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de Melo-Martín I, Palmer LI, Fins JJ. Viewpoint: developing a research ethics consultation service to foster responsive and responsible clinical research. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2007; 82:900-4. [PMID: 17726404 DOI: 10.1097/acm.0b013e318132f0ee] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Although clinical ethics has become a central, and welcome, component of the health care landscape, research ethics consultation services are still uncommon. Indeed, the usual approach to ethical concerns in research with human subjects has been primarily a regulatory one. Nonetheless, ethical problems also arise in the context of research and thus collaborations between investigators and research ethicists are as essential as those between physicians and clinical ethicists. The authors argue that the use of research ethics consultation services can be of benefit to clinical scientists, bioethicists, research institutions, and research subjects. Such services can increase sensitivity among researchers to the ethical implications of their work, result in better institutional research policies, and facilitate the development of an organizational culture that is receptive to the identification and resolution of ethical conflicts. The authors conclude by describing the process of development and implementation of such a research ethics consultation service at Weill Medical College of Cornell University.
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Ruiz Moral R, Loayssa Lara JR. [The bioethics portfolio in family doctor training]. Aten Primaria 2007; 39:491-4. [PMID: 17919402 PMCID: PMC7659563 DOI: 10.1157/13109500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Fiester A. Viewpoint: why the clinical ethics we teach fails patients. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2007; 82:684-9. [PMID: 17595566 DOI: 10.1097/acm.0b013e318067456d] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The clinical ethics framework that is typically taught to medical students and residents is deeply flawed, and the result of using this framework exclusively to resolve ethical conflicts at the bedside is compromised patient care. The author calls this framework the principlist paradigm and maintains that it blinds clinicians from seeing the full set of moral obligations they have to the patient and limits the range of options they see as available to navigate through ethical conflicts. Although it is important for the moral obligations it does recognize (e.g., those based on the principles of autonomy, beneficence, nonmaleficence, and justice), the principlist paradigm should not be used as the only moral template for case analysis. The author illustrates the paradigm's limitations with a clinical case study, in which the treating clinicians failed to recognize three important moral obligations to the patient: the obligation to express regret, the obligation to apologize, and the obligation to make amends. The failure to recognize these widely accepted moral obligations can have tragic consequences. The principlist paradigm undertrains clinicians for the complex ethical dilemmas they face in practice, and medical ethics educators need to rethink the tools they offer student clinicians to guide their ethical analysis. The author advocates a reexamination of this standard approach to teaching clinical ethics.
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Schonfeld TL, Spetman MK. Ethics education for allied health students: an evaluation of student performance. JOURNAL OF ALLIED HEALTH 2007; 36:77-80. [PMID: 17633964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
We analyzed student performance in an interdisciplinary, Web-based course in health care ethics at a university-based school of allied health. Student performance was measured according to students' 1) degree status, 2) clinical hour requirement during the semester in which they took the ethics course, 3) total credit hours during the semester in which they took the ethics course, and 4) clinical and credit hours combined. Statistical analyses were performed to examine curricular and extracurricular predictors of student performance. Only the number of credit hours in which students were enrolled while taking the ethics course demonstrated a statistically significant difference in mean student performance, and this difference was only detected on the final examination and written assignments. When developing an ethics course for allied health students, course components such as conceptual difficulty, reading and writing assignments, and student workload may need to be adjusted according to students' curricular responsibilities.
