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Krogh TB, Mielke-Christensen A, Madsen MD, Østergaard D, Dieckmann P. Medical students' experiences, perceptions, and management of second victim: an interview study. BMC MEDICAL EDUCATION 2023; 23:786. [PMID: 37875909 PMCID: PMC10598910 DOI: 10.1186/s12909-023-04763-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 10/11/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND The term second victim describes a healthcare professional who has been involved in an adverse event and feels wounded by the event. The effects of this experience differ. It can present as second victim syndrome, describing a wide range and degree of emotional and behavioural responses. Studies show that medical students can also experience second victim. The aim of this study was to elucidate medical students' experiences, perceptions, and management of second victim and second victim syndrome and to describe possible learning needs around these issues. METHODS Thirteen medical students and two recent medical graduates participated in semi-structured focus group interviews. The interviews lasted 1.5-2 h and were audiotaped, transcribed, and analysed using Braun and Clarke's six-step approach for thematic analysis. RESULTS Four main themes were identified: contributing factors; current coping strategies; perception of own requirements and learning needs; wishes for the future healthcare system. Students' behavioural and emotional response to dilemmas were affected by stakeholders and practices embedded in the healthcare system. Students described patient-injury and unexpected events as triggers for second victim, but also harmful interactions with individuals and feelings of self-blame. Students' coping centred around their network, formal offers, and separation of personal- and work-life. Students sought a clear definition of second victim and a desire for role-models. Students' wished to learn how to handle feeling like a burden to others, managing waiting time after patient complaints, and learning how to help second victims recover. Students emphasized the importance of the healthcare organisation understanding students' needs and providing them relevant support. CONCLUSION Students experience second victim as described in the literature. Students' emotional responses were caused by classical second victim triggers, but also other triggers in the educational environment: harmful interactions and self-blame. Although some triggers differ from the second victim definition, these different triggers should be considered equally serious and acknowledged. We must aim to prepare students for future adverse events and emotional responses. The health organisation and healthcare professionals must support students' mental well-being and contribute to ideal conditions for students' professional development and management of second victim as future physicians.
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Affiliation(s)
- Tobias Browall Krogh
- Copenhagen Academy for Medical Education and Simulation (CAMES), Herlev Hospital, Herlev, Denmark.
| | - Anne Mielke-Christensen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Herlev Hospital, Herlev, Denmark
| | - Marlene Dyrløv Madsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Herlev Hospital, Herlev, Denmark
| | - Doris Østergaard
- Copenhagen Academy for Medical Education and Simulation (CAMES), Herlev Hospital, Herlev, Denmark
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Peter Dieckmann
- Copenhagen Academy for Medical Education and Simulation (CAMES), Herlev Hospital, Herlev, Denmark
- Department of Quality and Health Technology, University Stavanger, Stavanger, Norway
- Department of Public Health, Copenhagen University, Copenhagen, Denmark
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Song X, Jiang N, Ding N, Li H, Xin C, Qu R, Wen D. "It really puts me in a bind", professionalism dilemmas reported by Chinese residents. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023:10.1007/s10459-022-10198-4. [PMID: 36595184 DOI: 10.1007/s10459-022-10198-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 12/11/2022] [Indexed: 06/17/2023]
Abstract
Residents play a pivotal role in the healthcare system. However, few tools have systematically revealed the dilemmas and challenges faced by residents. This study aimed to develop a checklist for professionalism dilemmas based on a behavior-based professionalism framework and to examine the range and proportion of professionalism dilemmas heard of, witnessed, or experienced by Chinese residents. Mixed methods were used, comprising qualitative (document analysis and focus group interviews) and quantitative (a small-scale questionnaire survey) data. Document analysis summarized professionalism dilemma items from previous publications. For focus group interviews, we used narrative inquiry to explore and make sense of residents' experiences and perceptions of professionalism dilemmas. A small-scale questionnaire survey was conducted during each focus group to investigate the proportion of professionalism dilemma items that residents reported to have heard of, witnessed, or experienced. Through document analysis and focus group interviews, we developed a checklist of professionalism dilemmas based on a behavior-based professionalism framework. The checklist included 58 items over four domains, with 10 sub-domains (compassion, respect, communication, collaboration, integrity, duty, pursuit of excellence, fair stewardship of health care resources, patient confidentiality, and informed consent). We also sought a preliminarily subjective impression by exploring the proportion of residents who have heard of, witnessed, and experienced each of the professionalism dilemma items and residents' perspectives when faced with professionalism dilemmas. Residents inevitably encounter or experience a diverse range of professionalism dilemmas. This checklist of professionalism dilemmas that was developed could prove to be a significant reference for targeted professionalism education, both for the resident as well as for faculty. It can also act as a helpful tool for improving hospital management guidelines and patient education.
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Affiliation(s)
- Xinzhi Song
- Institute for International Health Professions Education and Research, China Medical University, No. 77 Puhe Road, Shenyang, 110122, People's Republic of China
| | - Nan Jiang
- Institute for International Health Professions Education and Research, China Medical University, No. 77 Puhe Road, Shenyang, 110122, People's Republic of China
| | - Ning Ding
- Institute for International Health Professions Education and Research, China Medical University, No. 77 Puhe Road, Shenyang, 110122, People's Republic of China
| | - Honghe Li
- Institute for International Health Professions Education and Research, China Medical University, No. 77 Puhe Road, Shenyang, 110122, People's Republic of China
| | - Chunyu Xin
- Institute for International Health Professions Education and Research, China Medical University, No. 77 Puhe Road, Shenyang, 110122, People's Republic of China
| | - Ruoyi Qu
- Institute for International Health Professions Education and Research, China Medical University, No. 77 Puhe Road, Shenyang, 110122, People's Republic of China
| | - Deliang Wen
- Institute for International Health Professions Education and Research, China Medical University, No. 77 Puhe Road, Shenyang, 110122, People's Republic of China.
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Cho C, Ko WYK, Ngan OMY, Wong WT. Exploring Professionalism Dilemma and Moral Distress through Medical Students' Eyes: A Mixed-Method Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10487. [PMID: 36078203 PMCID: PMC9517822 DOI: 10.3390/ijerph191710487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/15/2022] [Accepted: 08/17/2022] [Indexed: 06/15/2023]
Abstract
This study aims to understand professionalism dilemmas medical students have experienced during clinical clerkships and the resulting moral distress using an explanatory mixed-method sequential design-an anonymous survey followed by in-depth interviews. A total of 153 students completed and returned the survey, with a response rate of 21.7% (153/706). The top three most frequently occurring dilemmas were the healthcare team answering patients' questions inadequately (27.5%), providing fragmented care to patients (17.6%), and withholding information from a patient who requested it (13.7%). Students felt moderately to severely distressed when they observed a ward mate make sexually inappropriate remarks (81.7%), were pressured by a senior doctor to perform a procedure they did not feel qualified to do (77.1%), and observed a ward mate inappropriately touching a patient, family member, other staff, or student (71.9%). The thematic analysis based on nine in-depth interviews revealed the details of clinicians' unprofessional behaviors towards patients, including verbal abuse, unconsented physical examinations, bias in clinical decisions, students' inaction towards the dilemmas, and students' perceived need for more guidance in applying bioethics and professionalism knowledge. Study findings provide medical educators insights into designing a professional development teaching that equips students with coping skills to deal with professionalism dilemmas.
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Affiliation(s)
- Cordelia Cho
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Wendy Y. K. Ko
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Olivia M. Y. Ngan
- CUHK Centre for Bioethics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Wai Tat Wong
- Department of Anaesthesia and Intensive Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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Shin Y, Kim S, Kim DH, Lee S, Cho M, Ihm J. The effect of deliberative process on the self-sacrificial decisions of utilitarian healthcare students. BMC Med Ethics 2022; 23:28. [PMID: 35305638 PMCID: PMC8933755 DOI: 10.1186/s12910-022-00769-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 03/10/2022] [Indexed: 11/17/2022] Open
Abstract
Background The COVID-19 pandemic has highlighted prosocial behavior as a professional healthcare core competency. Although medical students are expected to work in the best interests of their patients, in the pandemic context, there is a greater need for ethical attention to be paid to the way medical students deal with moral dilemmas that may conflict with their obligations. Methods This study was conducted in the spring semester of 2019 on 271 students majoring in health professions: medicine, dentistry, and veterinary medicine. All participants provided informed consent and completed measures that assessed utilitarian moral views, cognitive reflections, cognitive reappraisal, and moral judgment. Results The healthcare-affiliated students who scored higher on the instrumental harm subscale in the measurement of utilitarian moral views were more likely to endorse not only other-sacrificial actions but also self-sacrificial ones for the greater good in moral dilemma scenarios. In particular, those engaged in deliberative processes tended to make more self-sacrificial judgments. The mediation analysis also revealed that the effect of deliberative processes on self-sacrificial judgments was mediated by cognitive reappraisal. Conclusions These findings suggested that cognitive reappraisal through deliberative processes is involved when the students with utilitarian inclination make prosocial decisions, that it is necessary to consider both moral views and emotional regulation when admitting candidates, and that moral education programs are needed in the healthcare field. Supplementary Information The online version contains supplementary material available at 10.1186/s12910-022-00769-w.
