Postgraduate Medical Ethics Education


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Project log

Andrew Papanikitas
added an update
This meeting is kindly hosted at St Catherine’s College Oxford by the Collaborating Centre for Values Based Practice in association with The Oxford Research Centre for The Humanities, Health Education England and The Nuffield Department of Primary Care Health Science
This Advanced Study Seminar is held with the aim of
· supporting a notional field of postgraduate medical ethics education, to understand its content, meanings and key stakeholders in academia, education and practice,
· fostering a network of academics, educators, practitioners and policy-shapers.
We will discuss the questions of whether there can be a distinct postgraduate medical ethics curriculum, different professional curricula and whether these ought to differ from or develop upon an undergraduate curriculum. This is as much a tool to better understand the principles, structures and processes at play as to determine possible answers to this question at the meeting.
Definition and focus: we define postgraduate medical ethics education (PGMEE) as
• Teaching and learning ethics (Ethics education) in/for healthcare practice - distinct from undergraduate students in healthcare professions in that learners have passed a certain threshold for accountability.
• Ethics education for healthcare workers whose ordinary professional/service commitments have priority over their identification as learners.
• Ethics education for the real world in the real world of contemporary healthcare
We consider postgraduate medical education as falling into 3 narrative phases in UK medicine: 1) The foundation years, 2) Core and Specialist Training 3) Post-completion continuing professional development
Stakeholders at the meeting attended from the GMC, HEE and selected Royal Medical Colleges as well as Universities and academia. If using any of the below material, please cite the authors, the presentation and the meeting and do let the organisers know show we can include your use in any impact case studies.
Andrew Papanikitas
added an update
Dr Andrew Papanikitas (Oxford) and Dr John Spicer (Health Education England), have been working on the TORCH project ‘Understanding postgraduate medical ethics education,’ (UPMEE). The idea that doctors should have a thoughtful approach to good, bad, professional and unprofessional is uncontroversial. Many scandals involving uncaring, reckless or even murderous clinicians in the UK have ensured that the topic remains current – and beg the question of whether undergraduate education is enough – is something in the workplace undoing ethical principles learned as a student? Does doing the right thing cost too much? Medical ethics, or the study of right and wrong, professional and unprofessional is included in all medical school curricula. It is also included albeit, to a much more varying degree, whilst doctors are training in all postgraduate curricula – which vary from bland statements like ‘doctors should be ethical’ to comprehensive statements about the philosophy underlying medicine. Doctors who are qualified also express educational needs in this area, whether this is related to a specialised role, such as healthcare commissioning, or survival in a workplace full of competing duties, unrealistic demands and consequent moral distress.
The project so far has had a number of elements. These have included outreach activities such teaching ethics to trainees at Oxford University Hospitals. Two knowledge exchange events are taking place in February and March 2019. The first is a briefing and discussion with policy and education stakeholders at Health Education England. We attach the flier and PowerPoint presentations for the February 18th 2019 event here.
The second is an advanced study seminar at St Catherine’s College for stakeholders and academics to think specifically about ethics in postgraduate curricula. UPMEE is also supporting a medical student special study module and engaging with a number or early career and doctoral researchers at Oxford and beyond, aiming to incubate the nascent field of postgraduate medical ethics education.
Andrew Papanikitas
added a research item
Primary care ethics is a field of study that has recently found new life, with calls to establish the relevance of ethical discussion in general practice, to gather a body of literature and to carve out an intellectual space for primary care on the academic landscape of bioethics. In this report, we reflect on the key strands of the 4th primary care ethics conference held at the Royal Society of Medicine, on a theme of ethics education and lifelong learning: first, to produce insights that have relevance for policy and practice; and second, to illustrate the idea that not only is ethics relevant in primary care, but primary care is relevant in medical ethics. Core themes included the advantages and disadvantages of prescriptive ways of doing ethics in education, ethical reflection and potential risk to professional status, the need to deal with societal change and to take on board the insights gained from empirical work, whether this is about different kinds of fatherhood, or work on the causes of moral distress in healthcare workers.
Andrew Papanikitas
added 2 research items
Professionalism is a key component of good general practice, and self-awareness is a key component of professionalism. Being self-aware means understanding your own fitness to practice as a GP. It is a critical skill for ePortfolio reflections and appraisals, as it is a critical skill for good practice. In this article I will offer an approach to professional self-awareness through a set of four questions: What are my goals? What are my beliefs? What are my values? and What is my condition?
GPs in the UK have been involved in commissioning healthcare for years; well before the Health and Social Care Act of 2012. In this article, we discuss the ethics of commissioning and resource allocation as an essential skill for all GPs. Limitations in resources for healthcare, need and expectations result in difficult decisions, which need to be visibly coherent and consistent for public trust in GPs is to be well-founded.
Andrew Papanikitas
added 2 research items
This short paper is the annotated version of a three minute 'elevator pitch' which was presented at the NIHR collaboration for leadership in applied health research and care (CLAHRC) Oxford stakeholder symposium on 11 th December 2014 at St Anne's College Oxford Translational approaches to medical research aim to improve links between science and application. Recently there have been calls for translational ethics in the context of medicine. In the first instance I suggest that a translational approach is an argument in itself for a distinct ethics of primary care. Most patient encounters take place primary care in the UK. Whilst Primary care is subject to many of the same concerns as hospital or experimental medicine, many consultation, research, business and commissioning decisions in primary care are as if not more complicated by ethical legal and social issues.