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Nilson EG, Fins JJ. Reinvigorating Ethics Consultations: An Impetus from the “Quality” Debate. HEC Forum 2006; 18:298-304. [PMID: 17717754 DOI: 10.1007/s10730-006-9020-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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White ED. Reflections on the Success of Hospital Ethics Committees in my Health System. HEC Forum 2006; 18:349-56. [PMID: 17717759 DOI: 10.1007/s10730-006-9025-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
KEY POINTS 1. Historically, medical ethics focused on the proper conduct of physicians as members of a profession. 2. Bioethics has emerged as a distinct field over the past several decades and has a broader scope than traditional medical ethics. The field of bioethics includes research ethics, public health ethics, organizational ethics, and clinical ethics. 3. Several factors contributed to the emergence of bioethics, helping to shape it, including the following: abuses of human subjects in research; advances in medical therapeutics and medical technology; and complex societal changes. 4. Principlism is an important approach to ethics, and in bioethics it includes the following core principles: respect for autonomy; beneficence; nonmaleficence; and justice. 5. Clinical ethics is a major part of bioethics and is concerned with ethical issues encountered in the care of patients. 6. Clinicians should recognize that every interaction between a doctor and a patient has a moral component, and that competency in bioethics is required to competently practice medicine. 7. Deficiencies exist in bioethics knowledge and performance among practicing clinicians and trainees; therefore, bioethics education is needed for learners at all levels (i.e., medical students, trainees, and practicing clinicians). 8. Bioethics is a dynamic, multidisciplinary field with several dedicated journals, a national organization, and numerous centers and institutes. 9. Important scholarly work in bioethics, both empirical and conceptual, is being conducted and disseminated, providing important information for practicing clinicians.
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Freeman JM. Ethical theory and medical ethics: a personal perspective. JOURNAL OF MEDICAL ETHICS 2006; 32:617-8. [PMID: 17012509 PMCID: PMC2563316 DOI: 10.1136/jme.2005.014837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Ethical physicians need to share their biases and prejudices and articulate alternatives and also be tolerant of the decisions of their patients and families.
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Craig JM, May T. Ethics consultation as a tool for teaching residents. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2006; 6:25-7. [PMID: 16885098 DOI: 10.1080/15265160600755490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
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Abstract
The equipoise requirement in clinical research demands that, if patients are to be randomly assigned to one of two interventions in a clinical trial, there must be genuine doubt about which is better. This reflects the traditional view that physicians must never knowingly compromise the care of their patients, even for the sake of future patients. Equipoise has proven to be deeply problematic, especially in the Third World. Some recent critics have argued against equipoise on the grounds that clinical research is fundamentally distinct from clinical care, and thus should be governed by different norms. I argue against this "difference position," and instead take issue with the traditional, exclusively patient-centered account of physicians' obligations that equipoise presupposes. In place of this traditional view, I propose a Kantian test for the reasonable partiality that physicians should show their patients, focusing on its application in clinical research and medical education.
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Abbo ED, Volandes AE. Teaching residents to consider costs in medical decision making. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2006; 6:33-4. [PMID: 16885102 DOI: 10.1080/15265160600755540] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
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Arnold RM. Focusing on education rather than clinical ethics. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2006; 6:18-9. [PMID: 16885094 DOI: 10.1080/15265160600755417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
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90
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Jotkowitz A, Glick S. Education in professionalism should never end. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2006; 6:27-8. [PMID: 16885099 DOI: 10.1080/15265160600755508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
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Spike JP. Residency education in clinical ethics and professionalism: not just what, but when, where, and how ought residents be taught? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2006; 6:23-5. [PMID: 16885097 DOI: 10.1080/15265160600755482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
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Goold SD, Stern DT. Ethics and professionalism: what does a resident need to learn? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2006; 6:9-17. [PMID: 16885093 DOI: 10.1080/15265160600755409] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Training in ethics and professionalism is a fundamental component of residency education, yet there is little empirical information to guide curricula. The objective of this study is to describe empirically derived ethics objectives for ethics and professionalism training for multiple specialties. Study design is a thematic analysis of documents, semi-structured interviews, and focus groups conducted in a setting of an academic medical center, Veterans Administration, and community hospital training more than 1000 residents. Participants were 84 informants in 13 specialties including residents, program directors, faculty, practicing physicians, and ethics committees. Thematic analysis identified commonalities across informants and specialties. Resident and nonresident informants identified consent, interprofessional relationships, family interactions, communication skills, and end-of-life care as essential components of training. Nonresidents also emphasized formal ethics instruction, resource allocation, and self-monitoring, whereas residents emphasized the learning environment and resident-attending interactions. Conclusions are that empirically derived learning needs for ethics and professionalism included many topics, such as informed consent and resource allocation, relevant for most specialties, providing opportunities for shared curricula and resources.