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Soemantri D, Greviana N, Findyartini A, Azzahra TB, Suryoadji KA, Mustika R, Felaza E. "To obey or not to obey" - Medical students' response towards professional dilemmas in a hierarchical and collectivist culture. PLoS One 2021; 16:e0261828. [PMID: 34941959 PMCID: PMC8699955 DOI: 10.1371/journal.pone.0261828] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 12/12/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Clinical clerkship programme in medical schools were developed to provide students with direct interactions with patients and observe clinical teachers in practice. However, professional dilemmas are prone to occur due to the nature of experiential learning. Several studies across different cultures showed that medical students responded differently towards professional dilemma. AIMS This study aims to explore how medical students respond to professional dilemmas occurred during their clinical clerkships and to what extent culture influences the responses. METHOD A qualitative descriptive approach was used in this study. We conducted four focus group discussions with final year medical students who were selected using maximum variety sampling method. Thematic analysis was conducted following the transcription of the focus groups. RESULTS We identified the impact of dilemmas on students' emotions and concerns, students' responses towards professional dilemmas, and factors affecting responses to dilemmas in clinical clerkship, which confirmed that cultures played roles in how students responded towards professional dilemmas. CONCLUSION This study has identified that culture, to some extent, influenced the way students responded to professional dilemmas. Therefore, it is paramount to develop a conducive and culturally sensitive educational environment and students' ability to learn from professional dilemma experienced in the workplace for developing their professional identity.
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Affiliation(s)
- Diantha Soemantri
- Faculty of Medicine, Department of Medical Education, Universitas Indonesia, Jakarta, Indonesia
- Faculty of Medicine, Medical Education Center, Indonesian Medical Education and Research Institute (IMERI), Universitas Indonesia, Jakarta, Indonesia
| | - Nadia Greviana
- Faculty of Medicine, Department of Medical Education, Universitas Indonesia, Jakarta, Indonesia
- Faculty of Medicine, Medical Education Center, Indonesian Medical Education and Research Institute (IMERI), Universitas Indonesia, Jakarta, Indonesia
- * E-mail:
| | - Ardi Findyartini
- Faculty of Medicine, Department of Medical Education, Universitas Indonesia, Jakarta, Indonesia
- Faculty of Medicine, Medical Education Center, Indonesian Medical Education and Research Institute (IMERI), Universitas Indonesia, Jakarta, Indonesia
| | - Tiara Berliana Azzahra
- Faculty of Medicine, Medical Education Center, Indonesian Medical Education and Research Institute (IMERI), Universitas Indonesia, Jakarta, Indonesia
- Faculty of Medicine, Undergraduate Medical Program, Universitas Indonesia, Jakarta, Indonesia
| | - Kemal Akbar Suryoadji
- Faculty of Medicine, Medical Education Center, Indonesian Medical Education and Research Institute (IMERI), Universitas Indonesia, Jakarta, Indonesia
- Faculty of Medicine, Undergraduate Medical Program, Universitas Indonesia, Jakarta, Indonesia
| | - Rita Mustika
- Faculty of Medicine, Department of Medical Education, Universitas Indonesia, Jakarta, Indonesia
- Faculty of Medicine, Medical Education Center, Indonesian Medical Education and Research Institute (IMERI), Universitas Indonesia, Jakarta, Indonesia
| | - Estivana Felaza
- Faculty of Medicine, Department of Medical Education, Universitas Indonesia, Jakarta, Indonesia
- Faculty of Medicine, Medical Education Center, Indonesian Medical Education and Research Institute (IMERI), Universitas Indonesia, Jakarta, Indonesia
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Shelton W, Campo-Engelstein L. Confronting the Hidden Curriculum: A Four-Year Integrated Course in Ethics and Professionalism Grounded in Virtue Ethics. THE JOURNAL OF MEDICAL HUMANITIES 2021; 42:689-703. [PMID: 33856600 DOI: 10.1007/s10912-021-09694-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/05/2021] [Indexed: 06/12/2023]
Abstract
We describe a virtue ethics approach and its application in a four-year, integrated, longitudinal, and required undergraduate medical education course that attempts to address some of the challenges of the hidden curriculum and minimize some of its adverse effects on learners. We discuss how a curriculum grounded in virtue ethics strives to have the practical effect of allowing students to focus on their professional identity as physicians in training rather than merely on knowledge and skills acquisition. This orientation, combined with a student-generated curriculum, is designed to prepare students to identify and face challenges during their clinical years, further nurturing their professional growth. In short, a four-year integrated ethics and professionalism curriculum intentionally centered on cultivating virtuous physicians may alleviate, and even counteract, the effects of the hidden curriculum in the clinical years of medical training.
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Affiliation(s)
- Wayne Shelton
- Alden March Bioethics Institute at Albany Medical College, 47 New Scotland Avenue, MC 153, Albany, NY, 12208, USA.
| | - Lisa Campo-Engelstein
- Institute for Bioethics & Health Humanities, University of Texas Medical Branch, Galveston, TX, USA
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Pinnock R, Ritchie D, Gallagher S, Henning MA, Webster CS. The efficacy of mindful practice in improving diagnosis in healthcare: a systematic review and evidence synthesis. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2021; 26:785-809. [PMID: 33389234 DOI: 10.1007/s10459-020-10022-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 12/21/2020] [Indexed: 06/12/2023]
Abstract
Despite a variety of definitions of mindfulness, over the past 20 years there have been increasing claims that mindful practice is helpful in improving the accuracy of clinical diagnosis. We performed a systematic review and evidence synthesis in order to: determine the nature and definitions of mindful practice and associated terms; evaluate the quality of evidence for the benefits of mindful practice; and conclude whether mindful practice may reduce diagnostic error. We screened 14397 refereed reports from the five common literature databases, to include 33 reports related to the use of mindful practice in clinical diagnosis. Our evidence synthesis contained no randomised controlled trials (level I evidence) of mindful practice, the majority of supporting evidence (26 reports or 79%) comprised conceptual commentary or opinion (level IV evidence). However, 2 supporting reports constituted controlled studies without randomisation (level IIa), 1 report was quasi-experimental (level IIb), and 4 reports were comparative studies (level III). Thus, we may tentatively conclude that mindful practice appears promising as a method of improving diagnostic accuracy, but that further definitive studies of efficacy are required. We identified a taxonomy of 71 terms related to mindful practice, 7 of which were deemed core terms due to being each cited 5 times or more. The 7 core terms appear to be sufficient to describe the findings at higher levels of evidence in our evidence synthesis, suggesting that future definitive studies of mindful practice should focus on these common core terms in order to promote more generalisable findings.
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Affiliation(s)
- Ralph Pinnock
- Medical Education Unit, Dunedin School of Medicine, Otago Medical School - Dunedin Campus, University of Otago, Dunedin, New Zealand.
| | - Darren Ritchie
- Medical Education Unit, Dunedin School of Medicine, Otago Medical School - Dunedin Campus, University of Otago, Dunedin, New Zealand
| | - Steve Gallagher
- Medical Education Unit, Dunedin School of Medicine, Otago Medical School - Dunedin Campus, University of Otago, Dunedin, New Zealand
| | - Marcus A Henning
- Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Craig S Webster
- Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Auckland, New Zealand
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Ribeiro DL, Costa M, Helmich E, Jaarsma D, de Carvalho‐Filho MA. 'I found myself a despicable being!': Medical students face disturbing moral dilemmas. MEDICAL EDUCATION 2021; 55:857-871. [PMID: 33386638 PMCID: PMC8248051 DOI: 10.1111/medu.14447] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 12/05/2020] [Accepted: 12/26/2020] [Indexed: 06/12/2023]
Abstract
CONTEXT The psychological realm of medical students' moral experiences is explored tangentially in medical education literature, often in the context of ethics or professionalism education. This study deepens our understanding by (a) investigating the nature of moral dilemmas experienced at the onset of clinical practice, (b) exploring students' emotional response to these dilemmas, and (c) examining how students perceive the influence of these dilemmas on their professional development. METHODS This is a cross-sectional qualitative study carried out in 2017 that applied thematic template analysis to individual interviews performed with last-year medical students. The interviews followed the drawing of a Rich Picture representing moral dilemmas experienced by medical students at the onset of clinical practice. RESULTS Moral dilemmas have four intertwined dimensions. The first relates to students' struggle to prioritise, balance and apply conflicting moral values; the second comprises the clash between students' inner motivation and the external constraints that limit the moral action; the third refers to the conflict between students' current attitudes with the desired/idealised attitudes of the doctor they intend to become; and the fourth corresponds to weighting conflicting ethical principles during the moral decision. Students' emotional responses are intense and long-lasting, and with a remarkable residue effect, particularly when the moral decision does not align with their moral beliefs. Moral dilemmas are impactful experiences that affect the professional development of medical students and can culminate in both detachment and growth in moral courage. CONCLUSION Moral dilemmas are memorable, complex and emotionally intense experiences that impact the professional development of medical students. Understanding students' moral dilemmas can help educators to devise pedagogical activities to anticipate and reflect on these experiences. These activities should happen under the guidance of a non-judgemental facilitator, capable of listening and legitimating students' thoughts and feelings while providing insights to nurture their professional development.
