgment among students in medical school.
This cross-sectional study involved students currently enrolled in undergraduate medical education. Recruited via email, 192 students took an online version of the Defining Issues Test to determine their current stage of moral judgment, as well as their percentage of postconventional thought. Independent variables included year of graduation, which indicated curriculum completion as well as participation in a professionalism course. Data was analyzed primarily using One-Way Analysis of Variance.
Of the 192 participants, 165 responses were utilized. ANOVA showed no significant differences in moral judgment between or among any of the student cohorts, which were grouped by year of matriculation. Comparisons included students in the four years of medical school, divided by graduation year; students about to graduate (n=30) vs. those still in school (n=135); and students who had participated in a course in professionalism (n=91) vs. those who had not (n=74).
These results demonstrate a lack of evolution in the moral reasoning of medical students and raise the issue of what might stimulate positive changes in moral judgment during the medical school experience.
... 12,13 Educators need to help learners selfidentify and promote incremental growth of professional virtues through critical reflection on the values, attitudes, and behaviors requisite for excellent patient care. [14][15][16][17][18] Learners need to appreciate that professionalism entails a lifelong commitment to internalizing and adhering to the standard of providing safe, competent, patient-centered care. 19,20 Although medical ethics and humanities educators will need to agree on common goals and outcomes, pedagogical methods in medical education venues will necessarily vary. ...
Given recent emphasis on professionalism training in medical schools by accrediting organizations, medical ethics and humanities educators need to develop a comprehensive understanding of this emphasis. To achieve this, the Project to Rebalance and Integrate Medical Education (PRIME) II Workshop (May 2011) enlisted representatives of the three major accreditation organizations to join with a national expert panel of medical educators in ethics, history, literature, and the visual arts. PRIME II faculty engaged in a dialogue on the future of professionalism in medical education. The authors present three overarching themes that resulted from the PRIME II discussions: transformation, question everything, and unity of vision and purpose.The first theme highlights that education toward professionalism requires transformational change, whereby medical ethics and humanities educators would make explicit the centrality of professionalism to the formation of physicians. The second theme emphasizes that the flourishing of professionalism must be based on first addressing the dysfunctional aspects of the current system of health care delivery and financing that undermine the goals of medical education. The third theme focuses on how ethics and humanities educators must have unity of vision and purpose in order to collaborate and identify how their disciplines advance professionalism. These themes should help shape discussions of the future of medical ethics and humanities teaching.The authors argue that improvement of the ethics and humanities-based knowledge, skills, and conduct that fosters professionalism should enhance patient care and be evaluated for its distinctive contributions to educational processes aimed at producing this outcome.