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Mueller PS, Koenig BA. Systematic review of ethics consultation: a route to curriculum development in post-graduate medical education. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2006; 6:21-3. [PMID: 16885096 DOI: 10.1080/15265160600755474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
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Otto S. Getting from here to there. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2006; 6:19-21. [PMID: 16885095 DOI: 10.1080/15265160600755425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
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Rentmeester CA. What's legal? What's moral? What's the difference? A guide for teaching residents. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2006; 6:31-3. [PMID: 16885101 DOI: 10.1080/15265160600755524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
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Reiheld A. An unexpected opening to teach the impact of interactions between healthcare personnel. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2006; 6:29-30. [PMID: 16885100 DOI: 10.1080/15265160600755516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
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Bolin JN. Strategies for incorporating professional ethics education in graduate medical programs. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2006; 6:35-6. [PMID: 16885103 DOI: 10.1080/15265160600755557] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
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Kon AA. Resident-generated versus instructor-generated cases in ethics and professionalism training. Philos Ethics Humanit Med 2006; 1:E10. [PMID: 16808848 PMCID: PMC1523356 DOI: 10.1186/1747-5341-1-10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2005] [Accepted: 06/29/2006] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND The emphasis on ethics and professionalism in medical education continues to increase. Indeed, in the United States the ACGME will require residency programs to include professionalism training in all curricula by 2007. Most courses focus on cases generated by the course instructors rather than on cases generated by the trainees. To date, however, there has been no assessment of the utility of these two case discussion formats. In order to determine the utility of instructor-generated cases (IGCs) versus resident-generated cases (RGCs) in ethics and professionalism training, the author developed an innovative course that included both case formats. The IGCs were landmark cases and cases from the experience of the course instructors, while the RGCs were selected by the residents themselves. Residents were then surveyed to assess the strengths and weaknesses of each format. RESULTS Of twenty-two second and third year residents, fourteen completed surveys (response rate 64%). Residents were nearly evenly split in preferring RGCs (38%), IGCs (31%), or not preferring one to the other (31%). 29% stated that they learn more from the RGCs, 21% stated that they learn more from the IGCs, and 50% stated that they did not find a difference in their learning based on format. In general, residents surveyed prefer a mix of formats. Residents tended to find the RGCs more relevant and interesting, and felt the IGCs were necessary to ensure adequate breadth of cases and concepts. CONCLUSION Based on our relatively small sample at a single institution, we believe that educators should consider incorporating both instructor-generated and resident-generated cases in their ethics and professionalism curricula, and should evaluate the utility of such a model at their own institution. Further work is needed to illuminate other potential improvements in ethics and professionalism education.
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Krych EH, Vande Voort JL. Medical students speak: a two-voice comment on learning professionalism in medicine. Clin Anat 2006; 19:415-8. [PMID: 16683233 DOI: 10.1002/ca.20302] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
We are two medical students. For one of us, medical school is just beginning; for the other, it is coming to an end. Our experiences are different, but our message is the same. Professionalism is a vital component in the field of medicine. Characteristics such as trustworthiness, compassion, integrity, honesty, leadership, and social responsibility must be embraced by the next generation of doctors so the future healthcare system will be one that patients and physicians admire and respect. To reach this goal, it is important to understand how medical students today view professionalism and how such a construct is integrated into medical education. We hope to provide insight into this area by reflecting on the lessons we have learned regarding professionalism in medical school. Professionalism, like the medical field itself, is a life-long learning process. By encouraging this process early in medical training, future doctors will be able to provide their patients with highest quality care.
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DeRenzo EG, Vinicky J, Redman B, Lynch JJ, Panzarella P, Rizk S. Rounding: a model for consultation and training whose time has come. Camb Q Healthc Ethics 2006; 15:207-15. [PMID: 16610759 DOI: 10.1017/s0963180106060269] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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