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Affiliation(s)
- Diego Lima Ribeiro
- Department of Ethics and Emergency MedicineUniversity of CampinasCampinasBrazil
| | - Marcos Costa
- University Medical Center AmsterdamAmsterdamThe Netherlands
| | - Esther Helmich
- Center for Education Development and Research in Health ProfessionsUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Debbie Jaarsma
- Center for Education Development and Research in Health ProfessionsUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Marco Antonio de Carvalho‐Filho
- Center for Education Development and Research in Health ProfessionsUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
- ICVS ‐ Life and Health Sciences Research InstituteUniversity of MinhoBragaPortugal
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Philosophy for Resilience: A Meaningful Intervention for Medical Students. JOURNAL OF ACADEMIC ETHICS 2021. [DOI: 10.1007/s10805-021-09394-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Jenkin AC, Winter DA. Exploration of Ethical Construing in Clinical Psychology Doctoral Students: An Adaptation of Repertory Grid Technique. JOURNAL OF CONSTRUCTIVIST PSYCHOLOGY 2020. [DOI: 10.1080/10720537.2020.1805830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Angie C. Jenkin
- Tavistock and Portman NHS Foundation Trust, London, United Kingdom
| | - David A. Winter
- Department of Psychology, Sport and Geography, University of Hertfordshire, Hatfield, United Kingdom
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RETRACTED ARTICLE: Study on ethical dilemmas faced by teaching professionals in rural environments. CURRENT PSYCHOLOGY 2020. [DOI: 10.1007/s12144-020-00845-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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12
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Li H, Novack DH, Duke P, Gracely E, Cestone C, Davis T. Predictors of medical students' ethical decision-making: A pilot study using the Theory of Interpersonal Behavior. PATIENT EDUCATION AND COUNSELING 2020; 103:S0738-3991(20)30292-5. [PMID: 32540095 DOI: 10.1016/j.pec.2020.05.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 05/15/2020] [Accepted: 05/20/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To understand medical students' (MS) ethical decision-making using the Theory of Interpersonal Behavior (TIB). METHODS We conducted two rounds of focus groups to develop a TIB-based questionnaire by eliciting students' perspectives on an ethical dilemma they will encounter in a standardized patient (SP) station, in which an SP "surgeon" asked them to intubate a sedated patient whom the student knew had requested no student involvement. We administrated questionnaires to 241 third-year MS following this SP station, asking for their decisions in the SP station and if a surgeon made the same request in their clerkship. Confirmatory factor analysis (CFA) was used to test whether observed data fit the proposed TIB-based model. RESULTS The CFA provided an acceptable fit to the a priori proposed model. Fifty-five percent of students indicated they would intubate in an actual situation versus 18% in the SP station (p < 0.05). Using logistic regression, TIB domains affect and facilitating factors reported significant association with students' decisions in both the SP and hypothesized actual situations. CONCLUSIONS The TIB appears to be an effective theoretical framework for explaining students' ethical decision-making. PRACTICE IMPLICATIONS The TIB may guide design and assessment of educational programs for professional formation.
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Affiliation(s)
- Honghe Li
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, China; Cambridge Health Alliance, Harvard Medical School, Cambridge, USA.
| | - Dennis H Novack
- Office of Educational Affairs, Drexel University College of Medicine, Philadelphia, USA
| | - Pamela Duke
- Office of Educational Affairs, Drexel University College of Medicine, Philadelphia, USA
| | - Edward Gracely
- Family Community and Preventive Medicine, Drexel University College of Medicine, Philadelphia, USA
| | - Christina Cestone
- Office of Educational Affairs, Drexel University College of Medicine, Philadelphia, USA
| | - Tiffany Davis
- Office of Educational Affairs, Drexel University College of Medicine, Philadelphia, USA
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Mor Z, Cadesky A, Halleluyan R, Sheffer R. Attitudes of Israeli medical students towards the medical treatment of uninsured migrants. BMC MEDICAL EDUCATION 2020; 20:72. [PMID: 32171315 PMCID: PMC7071779 DOI: 10.1186/s12909-020-1973-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 02/20/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Undocumented migration to developed countries poses practical concerns, as migrants are not medically insured. This cross-sectional study aims to appraise the attitudes of Israeli medical students towards the uninsured migrant population. METHODS Participants from five medical schools in Israel completed anonymous questionnaires in Hebrew, based on the "Medical Students' Attitudes Toward the Underserved" (MSATU), which assessed students' attitudes regarding the professional responsibility and societal expectations towards the migrants. It also evaluated students' views of the migrants as eligible for expensive medical procedures. RESULTS A total of 891 students completed the survey with a median age of 28 years. The majority were Jews (N = 816, 91.6%) and singles (N = 681, 68.5%). Participants in the pre-clinical years were likely to be female and unmarried compared to those in clinical training. They also demonstrated higher scores on professional responsibilities and societal expectations than students in clinical training, but no significant differences were found in their views on expensive medical services. Students of minorities (non-Jews and migrants) scored higher on professional responsibilities and societal expectations. The scores for professional responsibilities and societal expectations decreased as students progressed in their medical training (Spearman coefficient p = 0.04 and p = 0.01, respectively). This trend was more apparent in males rather than females. CONCLUSION MSATU scores declined as students progressed through medical school, with females maintaining more favorable attitudes than males. Medical schools should attempt to maintain the enthusiasm and idealism that students possess as they enter medical training and provide clinical experience with migrant populations that allows for cross-cultural communication.
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Affiliation(s)
- Zohar Mor
- Tel Aviv Department of Health, Tel Aviv, Israel.
- School of Health Sciences, Ashkelon Academic College, Ashkelon, Israel.
| | - Adam Cadesky
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Halleluyan
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Zaidi D, Blythe JA, Frush BW, Malone JR. Clerkship Ethics: Unique Ethical Challenges for Physicians-in-Training. HEC Forum 2020; 32:99-109. [DOI: 10.1007/s10730-020-09400-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Professionalism dilemmas experienced by health professions students: a cross-sectional study. J Interprof Care 2019; 34:259-268. [PMID: 31516056 DOI: 10.1080/13561820.2019.1649645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Health professions students will invariably confront professionalism dilemmas. These early encounters significantly influence future professional attitudes and behaviours. Heretofore, studies concerning professionalism dilemmas experienced by health professions students across disciplines have been limited. To address this issue, we recruited 56 students with clinical experience from the National Taiwan University College of Medicine in the nursing, dentistry, pharmacy, medical technology, occupational therapy, and physiotherapy programs to participate in this research to compare health professions students' understandings of professionalism and their experiences of professionalism dilemmas. We used group interviews to uncover students' experiences of professionalism dilemmas. We identified the six most commonly reported professionalism dilemmas and found that interprofessional dilemmas were the dominant workplace professionalism dilemma for health professions students. We also identified significant disciplinary differences regarding dilemma types and frequencies. We employed the framework of dual identity development to better understand the role of professional and interprofessional identities in interprofessional dilemmas. The professionalism dilemmas that individual students encountered were shaped by disciplinary differences. Our findings suggest that the development of a sense of belonging to both their own profession and a broader interprofessional care team in health professions students can increase the effectiveness of interprofessional healthcare teams.
