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AlRukban M, Alajlan F, Alnasser A, Almousa H, Alzomia S, Almushawah A. Teaching medical ethics and medical professionalism in Saudi public and private medical schools. PLoS One 2024; 19:e0298605. [PMID: 38421988 PMCID: PMC10903870 DOI: 10.1371/journal.pone.0298605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 01/26/2024] [Indexed: 03/02/2024] Open
Abstract
Medical ethics and professionalism are two essential parts of building up the identity of a competent physician. This study was conducted to determine the nature, content, and methods of medical ethics and professionalism education in Saudi public and private medical schools. It also sought to identify the challenges and obstacles in teaching and assessing medical ethics and professionalism and suggest appropriate changes. A cross-sectional study was carried out in Saudi private and public medical schools. To achieve the study's aim, an assessment tool in the form of a novel self-administered questionnaire was developed, piloted, and then used. A representative from each of the 28 Saudi medical schools participated in the study. Twenty-four (82.1%) responding medical schools have no medical ethics department. Most of the medical schools (64.2%) have 25% or less of their faculty staff who teach ethics holding a qualification in medical ethics. Most schools have a specific course for medical ethics and professionalism (85.7% and 57.1%, respectively). Multiple-choice questioning is the most popular assessment method in medical ethics and professionalism courses (89.3% and 60.7%, respectively). The need for more qualified staff and clear guidelines/resources is a significant drawback to the teaching of medical ethics. Therefore, the study recommends developing national guidelines dedicated to the undergraduate teaching curriculum from which courses would be designed to enhance medical ethics and medical professionalism.
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Affiliation(s)
- Mohammed AlRukban
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Fahad Alajlan
- Department of Family and Community Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Ali Alnasser
- College of Medicine, King Saud University, Riyadh, Saudi Arabia, Saudi Arabia
| | - Hisham Almousa
- College of Medicine, King Saud University, Riyadh, Saudi Arabia, Saudi Arabia
| | - Sulaiman Alzomia
- College of Medicine, King Saud University, Riyadh, Saudi Arabia, Saudi Arabia
| | - Abdullah Almushawah
- College of Medicine, King Saud University, Riyadh, Saudi Arabia, Saudi Arabia
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Embedding Ethics Education in Clinical Clerkships by Identifying Clinical Ethics Competencies: The Vanderbilt Experience. HEC Forum 2020; 32:163-174. [PMID: 32307620 DOI: 10.1007/s10730-020-09410-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The clinical clerkships in medical school are the first formal opportunity for trainees to apply bioethics concepts to clinical encounters. These clerkships are also typically trainees' first sustained exposure to the "reality" of working in clinical teams and the full force of the challenges and ethical tensions of clinical care. We have developed a specialized, embedded ethics curriculum for Vanderbilt University medical students during their second (clerkship) year to address the unique experience of trainees' first exposure to clinical care. Our embedded curriculum is centered around core "ethics competencies" specific to the clerkship: for Medicine, advanced planning and end-of-life discussions; for Surgery, informed consent; for Pediatrics, the patient-family-provider triad; for Obstetrics and Gynecology, women's autonomy, unborn child's interests, and partner's rights; and for Neurology/Psychiatry, decision-making capacity. In this paper, we present the rationale for these competencies, how we integrated them into the clerkships, and how we assessed these competencies. We also review the additional ethical issues that have been identified by rotating students in each clerkship and discuss our strategies for continued evolution of our ethics curriculum.