An ethically problematic clinical case is used to illustrate the potential importance of understanding clinical ethics in an interdisciplinary context. Whilst much has been written on ethics education for multidisciplinary and interdisciplinary teams, we argue that it is important that both healthcare professions and healthcare teams are able to look outside their own disciplinary ethos and sometimes outside their formal teams when considering the ramifications of an ethical issue. A complex (fictional but based on the authors’ pooled experiences) case involving the delivery of a new-born from a mother with HIV is used to illustrate this, because multiple clinical teams will be involved at different times and in parallel with one another.
Andrew Papanikitas
added an update
Ethics Education after Medical School
On June 5th the IME held its first symposium on medical ethics education of and for qualified doctors at St Catherine's College in Oxford. In addition to a small community of postgraduate ethics educators, 40 delegates included representatives from Health Education England, The General Medical Council, senior university academics and, most importantly, junior doctors. The rationale for the event had been present since the IME's influential Pond Report recognised that junior doctors also have learning needs with respect to ethics. On both sides of the Atlantic, medical ethics education has focused on medical students. However, the IME leads for this initiative, Dr Andrew Papanikitas (Oxford), Miss Lorraine Corfield (Keele) and Dr Laura Machin (Leicester) highlighted that education and support  for qualified doctors has become a pressing concern also. This reflects changing work environments, the increased potency of the hidden curriculum in medical training, and diversity of educational experience prior to work as a doctor in the UK, among many other challenges to good medical practice.
The day looked at what does, what might, and what ought to, happen in terms of teaching and learning ethics after medical school. We looked at ethics education in three broad areas: education for newly-qualified doctors (experiencing their first major dose of accountability), education for specialist medical training (with emphasis on better translation from curricular documents into teaching and learning), and ethics education as  a key element of continuing medical education and professional development.  These elements were reflected in a series of plenary talks, three breakout sessions, and two unstructured networking events on the evening before and the evening of the the event (An enhanced version of the delegates' handbook will be available to download from the IME website). Andrew Papanikitas and John Spicer (HEE) used Eisner's five orientations for a curriculum to ask what ethics education is for, because this affects its perceived value and mode of delivery. Mikey Dunn (Ethox) showcased an online bioethics casebook and discussed the potential for internet-based educational tools in the context of extreme limitations on time and space for postgraduate medical education. Lorraine Corfield and Laura Machin discussed the educational needs of foundation year doctors, drawing on personal experience and previous empirical research and showcasing a planned survey of foundation years with plans to create a support network of IME foundation year 'champions'. David Molyneux, a senior examiner for the RCGP discussed the teaching and assessment of ethics in GP vocational training as a case-study and illustrated the limitations of various educational tools in this regard. We were very fortunate to have trainee responses from Joshua Parker (FY2) and Selena Knight (ST4) - both highlighted the potential for moral distress on the one hand and trainees' perceived fear of incoherent decision-making set against haphazard provision of education in training and low perceived value of that education. Our international speaker Professor Stephen Bolsin required no introduction as the anaesthetist who brought an end to a conspiracy of silence around fatally incompetent children's heart surgery in Bristol. He discussed the failure of medical ethics to prevent medical atrocity, and argued that good guidelines should be ethical and that to be ethical one should follow good guidelines.
E-posters (all of which are included along with speaker materials, links, and reference lists in the delegates' handbook available online) discussed the role of virtues, moral psychology, and an interprofessional approach in medical training.
They also discussed the role of social media in ethics support, specific learning needs such as ethics in chemical restraint and sedation, and whether postgraduate medical conferences can be a site for ethics education. Special thanks are due to the IME trustees for supporting this initiative, support from the IME office and Education Committee Chair Georgia Testa, who also chaired part of the day. 
Delegates described being left 'refreshed' from the day - and plans are already in preparation to build on the insights and enthusiasm. Watch this space!
Andrew Papanikitas
added 4 research items
We comment on a paper published in the same issue of the London Journal of Primary Care. We applaud Bow's engagement with the ethical issues in a previous LJPC paper but argue that further work is needed to establish the everyday moral concerns of health care workers in primary care. We also suggest that the ethical distinction between advice and medication and devices may be artificial if both have an effect on a patient.
In advance of a medical conference on the duty of candour for medical ethics educators, this paper discusses the duty of candour as a significant development in the culture of medicine. Those who teach medical ethics need to assess its implications for their own practice. It is also a duty that needs to be critically examined in light of both patients’ interests and clinical work environments if it is to be practical and not meaningless rhetoric. Two examples of ways in which that critical examination might take place are outlined.
Andrew Papanikitas
added 2 research items
In this paper I discuss the ways in which the conference stream ethics and values manifested at the 2015 RCGP Annual Conference in Glasgow, and the ways in which it is planned for the 2016 RCGP Annual Conference in Harrogate. The 2015 RCGP had plenaries, oral presentations, breakout symposia, a debate, and a poster stream. I briefly discuss each in turn before offering a manifesto (a public statement of aims and proposed policy) for ethics and values at healthcare conferences. It is my hope that others will critique this, flesh it out further and even consider how ethics and values relate to conferences for healthcare workers of various specialities. A conference provides opportunities for ethics and values discussion that are potentially distinctive from any other kind of forum. Because conferences offer the potential for knowledge and attitudes to be revisited and revised, issues can be ‘unsettled’ in a way that permits different perspectives to be more fully discussed.