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Bächli P, Meindl-Fridez C, Weiss-Breckwoldt AN, Breckwoldt J. Challenging cases during clinical clerkships beyond the domain of the "medical expert": an analysis of students' case vignettes. GMS JOURNAL FOR MEDICAL EDUCATION 2019; 36:Doc30. [PMID: 31211225 PMCID: PMC6545608 DOI: 10.3205/zma001238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 11/23/2018] [Accepted: 02/01/2019] [Indexed: 06/01/2023]
Abstract
Background: During clinical clerkships students experience complex and challenging clinical situations related to problems beyond the domain of the "Medical Expert". Workplace routine may leave little opportunity to reflect on these situations. The University of Zurich introduced a mandatory course directly after the clinical clerkship year (CCY) to work up these situations. Prior to the course each student submitted a vignette on a case he or she had perceived challenging during the CCY and which was not related to the domain of the "Medical Expert" role. In this paper we want to characterize these cases in respect to most prominent themes and related CanMEDS roles. The goal was to inform clinical supervisors about potential teaching demands during the CCY. Methods: All case vignettes submitted by a years' cohort were analysed by three researchers in two ways: for the clinical characteristics and the main theme of the underlying problem and the most prominent CanMEDS roles involved. Themes of the underlying problem were aggregated to overarching topics and subsequently to main categories by pragmatic thematic analysis. Results: 254 case vignettes covered the whole spectrum of clinical disciplines. A wide range of underlying themes could be assigned to five main categories: "communication within team" (23.2%), "communication with patients and relatives" (24.8%), "patient behavior and attitudes" (18.5%), "clinical decision making" (24.0%), and "social and legal issues" (9.4%). Most frequent CanMEDS roles were "Communicator" (26.9%) and "Professional" (23.5%). Conclusions: Cases students perceived as challenging beyond the "Medical Expert" were reported from all clinical disciplines. These were mainly related to communicational and professional issues, mirrored by the CanMEDS roles "Communicator" and "Professional". Therefore, supervisors in clinical clerkships should put an additional teaching focus on communication and professionalism.
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Affiliation(s)
- Patrik Bächli
- Kantonsspital Aarau, Dept. of Anesthesiology, Aarau, Switzerland
| | - Claudine Meindl-Fridez
- University Hospital Zurich, Department of General Internal Medicine, Zurich, Switzerland
| | | | - Jan Breckwoldt
- University Hospital Zurich, Institute of Anesthesiology, Zurich, Switzerland
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Damiano RF, Cruz AOD, Oliveira JGD, DiLalla LF, Tackett S, Ezequiel ODS, Lucchetti G. Mapping scientific research on the negative aspects of the medical school learning environment. ACTA ACUST UNITED AC 2019; 65:232-239. [PMID: 30892449 DOI: 10.1590/1806-9282.65.2.232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 08/27/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We sought to understand the landscape of published articles regarding medical schools' learning environments (LE) worldwide, with an explicit focus on potentially harmful aspects of the LE as an effort to identify areas specifically in need of remediation or intervention that could prevent future unprofessional behaviors, burnout, violence and mistreatment among students and physicians. METHODS A bibliometric analysis was conducted in six electronic databases (PubMed/Medline, Web of Science, Cochrane Library, SCOPUS, ERIC-ProQuest, and PsycINFO) up to December 31, 2016, including 12 themes: learning environment - general, hidden curriculum (harmful), unethical behaviors, bullying/hazing, violence, sexual discrimination, homophobia, racism, social discrimination, minorities discrimination, professional misconduct, and other negative aspects. RESULTS Of the 9,338 articles found, 710 met the inclusion criteria. The most common themes were general LE (233 articles), unprofessional behaviors (91 articles), and sexual discrimination (80 articles). Approximately 80% of articles were published in the 21st century. CONCLUSION There is a definite increase in scientific articles on negative aspects of the medical school LE in high-quality journals, especially in the 21st century. However, more studies are needed to investigate negative LE aspects with greater attention to experimental, longitudinal, and cross-cultural study designs.
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Affiliation(s)
| | - Andrey O da Cruz
- Pontifical Catholic University of São Paulo, Sorocaba, São Paulo, Brasil
| | - José G de Oliveira
- Pontifical Catholic University of São Paulo, Sorocaba, São Paulo, Brasil
| | - Lisabeth F DiLalla
- Family and Community Medicine, Southern Illinois University School of Medicine, Carbondale, Illinois, USA
| | - Sean Tackett
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - Giancarlo Lucchetti
- School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brasil
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Malički M, Katavić V, Marković D, Marušić M, Marušić A. Perceptions of Ethical Climate and Research Pressures in Different Faculties of a University: Cross-Sectional Study at the University of Split, Croatia. SCIENCE AND ENGINEERING ETHICS 2019; 25:231-245. [PMID: 29071571 PMCID: PMC6418058 DOI: 10.1007/s11948-017-9987-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 10/12/2017] [Indexed: 06/07/2023]
Abstract
We determined the prevailing ethical climate at three different schools of a single university, in order to explore possible differences in the ethical climate related to different research fields: the School of Electrical Engineering, Mechanical Engineering, and Naval Architecture; the School of Humanities and Social Sciences; and the School of Medicine. We used the Ethical Climate Questionnaire to survey the staff (teachers and administration) at the three schools, and used the research integrity and organizational climate (RIOC) survey for early-stage researchers at the three schools. The dominant ethical climate type perceived collectively at the three university schools (response rate 49%, n = 294) was Laws and professional codes, which is associated with the cosmopolitan level of analysis and the ethical construct of principle. Individually, the same climate predominated at the schools for engineering and humanities, but the School of Medicine had the Self-interest ethical climate, which is associated with the individual level of analysis and the egoism ethical construct. In the RIOC survey (response rate 85%; n = 70), early-stage researchers from the three university schools did not differ in their perceptions of the organizational research integrity climate, or in their perceived individual, group or organizational pressures. Our study is the first, to the best of our knowledge, to show differences in perceived ethical climate at a medical school compared to other schools at a university. Further studies are needed to explore the reasons for these differences and how they translate to organizational outcomes, such as job satisfaction, commitment to the institution and dysfunctional behaviour, including research misconduct.
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Affiliation(s)
- Mario Malički
- Department of Research in Biomedicine and Health, University of Split School of Medicine, Šoltanska 2, 21000, Split, Croatia
- Cochrane Croatia, University of Split School of Medicine, Split, Croatia
| | - Vedran Katavić
- Department of Anatomy, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Domagoj Marković
- Department of Cardiology, University of Split Hospital Centre, Split, Croatia
| | - Matko Marušić
- Department of Research in Biomedicine and Health, University of Split School of Medicine, Šoltanska 2, 21000, Split, Croatia
- Cochrane Croatia, University of Split School of Medicine, Split, Croatia
| | - Ana Marušić
- Department of Research in Biomedicine and Health, University of Split School of Medicine, Šoltanska 2, 21000, Split, Croatia.
- Cochrane Croatia, University of Split School of Medicine, Split, Croatia.
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Damiano RF, Cruz AOD, Oliveira JGD, DiLalla LF, Tackett S, Ezequiel ODS, Lucchetti G. Mapping the scientific research on the negative aspects of the medical school learning environment. ACTA ACUST UNITED AC 2018; 64:1050-1057. [PMID: 30570060 DOI: 10.1590/1806-9282.64.11.1050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 08/27/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We sought to understand the landscape of published articles regarding medical schools' learning environments (LE) worldwide, with an explicit focus on potentially negative aspects of the LE as an effort to identify areas specifically in need of remediation or intervention that could prevent future unprofessional behaviours, burnout, violence and mistreatment among students and physicians. METHODS A bibliometric analysis was conducted in six electronic databases (PubMed/Medline, Web of Science, Cochrane Library, SCOPUS, ERIC-ProQuest and PsycINFO) through December 31, 2016, including 12 themes: learning environment - general, hidden curriculum (negative), unethical behaviours, bullying/hazing, violence, sexual discrimination, homophobia, racism, social discrimination, minorities' discrimination, professional misconduct, and "other" negative aspects. RESULTS Of 9,338 articles found, 710 met the inclusion criteria. The most common themes were general LE (233 articles), unprofessional behaviours (91 articles), and sexual discrimination (80 articles). Approximately 80% of articles were published in the 21st century. CONCLUSION There is a clear increase in scientific articles on negative aspects of the medical school LE in high-quality journals, especially in the 21st century. However, more studies are needed to investigate negative LE aspects with greater attention paid to experimental, longitudinal, and cross-cultural study designs.
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Affiliation(s)
- Rodolfo F Damiano
- Institute of Psychiatry, University of São Paulo, São Paulo, SP, Brasil
| | - Andrey O da Cruz
- Pontifical Catholic University of São Paulo, Sorocaba, SP, Brasil
| | | | - Lisabeth F DiLalla
- Family and Community Medicine, Southern Illinois University School of Medicine, Carbondale, Illinois, USA
| | - Sean Tackett
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - Giancarlo Lucchetti
- School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, MG, Brasil
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AlMahmoud T, Hashim MJ, Almahmoud R, Branicki F, Elzubeir M. Informed consent learning: Needs and preferences in medical clerkship environments. PLoS One 2018; 13:e0202466. [PMID: 30281603 PMCID: PMC6169846 DOI: 10.1371/journal.pone.0202466] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 08/03/2018] [Indexed: 11/18/2022] Open
Abstract
Purpose Limited information exists regarding students’ routine educational needs in support of ethics and professionalism practices faced in real clinical practice. As such the authors aimed to explore medical students learning needs and preferences for informed consent and relevant ethical issues in the clerkship environments. Materials and methods A cross-sectional study using a self-administered, printed survey distributed to final year clinical clerks. Results 84% completed the survey. Students indicated the need for more attention to all topics related to informed consent (mean = 7.1 on a scale of 0 to 9; ±1.2). Most additional instructional attention was requested for topics raised in discussions with patients concerning the risks, benefits and alternatives to recommended treatments (7.3 ±1.4). The cohort expressed the need for education in the care of vulnerable patients (7.2 ±1.2) with a maximum score for the care of abused children. Women perceived greater need for education concerning informed consent than male respondents (p>0.05). There were significant differences between students who scored high or low on the item “being treated in professional manner” and “endorsement of educational needs for care of adolescents” (p = 0.05). Conclusion There was heightened perception among final year medical students of the need for greater attention to be paid to informed consent education.