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Stites SD, Clapp J, Gallagher S, Fiester A. Moving beyond the theoretical: Medical students' desire for practical, role-specific ethics training. AJOB Empir Bioeth 2018; 9:154-163. [PMID: 29727598 DOI: 10.1080/23294515.2018.1472149] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND It has been widely reported that medical trainees experience situations with profound ethical implications during their clinical rotations. To address this, most U.S. medical schools include ethics curricula in their undergraduate programs. However, the contents of these curricula vary substantially. Our pilot study aimed to discover, from the students' perspective, how ethics pedagogy prepares medical students for clerkship and what gaps might remain. METHODS This qualitative study organized focus groups of third- and fourth-year medical students. Participants recounted ethical concerns encountered during clerkship rotations and reflected on how their medical school ethics curriculum informed their responses to these scenarios. Transcripts of the focus-group sessions were analyzed using a grounded theory approach to identify common themes that characterized the students' experiences. RESULTS While students' accounts demonstrated a solid grasp of ethical theory and attunement to ethical concerns presented in the clinic, they also consistently evinced an inability to act on these issues given clerks' particular position in a complex learning hierarchy. Students felt they received too little training in the role-specific application of medical ethics as clinical trainees. We found a desire among trainees for enhanced practical ethics training in preparation for the clerkship phase of medical education. CONCLUSION We recommend several strategies that can begin to address these findings. The use of roleplaying with standardized patients can enable students to practice engagement with ethical issues. Conventional ethics courses can focus more on action-based pedagogy and instruction in conflict management techniques. Finally, clear structures for reporting and seeking advice and support for addressing ethical issues can lessen students' apprehension about acting on ethical concerns.
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Affiliation(s)
- Shana D Stites
- a Department of Medical Ethics and Health Policy , University of Pennsylvania
| | - Justin Clapp
- b Department of Anesthesiology and Critical Care , University of Pennsylvania
| | - Stefanie Gallagher
- a Department of Medical Ethics and Health Policy , University of Pennsylvania
| | - Autumn Fiester
- a Department of Medical Ethics and Health Policy , University of Pennsylvania
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Franco CAGDS, Franco RS, Lopes JMC, Severo M, Ferreira MA. Clinical communication skills and professionalism education are required from the beginning of medical training - a point of view of family physicians. BMC MEDICAL EDUCATION 2018; 18:43. [PMID: 29558914 PMCID: PMC5859538 DOI: 10.1186/s12909-018-1141-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 03/06/2018] [Indexed: 05/26/2023]
Abstract
BACKGROUND The Brazilian undergraduate medical course is six years long. As in other countries, a medical residency is not obligatory to practice as a doctor. In this context, this paper aims to clarify what and when competencies in communication and professionalism should be addressed, shedding light on the role of university, residency and post-residency programmes. METHODS Brazilian family physicians with diverse levels of medical training answered a questionnaire designed to seek a consensus on the competencies that should be taught (key competencies) and when students should achieve them during their medical training. The data were analysed using descriptive statistics and correlation tests. RESULTS A total of seventy-four physicians participated; nearly all participants suggested that the students should achieve communication and professionalism competencies during undergraduate study (twenty out of thirty competencies - 66.7%) or during residency (seven out of thirty competencies - 23.33%). When competencies were analysed in domains, the results were that clinical communication skills and professionalism competencies should be achieved during undergraduate medical education, and interpersonal communication and leadership skills should be reached during postgraduate study. CONCLUSION The authors propose that attainment of clinical communication skills and professionalism competencies should be required for undergraduate students. The foundation for Leadership and Interpersonal Abilities should be particularly formed at an undergraduate level and, furthermore, mastered by immersion in the future workplace and medical responsibilities in residency.