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Affiliation(s)
- Tahra AlMahmoud
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
- * E-mail:
| | - M. Jawad Hashim
- Department of Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
| | - Rabah Almahmoud
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, UAE
| | - Frank Branicki
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
| | - Margaret Elzubeir
- Department of Medical Education, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
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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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D'Souza RF, Mathew M, D'Souza DSJ, Palatty P. Novel horizontal and vertical integrated bioethics curriculum for medical courses. MEDICAL TEACHER 2018; 40:573-577. [PMID: 29490543 DOI: 10.1080/0142159x.2018.1442921] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Studies conducted by the University of Haifa, Israel in 2001, evaluating the effectiveness of bioethics being taught in medical colleges, suggested that there was a significant lack of translation in clinical care. Analysis also revealed, ineffectiveness with the teaching methodology used, lack of longitudinal integration of bioethics into the undergraduate medical curriculum, and the limited exposure to the technology in decision making when confronting ethical dilemmas. A modern novel bioethics curriculum and innovative methodology for teaching bioethics for the medical course was developed by the UNESCO Chair in Bioethics, Haifa. The horizontal (subject-wise) curriculum was vertically integrated seamlessly through the entire course. An innovative bioethics teaching methodology was employed to implement the curriculum. This new curriculum was piloted in a few medical colleges in India from 2011 to 2015 and the outcomes were evaluated. The evaluation confirmed gains over the earlier identified translation gap with added high student acceptability and satisfaction. This integrated curriculum is now formally implemented in the Indian program's Health Science Universities which is affiliated with over 200 medical schools in India. This article offers insights from the evaluated novel integrated bioethics curriculum and the innovative bioethics teaching methodology that was used in the pilot program.
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Affiliation(s)
- Russell F D'Souza
- a International Institute of Organizational Psychological Medicine , Dandenong , Australia
| | - Mary Mathew
- b Department of Pathology , Kasturba Medical College, Manipal Academy of Higher Education , Manipal , India
| | - Derek S J D'Souza
- c Department of Dental Surgery , Maharashtra Institute of Medical Sciences , Pune , India
| | - Princy Palatty
- d Department of Pharmacology , Father Muller Medical College , Mangalore , India
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Esquerda M, Pifarré J, Roig H, Busquets E, Yuguero O, Viñas J. [Assessing bioethics education: Teaching to be virtuous doctors or just doctors with practical ethical skills]. Aten Primaria 2018; 51:99-104. [PMID: 29627144 PMCID: PMC6837039 DOI: 10.1016/j.aprim.2017.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 05/01/2017] [Accepted: 05/22/2017] [Indexed: 11/29/2022] Open
Abstract
Objetivo La bioética se ha incorporado en la formación de las Facultades de Medicina las últimas décadas. Diversos estudios analizan el desarrollo ético-moral de los estudiantes y el efecto de la educación ética, midiendo la evolución del razonamiento moral de Kohlberg (médicos virtuosos), y la sensibilidad ética para resolver casos clínicos (médicos con habilidades éticas). El objetivo del estudio es valorar el impacto de la formación en ética en estas dos variables en nuestro ámbito. Diseño Estudio observacional transversal. Emplazamiento Facultad de Medicina, Universidad de Lleida. Participantes Un total de 175 estudiantes de tercer curso de medicina (78 antes de realizar bioética y 97 después de realizar bioética, en diferentes cursos). Intervención Formación reglada en bioética. Mediciones principales Se administra un cuestionario sociodemográfico, el Defining Issue Test de Rest como medida del razonamiento moral, y el Problem Identification Test de Hébert como medida de la sensibilidad ética. Resultados Se halla una relación consistente y significativa entre razonamiento moral y sensibilidad ética. Las mujeres presentan mayor razonamiento posconvencional, es decir, mayor desarrollo moral. No se aprecian cambios en el estadio de razonamiento moral global de Kohlberg con la formación ética. Sí se incrementa de forma significativa y global la sensibilidad ética, medida en forma de Problem Identification Test. Conclusión No se hallan diferencias en el desarrollo moral de estudiantes de medicina antes y después de la formación reglada en bioética, pero sí con respecto a las habilidades en resolución de casos. Se plantea si esta mejora es suficiente para formar médicos preparados para los nuevos retos.
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Affiliation(s)
- Montse Esquerda
- Institut Borja de Bioética, Universitat Ramon Llull, Esplugues de Llobregat, Barcelona, España; Facultat de Medicina, Universitat de Lleida, Lleida, España; Sant Joan de Déu Terres de Lleida, Lleida, España; Institut de Recerca Biomèdica de Lleida (IRB-Lleida), Lleida, España
| | - Josep Pifarré
- Facultat de Medicina, Universitat de Lleida, Lleida, España; Sant Joan de Déu Terres de Lleida, Lleida, España; Institut de Recerca Biomèdica de Lleida (IRB-Lleida), Lleida, España; Gestió de Serveis Sanitaris (GSS)-Hospital Universitari Santa Maria, Lleida, España.
| | - Helena Roig
- Institut Borja de Bioética, Universitat Ramon Llull, Esplugues de Llobregat, Barcelona, España
| | - Ester Busquets
- Institut Borja de Bioética, Universitat Ramon Llull, Esplugues de Llobregat, Barcelona, España
| | - Oriol Yuguero
- Facultat de Medicina, Universitat de Lleida, Lleida, España; Institut de Recerca Biomèdica de Lleida (IRB-Lleida), Lleida, España
| | - Joan Viñas
- Institut Borja de Bioética, Universitat Ramon Llull, Esplugues de Llobregat, Barcelona, España; Facultat de Medicina, Universitat de Lleida, Lleida, España; Institut de Recerca Biomèdica de Lleida (IRB-Lleida), Lleida, España
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Dwyer J, Faber-Langendoen K. Speaking Up: An Ethical Action Exercise. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:602-605. [PMID: 29116984 DOI: 10.1097/acm.0000000000002047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PROBLEM Health care professionals encounter situations in which they need to speak up to prevent harm, ensure better care, and/or address unprofessional behavior. Speaking up is often difficult, especially for medical students; nonetheless, it is a skill students must practice, so they can better advocate for patients. APPROACH The authors have designed an ethical action exercise and incorporated it into a required bioethics course that meets concurrently with third-year clerkships. The exercise requires students to speak up to try to correct, resolve, or improve one situation during a clerkship. The exercise involves overt action, but students determine how, where, and when to act. OUTCOMES In 2013-2014, 111 students at State University of New York Upstate Medical University completed the exercise. Most spoke up about situations in which they thought that some aspect of patient care could be improved (n = 78; 70%); others spoke up when they perceived unprofessional conduct (n = 32; 29%). Although most students found speaking up to be difficult (n = 96; 86%), speaking up often led to improved care (n = 46; 41%). As a result of completing the ethical action exercise, 2 students reported becoming less likely to speak up in the future, whereas 64 students reported becoming more likely. NEXT STEPS Going forward, the authors want to address three issues: the development of lasting habits, the role of culture, and connections with other initiatives to improve care.
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Affiliation(s)
- James Dwyer
- J. Dwyer is professor, Center for Bioethics and Humanities, State University of New York Upstate Medical University, Syracuse, New York. K. Faber-Langendoen is professor and chair, Center for Bioethics and Humanities, State University of New York Upstate Medical University, Syracuse, New York
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Kong WM, Knight S. Bridging the education-action gap: a near-peer case-based undergraduate ethics teaching programme. JOURNAL OF MEDICAL ETHICS 2017; 43:692-696. [PMID: 28143942 DOI: 10.1136/medethics-2016-103762] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 12/14/2016] [Accepted: 01/10/2017] [Indexed: 05/17/2023]
Abstract
Undergraduate ethics teaching has made significant progress in the past decade, with evidence showing that students and trainee doctors feel more confident in identifying and analysing ethical issues. There is general consensus that ethics education should enable students and doctors to take ethically appropriate actions, and nurture moral integrity. However, the literature reports that doctors continue to find it difficult to take action when faced with perceived unethical behaviour. This has been evident in recent healthcare scandals, in which care has fallen below acceptable ethical standards, despite the presence of professional ethical guidelines and competencies. The National Foundation Training Programme forms the first 2 years of training for new UK doctors. We designed a Foundation Doctor (FD)-led teaching programme in which medical students were invited to bring cases and experiences from clinical placements for small group discussion facilitated by FDs. The aim was to enable students to act ethically in practice through developing moral sensitivity and moral identity, together with skills in ethical reasoning and tools to address barriers to taking ethical action. FDs were chosen as facilitators, based on the evidence that near-peer is an effective form of teaching in medicine and may provide positive role models for students. This article reviews the background rationale for the programme and its design. Important themes emerging from the case discussions are explored. Student and FD facilitator feedbacks are evaluated, and practical challenges to the implementation of this type of programme are discussed.
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Affiliation(s)
- Wing May Kong
- Imperial College London and Central Middlesex Hospital LNWH NHS Trust, London, UK
| | - Selena Knight
- Department of Primary Care and Public Health Sciences, King's College London and Chelsea and Westminster NHS Foundation Trust, London, UK
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Li DG, Wong GX, Martin DT, Tybor DJ, Kim J, Lasker J, Mitty R, Salem D. Attitudes on cost-effectiveness and equity: a cross-sectional study examining the viewpoints of medical professionals. BMJ Open 2017; 7:e017251. [PMID: 28765138 PMCID: PMC5642791 DOI: 10.1136/bmjopen-2017-017251] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To determine the attitudes of physicians and trainees in regard to the roles of both cost-effectiveness and equity in clinical decision making. DESIGN In this cross-sectional study, electronic surveys containing a hypothetical decision-making scenario were sent to medical professionals to select between two colon cancer screening tests for a population. SETTING Three Greater Boston academic medical institutions: Tufts University School of Medicine, Tufts Medical Centre and Lahey Hospital and Medical Centre. PARTICIPANTS 819 medical students, 497 residents-in-training and 671 practising physicians were contacted electronically using institutional and organisational directories. MAIN OUTCOMES AND MEASURES Stratified opinions of medical providers and trainee subgroups regarding cost-effectiveness and equity. RESULTS A total of 881 respondents comprising 512 medical students, 133 medical residents-in-training and 236 practising physicians completed the survey (total response rate 44.3%). Thirty-six per cent of medical students, 44% of residents-in-training and 53% of practising physicians favoured the less effective and more equitable screening test. Residents-in-training (OR 1.49, CI 1.01 to 2.21; p=0.044) and practising physicians (OR 2.12, CI 1.54 to 2.92; p<0.001) were more likely to favour the equitable option compared with medical students. Moreover, female responders across all three cohorts favoured the more equitable screening test to a greater degree than did male responders (OR 1.70, CI 1.29 to 2.24; p<0.001). CONCLUSIONS Cost-effectiveness analysis does not accurately reflect the importance that medical professionals place on equity. Among medical professionals, practising physicians appear to be more egalitarian than residents-in-training, while medical students appear to be most utilitarian and cost-effective. Meanwhile, female respondents in all three cohorts favoured the more equitable option to a greater degree than their male counterparts. Healthcare policies that trade off equity in favour of cost-effectiveness may be unacceptable to many medical professionals, especially practising physicians and women.
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Affiliation(s)
- David G Li
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Gordon X Wong
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - David T Martin
- Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - David J Tybor
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Jennifer Kim
- Stanford Medical Center, Palo Alto, California, USA
| | - Jeffrey Lasker
- New England Quality Care Alliance, Boston, Massachusetts, USA
| | - Roger Mitty
- St. Elizabeth's Medical Center, Brighton, Massachusetts, USA
| | - Deeb Salem
- Tufts Medical Center, Boston, Massachusetts, USA
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Kohn JR, Armstrong JM, Taylor RA, Whitney DL, Gill AC. Student-derived solutions to address barriers hindering reports of unprofessional behaviour. MEDICAL EDUCATION 2017; 51:708-717. [PMID: 28418106 PMCID: PMC5605389 DOI: 10.1111/medu.13271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 11/07/2016] [Accepted: 12/29/2016] [Indexed: 05/28/2023]
Abstract
BACKGROUND Barriers hinder medical students from reporting breaches in professional behaviour, which can adversely impact institutional culture. No studies have reported student perspectives on how to address these barriers successfully. Our study (i) evaluated the likelihood of reporting based on violation severity, (ii) assessed barriers to reporting and (iii) elicited students' proposed solutions. METHODS Four medical students designed a cross-sectional study in 2015. In response to seven scenarios, students rated the likelihood of reporting the violation, indicated perceived barriers and identified solutions. Additional questions investigated the perceived importance of professionalism, confidence in understanding professionalism and trust in administrative protection from negative consequences. RESULTS Two hundred and seventy-two students in their clinical years (MS2-4) responded to the survey (RR = 50%). Students were 70-90% likely to report major violations, but < 30% likely to report minor or moderate violations. Barriers included concerns about an uncomfortable relationship (41%), potential negative repercussions on grades or opportunities (23%), and addressing by direct discussion rather than reporting (23%). Solutions included simplified reporting, control over report release date, improved feedback to reporters, training for real-time resolution of concerns and a neutral resource to help students triage concerns. No differences existed between classes regarding the importance or understanding of professionalism. In linear regression, only importance of professionalism predicted likelihood of reporting and this did not change with training. CONCLUSIONS Hindered by common barriers, students are unlikely to report a violation unless it is a serious breach of professionalism. Student-derived solutions should be explored by medical school administrators to encourage reporting of violation of professionalism.
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Affiliation(s)
| | - Joseph M. Armstrong
- Department of Urology, University of Utah School of Medicine, Salt Lake City, UT
| | - Rachel A. Taylor
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA
| | - Diana L. Whitney
- Departments of Medicine and Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Anne C. Gill
- Department of Pediatrics and Center for Medical Ethics, Baylor College of Medicine, Houston, TX
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Ho MJ, Gosselin K, Chandratilake M, Monrouxe LV, Rees CE. Taiwanese medical students' narratives of intercultural professionalism dilemmas: exploring tensions between Western medicine and Taiwanese culture. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2017; 22:429-445. [PMID: 27888427 DOI: 10.1007/s10459-016-9738-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 11/14/2016] [Indexed: 06/06/2023]
Abstract
In an era of globalization, cultural competence is necessary for the provision of quality healthcare. Although this topic has been well explored in non-Western cultures within Western contexts, the authors explore how Taiwanese medical students trained in Western medicine address intercultural professionalism dilemmas related to tensions between Western medicine and Taiwanese culture. A narrative interview method was employed with 64 Taiwanese medical students to collect narratives of professionalism dilemmas. Noting the prominence of culture in students' narratives, we explored this theme further using secondary analysis, identifying tensions between Western medicine and Taiwanese culture and categorizing students' intercultural professionalism dilemmas according to Friedman and Berthoin Antal's 'intercultural competence' framework: involving combinations of advocacy (i.e., championing one's own culture) and inquiry (i.e., exploring one's own and others' cultures). One or more intercultural dilemmas were identified in nearly half of students' professionalism dilemma narratives. Qualitative themes included: family relations, local policy, end-of-life care, traditional medicine, gender relations and Taiwanese language. Of the 62 narratives with sufficient detail for further analysis, the majority demonstrated the 'suboptimal' low advocacy/low inquiry approach (i.e., withdrawal or inaction), while very few demonstrated the 'ideal' high advocacy/high inquiry approach (i.e., generating mutual understanding, so 'intercultural competence'). Though nearly half of students' professionalism narratives concerned intercultural dilemmas, most narratives represented disengagement from intercultural dilemmas, highlighting a possible need for more attention on intercultural competence training in Taiwan. The advocacy/inquiry framework may help educators to address similar disconnects between Western medicine and non-Western cultures in other contexts.
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Affiliation(s)
- Ming-Jung Ho
- Department of Medical Education & Bioethics, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Katherine Gosselin
- Department of Medical Education & Bioethics, National Taiwan University College of Medicine, Taipei, Taiwan
| | | | - Lynn V Monrouxe
- Chang Gung Medical Education Research Center (CG-MERC), Chang Gung Memorial Hospital, Linkou, Chang Gung Medical Foundation, 5. Fu-Hsing St., Kuei Shan Dist., Taoyuan City, 333, Taiwan, ROC.
| | - Charlotte E Rees
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
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AlMahmoud T, Hashim MJ, Elzubeir MA, Branicki F. Ethics teaching in a medical education environment: preferences for diversity of learning and assessment methods. MEDICAL EDUCATION ONLINE 2017; 22:1328257. [PMID: 28562234 PMCID: PMC5508649 DOI: 10.1080/10872981.2017.1328257] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 04/22/2017] [Indexed: 05/31/2023]
Abstract
BACKGROUND Ethics and professionalism are an integral part of medical school curricula; however, medical students' views on these topics have not been assessed in many countries. OBJECTIVE The study aimed to examine medical students' perceptions toward ethics and professionalism teaching, and its learning and assessment methods. DESIGN A self-administered questionnaire eliciting views on professionalism and ethics education was distributed to a total of 128 final-year medical students. RESULTS A total of 108 students completed the survey, with an 84% response rate. Medical students reported frequently encountering ethical conflicts during training but stated only a moderate level of ethics training at medical school (mean = 5.14 ± 1.8). They noted that their education had helped somewhat to deal with ethical conflicts (mean = 5.39 ± 2.0). Students strongly affirmed the importance of ethics education (mean = 7.63 ± 1.03) and endorsed the value of positive role models (mean = 7.45 ± 1.5) as the preferred learning method. The cohort voiced interest in direct faculty supervision as an approach to assessment of knowledge and skills (mean = 7.62 ± 1.26). Female students perceived greater need for more ethics education compared to males (p = < 0.05). Students who claimed that they had experienced some unprofessional treatment had a more limited view of the importance of ethics as a subject (P = 0.001). CONCLUSION Medical students viewed ethics education positively and preferred clinically attuned methods for learning.