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Affiliation(s)
- Camila Ament Giuliani dos Santos Franco
- School of Medicine (discipline of Family Medicine), Pontifical University of Paraná, Curitiba, Brazil
- Department of Medical Education and Simulation, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Renato Soleiman Franco
- Department of Medical Education and Simulation, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- School of Medicine (discipline of Introduction to the Medical Practice), Pontifical University of Paraná, Curitiba, Brazil
| | - José Mauro Ceratti Lopes
- Department of Public Health, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
- Community Health Service of the Conceição Hospital Group, R. Sarmento Leite, 245 - Centro Histórico, Porto Alegre, RS 90050-170 Brazil
| | - Milton Severo
- Department of Medical Education and Simulation, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- Department of Epidemiology, Predictive Medicine and Public Health, Faculty of Medicine, University of Porto, Porto, Portugal
- Institute of Public Health, University of Porto, Portugal. Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Maria Amélia Ferreira
- Department of Medical Education and Simulation, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
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Stolper M, Molewijk B, Widdershoven G. Bioethics education in clinical settings: theory and practice of the dilemma method of moral case deliberation. BMC Med Ethics 2016; 17:45. [PMID: 27448597 PMCID: PMC4957934 DOI: 10.1186/s12910-016-0125-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 06/17/2016] [Indexed: 11/29/2022] Open
Abstract
Background Moral Case Deliberation is a specific form of bioethics education fostering professionals’ moral competence in order to deal with their moral questions. So far, few studies focus in detail on Moral Case Deliberation methodologies and their didactic principles. The dilemma method is a structured and frequently used method in Moral Case Deliberation that stimulates methodological reflection and reasoning through a systematic dialogue on an ethical issue experienced in practice. Methods In this paper we present a case-study of a Moral Case Deliberation with the dilemma method in a health care institution for people with an intellectual disability, describing the theoretical background and the practical application of the dilemma method. The dilemma method focuses on moral experiences of participants concerning a concrete dilemma in practice. By an in-depth description of each of the steps of the deliberation process, we elucidate the educational value and didactics of this specific method. Results The didactics and methodical steps of the dilemma method both supported and structured the dialogical reflection process of the participants. The process shows that the participants learned to recognize the moral dimension of the issue at stake and were able to distinguish various perspectives and reasons in a systematic manner. The facilitator played an important role in the learning process of the participants, by assisting them in focusing on and exploring moral aspects of the case. Discussion The reflection and learning process, experienced by the participants, shows competency-based characteristics. The role of the facilitator is that of a Socratic teacher with specific knowledge and skills, fostering reflection, inquiry and dialogue. Conclusion The specific didactics of the dilemma method is well suited for teaching bioethics in clinical settings. The dilemma method follows an inductive learning approach through a dialogical moral inquiry in which participants develop not only knowledge but also skills, attitude and character. The role of a trained facilitator and a specific view on teaching and practicing ethics are essential when using the dilemma method in teaching health care professionals how to reflect on their own moral issues in practice.
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Affiliation(s)
- Margreet Stolper
- Department of Medical Humanities, EMGO+ Institute for Health and Care Research, VU University medical centre (VUmc), De Boelenlaan 1089a, 1081, HV, Amsterdam, The Netherlands.
| | - Bert Molewijk
- Department of Medical Humanities, EMGO+ Institute for Health and Care Research, VU University medical centre (VUmc), De Boelenlaan 1089a, 1081, HV, Amsterdam, The Netherlands.,Centre of Medical Ethics, University of Oslo, Oslo, Norway
| | - Guy Widdershoven
- Department of Medical Humanities, EMGO+ Institute for Health and Care Research, VU University medical centre (VUmc), De Boelenlaan 1089a, 1081, HV, Amsterdam, The Netherlands
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Abstract
Educators in bioethics have struggled to find valid and reliable assessments that transcend the "reproduction of knowledge" to target more important skill sets. This manuscript reports on the process of developing and grading a minimal-competence comprehensive examination in a bioethics master's degree program. We describe educational theory and practice for the creation and deployment of scoring rubrics for high-stakes performance assessments that reduce scoring inconsistencies. The rubric development process can also benefit the program by building consensus among stakeholders regarding program goals and student outcomes. We describe the Structure of the Observed Learning Outcome taxonomy as a mechanism for rubric design and provide an example of how we applied that taxonomy to define pass/fail cut scores. Details about domains of assessment and writing descriptors of performance are also presented. Despite the laborious work required to create a scoring rubric, we found the effort to be worthwhile for our program.