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Affiliation(s)
- Tahra AlMahmoud
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - M. Jawad Hashim
- Department of Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Margaret Ann Elzubeir
- Department of Medical Education, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Frank Branicki
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
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Bezuidenhout LM, Morrison M. Between Scylla and Charybdis: reconciling competing data management demands in the life sciences. BMC Med Ethics 2016; 17:29. [PMID: 27184750 PMCID: PMC4869374 DOI: 10.1186/s12910-016-0112-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 05/09/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The widespread sharing of biologicaConcluding Comments: Teaching Responsible Datal and biomedical data is recognised as a key element in facilitating translation of scientific discoveries into novel clinical applications and services. At the same time, twenty-first century states are increasingly concerned that this data could also be used for purposes of bioterrorism. There is thus a tension between the desire to promote the sharing of data, as encapsulated by the Open Data movement, and the desire to prevent this data from 'falling into the wrong hands' as represented by 'dual use' policies. Both frameworks posit a moral duty for life sciences researchers with respect to how they should make their data available. However, Open data and dual use concerns are rarely discussed in concert and their implementation can present scientists with potentially conflicting ethical requirements. DISCUSSION Both dual use and Open data policies frame scientific data and data dissemination in particular, though different, ways. As such they contain implicit models for how data is translated. Both approaches are limited by a focus on abstract conceptions of data and data sharing. This works to impede consensus-building between the two ethical frameworks. As an alternative, this paper proposes that an ethics of responsible management of scientific data should be based on a more nuanced understanding of the everyday data practices of life scientists. Responsibility for these 'micromovements' of data must consider the needs and duties of scientists as individuals and as collectively-organised groups. Researchers in the life sciences are faced with conflicting ethical responsibilities to share data as widely as possible, but prevent it being used for bioterrorist purposes. In order to reconcile the responsibilities posed by the Open Data and dual use frameworks, approaches should focus more on the everyday practices of laboratory scientists and less on abstract conceptions of data.
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Affiliation(s)
- Louise M Bezuidenhout
- Steve Biko Centre for Bioethics, Faculty of Health Sciences, University of the Witwatersrand, Parktown Johannesburg, 2193, South Africa
- Egenis Centre for the Study of the Life Sciences, University of Exeter, Byrne House St German's Road, Exeter, Devon, EX4 4PJ, UK
| | - Michael Morrison
- Centre for Health, Law and Emerging Technologies (HeLEX), Nuffield Department of Population Health, University of Oxford, Ewert House Banbury Road, Oxford, OX2 7DD, UK.
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Abstract
Although ethics is an essential component of undergraduate medical education, research suggests that current medical ethics curricula face considerable challenges in improving students' ethical reasoning. This article discusses these challenges and introduces a promising new mode of graduate and professional ethics instruction for overcoming them. We begin by describing common ethics curricula, focusing in particular on established problems with current approaches. Next, we describe a novel method of ethics education and assessment for medical students that we have devised: the Medical Ethics Bowl (MEB). Finally, we suggest the pedagogical advantages of the MEB when compared to other ethics curricula.
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Giorgini V, Gibson C, Mecca JT, Medeiros KE, Mumford MD, Connelly S, Devenport LD. Differences in Biases and Compensatory Strategies Across Discipline, Rank, and Gender Among University Academics. SCIENCE AND ENGINEERING ETHICS 2015; 21:1551-1579. [PMID: 25479960 PMCID: PMC4458235 DOI: 10.1007/s11948-014-9615-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 11/21/2014] [Indexed: 06/04/2023]
Abstract
The study of ethical behavior and ethical decision making is of increasing importance in many fields, and there is a growing literature addressing the issue. However, research examining differences in ethical decision making across fields and levels of experience is limited. In the present study, biases that undermine ethical decision making and compensatory strategies that may aid ethical decision making were identified in a series of interviews with 63 faculty members across six academic fields (e.g., biological sciences, health sciences, social sciences) and three levels of rank (assistant professor, associate professor, and full professor) as well as across gender. The degree to which certain biases and compensatory strategies were used in justifications for responses to ethical situations was compared across fields, level of experience, and gender. Major differences were found across fields for several biases and compensatory strategies, including biases and compensatory strategies related to use of professional field principles and field-specific guidelines. Furthermore, full professors tend to differ greatly from assistant and associate professors on a number of constructs, and there were differences in the consistency with which biases and compensatory strategies were displayed within these various groups. Implications of these findings for ethics training and future research are discussed.
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Affiliation(s)
- Vincent Giorgini
- University of Oklahoma, 3100 Monitor, Suite 100, Norman, OK, 73072, USA.
- Department of Psychology, University of Oklahoma, Norman, OK, 73019, USA.
| | - Carter Gibson
- University of Oklahoma, 3100 Monitor, Suite 100, Norman, OK, 73072, USA.
| | - Jensen T Mecca
- University of Oklahoma, 3100 Monitor, Suite 100, Norman, OK, 73072, USA.
| | - Kelsey E Medeiros
- University of Oklahoma, 3100 Monitor, Suite 100, Norman, OK, 73072, USA.
| | - Michael D Mumford
- University of Oklahoma, 3100 Monitor, Suite 100, Norman, OK, 73072, USA.
| | - Shane Connelly
- University of Oklahoma, 3100 Monitor, Suite 100, Norman, OK, 73072, USA.
| | - Lynn D Devenport
- University of Oklahoma, 3100 Monitor, Suite 100, Norman, OK, 73072, USA.
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Murgic L, Hébert PC, Sovic S, Pavlekovic G. Paternalism and autonomy: views of patients and providers in a transitional (post-communist) country. BMC Med Ethics 2015; 16:65. [PMID: 26420014 PMCID: PMC4589086 DOI: 10.1186/s12910-015-0059-z] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 09/21/2015] [Indexed: 11/10/2022] Open
Abstract
Background Patient autonomy is a fundamental, yet challenging, principle of professional medical ethics. The idea that individual patients should have the freedom to make choices about their lives, including medical matters, has become increasingly prominent in current literature. However, this has not always been the case, especially in communist countries where paternalistic attitudes have been interwoven into all relationships including medical ones. Patients’ expectations and the role of the doctor in the patient-physician relationship are changing. Croatia, as a transitional country, is currently undergoing this particular process. Methods Qualitative research was conducted by means of six focus group discussions held in the years 2012 and 2013 in Croatia. Focus groups were held separately with each of the following: first year and final (6th) year medical students, physicians engaged in medical ethics education, physicians practicing in a clinical hospital, family medicine residents and individuals representing patients with chronic disease. This research specifically addresses issues related to patient autonomy, in particular, the principles of truth telling, confidentiality, and informed consent. All focus group discussions were audio taped and then transcribed verbatim and systematized according to acknowledged qualitative analysis methods. Results and discussion Patient autonomy is much more than a simple notion defined as the patient’s right to make treatment decisions independently. It has to be understood in context of the broader socio-cultural setting. At present, both patients and medical doctors in Croatia are increasingly appreciating the importance of promoting the principle of autonomy in medical decision-making. However, the current views of medical students, physicians and patients reveal inconsistencies. Conclusions Knowing how to respect the various facets of patients’ autonomy should be part of physician’s professional duties, and also be reflected in his or her core clinical competencies. For this reason greater importance should be dedicated to patient autonomy issues in medical education in Croatia.
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Affiliation(s)
- Lucija Murgic
- Department of Educational Technology, Andrija Stampar School of Public Health, School of Medicine, University of Zagreb, Zagreb, Croatia.
| | - Philip C Hébert
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
| | - Slavica Sovic
- Department of Medical Statistics, Epidemiology and Medical Informatics, Andrija Stampar School of Public Health, School of Medicine, University of Zagreb, Zagreb, Croatia.
| | - Gordana Pavlekovic
- Department for Social Medicine and Organization of Health Care, Andrija Stampar School of Public Health, School of Medicine, University of Zagreb, Zagreb, Croatia.