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Pearlman RA, Foglia MB, Fox E, Cohen JH, Chanko BL, Berkowitz KA. Ethics Consultation Quality Assessment Tool: A Novel Method for Assessing the Quality of Ethics Case Consultations Based on Written Records. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2016; 16:3-14. [PMID: 26913651 DOI: 10.1080/15265161.2015.1134704] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Although ethics consultation is offered as a clinical service in most hospitals in the United States, few valid and practical tools are available to evaluate, ensure, and improve ethics consultation quality. The quality of ethics consultation is important because poor quality ethics consultation can result in ethically inappropriate outcomes for patients, other stakeholders, or the health care system. To promote accountability for the quality of ethics consultation, we developed the Ethics Consultation Quality Assessment Tool (ECQAT). ECQAT enables raters to assess the quality of ethics consultations based on the written record. Through rigorous development and preliminary testing, we identified key elements of a quality ethics consultation (ethics question, consultation-specific information, ethical analysis, and conclusions and/or recommendations), established scoring criteria, developed training guidelines, and designed a holistic assessment process. This article describes the development of the ECQAT, the resulting product, and recommended future testing and potential uses for the tool.
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Affiliation(s)
- Robert A Pearlman
- a National Center for Ethics in Health Care , Department of Veterans Affairs
| | - Mary Beth Foglia
- a National Center for Ethics in Health Care , Department of Veterans Affairs
| | | | - Jennifer H Cohen
- a National Center for Ethics in Health Care , Department of Veterans Affairs
| | - Barbara L Chanko
- a National Center for Ethics in Health Care , Department of Veterans Affairs
| | - Kenneth A Berkowitz
- a National Center for Ethics in Health Care , Department of Veterans Affairs
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Carrese JA, Malek J, Watson K, Lehmann LS, Green MJ, McCullough LB, Geller G, Braddock CH, Doukas DJ. The essential role of medical ethics education in achieving professionalism: the Romanell Report. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2015; 90:744-52. [PMID: 25881647 DOI: 10.1097/acm.0000000000000715] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
This article-the Romanell Report-offers an analysis of the current state of medical ethics education in the United States, focusing in particular on its essential role in cultivating professionalism among medical learners. Education in ethics has become an integral part of medical education and training over the past three decades and has received particular attention in recent years because of the increasing emphasis placed on professional formation by accrediting bodies such as the Liaison Committee on Medical Education and the Accreditation Council for Graduate Medical Education. Yet, despite the development of standards, milestones, and competencies related to professionalism, there is no consensus about the specific goals of medical ethics education, the essential knowledge and skills expected of learners, the best pedagogical methods and processes for implementation, and optimal strategies for assessment. Moreover, the quality, extent, and focus of medical ethics instruction vary, particularly at the graduate medical education level. Although variation in methods of instruction and assessment may be appropriate, ultimately medical ethics education must address the overarching articulated expectations of the major accrediting organizations. With the aim of aiding medical ethics educators in meeting these expectations, the Romanell Report describes current practices in ethics education and offers guidance in several areas: educational goals and objectives, teaching methods, assessment strategies, and other challenges and opportunities (including course structure and faculty development). The report concludes by proposing an agenda for future research.
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Affiliation(s)
- Joseph A Carrese
- J.A. Carrese is professor, Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, and core faculty, Johns Hopkins Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland. J. Malek is associate professor, Department of Bioethics and Interdisciplinary Studies, Brody School of Medicine, East Carolina University, Greenville, North Carolina. K. Watson is assistant professor, Medical Humanities and Bioethics Program, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. L.S. Lehmann is associate professor, Center for Bioethics, Brigham and Women's Hospital, and Division of Medical Ethics, Harvard Medical School, Boston, Massachusetts. M.J. Green is professor, Department of Humanities and Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania. L.B. McCullough is professor and Dalton Tomlin Chair in Medical Ethics and Health Policy, Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas. G. Geller is professor, Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, and core faculty, Johns Hopkins Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland. C.H. Braddock III is professor and vice dean for education, David Geffen School of Medicine at UCLA, Los Angeles, California. D.J. Doukas is William Ray Moore Endowed Chair of Family Medicine and Medical Humanism and director, Division of Medical Humanism and Ethics, Department of Family and Geriatric Medicine, University of Louisville School of Medicine, Louisville, Kentucky
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