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Monrouxe LV, Rees CE, Dennis I, Wells SE. Professionalism dilemmas, moral distress and the healthcare student: insights from two online UK-wide questionnaire studies. BMJ Open 2015; 5:e007518. [PMID: 25991457 PMCID: PMC4442195 DOI: 10.1136/bmjopen-2014-007518] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To understand the prevalence of healthcare students' witnessing or participating in something that they think unethical (professionalism dilemmas) during workplace learning and examine whether differences exist in moral distress intensity resulting from these experiences according to gender and the frequency of occurrence. DESIGN Two cross-sectional online questionnaires of UK medical (study 1) and nursing, dentistry, physiotherapy and pharmacy students (study 2) concerning professionalism dilemmas and subsequent distress for (1) Patient dignity and safety breaches; (2) Valid consent for students' learning on patients; and (3) Negative workplace behaviours (eg, student abuse). PARTICIPANTS AND SETTING 2397 medical (67.4% female) and 1399 other healthcare students (81.1% female) responded. MAIN RESULTS The most commonly encountered professionalism dilemmas were: student abuse and patient dignity and safety dilemmas. Multinomial and logistic regression identified significant effects for gender and frequency of occurrence. In both studies, men were more likely to classify themselves as experiencing no distress; women were more likely to classify themselves as distressed. Two distinct patterns concerning frequency were apparent: (1) Habituation (study 1): less distress with increased exposure to dilemmas 'justified' for learning; (2) Disturbance (studies 1 and 2): more distress with increased exposure to dilemmas that could not be justified. CONCLUSIONS Tomorrow's healthcare practitioners learn within a workplace in which they frequently encounter dilemmas resulting in distress. Gender differences could be respondents acting according to gendered expectations (eg, males downplaying distress because they are expected to appear tough). Habituation to dilemmas suggests students might balance patient autonomy and right to dignity with their own needs to learn for future patient benefit. Disturbance contests the 'accepted' notion that students become less empathic over time. Future research might examine the strategies that students use to manage their distress, to understand how this impacts of issues such as burnout and/or leaving the profession.
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Affiliation(s)
- Lynn V Monrouxe
- Institute of Medical Education, Cardiff University, Cardiff, UK
| | - Charlotte E Rees
- Centre for Medical Education, Medical Education Institute, School of Medicine, University of Dundee, Dundee, UK
| | - Ian Dennis
- School of Psychology, Portland Square, Plymouth University, Plymouth, UK
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Miller JE, Camacho‐Soto A, Odonkor CA, Ferker S, Mukherjee D. Ethical Concerns Identified by Physical Medicine and Rehabilitation Residents. PM R 2015; 7:428-34. [DOI: 10.1016/j.pmrj.2015.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 02/18/2015] [Indexed: 10/23/2022]
Affiliation(s)
| | - Alejandra Camacho‐Soto
- Rehabilitation Institute of Chicago & Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Charles Amoatey Odonkor
- Physical Medicine & Rehabilitation, The Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Debjani Mukherjee
- Director, Donnelley Ethics Program, Rehabilitation Institute of Chicago, and Associate Professor, PM&R and Medical Humanities & Bioethics, Northwestern University Feinberg School of Medicine, Chicago, IL 60611
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Jafree SR, Zakar R, Fischer F, Zakar MZ. Ethical violations in the clinical setting: the hidden curriculum learning experience of Pakistani nurses. BMC Med Ethics 2015; 16:16. [PMID: 25888967 PMCID: PMC4369076 DOI: 10.1186/s12910-015-0011-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 03/03/2015] [Indexed: 11/10/2022] Open
Abstract
Background The importance of the hidden curriculum is recognised as a practical training ground for the absorption of medical ethics by healthcare professionals. Pakistan’s healthcare sector is hampered by the exclusion of ethics from medical and nursing education curricula and the absence of monitoring of ethical violations in the clinical setting. Nurses have significant knowledge of the hidden curriculum taught during clinical practice, due to long working hours in the clinic and front-line interaction with patients and other practitioners. Methods The means of inquiry for this study was qualitative, with 20 interviews and four focus group discussions used to identify nurses’ clinical experiences of ethical violations. Content analysis was used to discover sub-categories of ethical violations, as perceived by nurses, within four pre-defined categories of nursing codes of ethics: 1) professional guidelines and integrity, 2) patient informed consent, 3) patient rights, and 4) co-worker coordination for competency, learning and patient safety. Results Ten sub-categories of ethical violations were found: nursing students being used as adjunct staff, nurses having to face frequent violence in the hospital setting, patient reluctance to receive treatment from nurses, the near-absence of consent taken from patients for most non-surgical medical procedures, the absence of patient consent taking for receiving treatment from student nurses, the practice of patient discrimination on the basis of a patient’s socio-demographic status, nurses withdrawing treatment out of fear for their safety, a non-learning culture and, finally, blame-shifting and non-reportage of errors. Conclusion Immediate and urgent attention is required to reduce ethical violations in the healthcare sector in Pakistan through collaborative efforts by the government, the healthcare sector, and ethics regulatory bodies. Also, changes in socio-cultural values in hospital organisation, public awareness of how to conveniently report ethical violations by practitioners and public perceptions of nurse identity are needed.
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Affiliation(s)
- Sara Rizvi Jafree
- Institute of Social and Cultural Studies, University of the Punjab, P.O. Box 54590, Lahore, Pakistan. .,Forman Christian College, Sociology Department, University of the Punjab, 21 FCC Maratib Ali Road, 54000, Gulberg, Lahore, Pakistan.
| | - Rubeena Zakar
- Institute of Social and Cultural Studies, University of the Punjab, P.O. Box 54590, Lahore, Pakistan.
| | - Florian Fischer
- School of Public Health, Department of Public Health Medicine, Bielefeld University, P.O. Box 100 131, 33501, Bielefeld, Germany.
| | - Muhammad Zakria Zakar
- Institute of Social and Cultural Studies, University of the Punjab, P.O. Box 54590, Lahore, Pakistan.
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Bezuidenhout L. Ethics in the minutiae: examining the role of the physical laboratory environment in ethical discourse. SCIENCE AND ENGINEERING ETHICS 2015; 21:51-73. [PMID: 24510311 DOI: 10.1007/s11948-013-9506-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 12/26/2013] [Indexed: 06/03/2023]
Abstract
Responsibility within life science research is a highly scrutinised field. Increasingly, scientists are presented with a range of duties and expectations regarding their conduct within the research setting. In many cases, these duties are presented deontologically, forgoing extensive discussion on how these are practically implemented into the minutiae of daily research practices. This de-contextualized duty has proven problematic when it comes to practical issues of compliance, however it is not often considered as a fundamental aspect of building ethics discourse. This paper examines this issue in detail, particularly focusing on how differences in the contrasts between the ideal and real physical research environments cause conceptual problems for scientists and retard ethical engagement. Such issues are particularly pertinent in low- and middle-income countries. This paper combines theoretical and empirical analyses using the concept of "dual-use" as a focalizing topic. The data show that the research environment acts as an intimate component in the interpretation and implementation of ethical actions.
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Affiliation(s)
- Louise Bezuidenhout
- Department of Sociology, Philosophy and Anthropology, University of Exeter, Exeter, UK,
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Hendelman W, Byszewski A. Formation of medical student professional identity: categorizing lapses of professionalism, and the learning environment. BMC MEDICAL EDUCATION 2014; 14:139. [PMID: 25004924 PMCID: PMC4102062 DOI: 10.1186/1472-6920-14-139] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 07/03/2014] [Indexed: 05/13/2023]
Abstract
BACKGROUND Acquiring the values of medical professionalism has become a critical issue in medical education. The purpose of this study was to identify lapses in professionalism witnessed by medical students during their four year MD curriculum, and to categorize, from the students' perspective, who was responsible and the settings in which these occurred. METHODS An electronic survey, developed by faculty and medical students, was sent to all students with two email reminders. It included quantitative responses and some open-ended opportunities for comments. All analyses were performed with SAS version 9.1. RESULTS The response rate was 45.6% (255 of 559 students) for all four years of the medical school curriculum. Thirty six percent of students had witnessed or been part of an exemplary demonstration of professionalism; 64% responded that they had witnessed a lapse of professionalism. At the pre-clerkship level, the most frequent lapses involved students: arrogance (42.2%), impairment (24.2%), followed by cultural or religious insensitivity (20.5%). At the clerkship level of training, where students are exposed to real clinical situations, the lapses involved primarily faculty (including preceptor and clinician) or other staff; these included arrogance (55.3%), breach of confidentiality (28.3%), and cultural or religious insensitivity (26.6%); impairment involved mostly students (25.5%). These findings are analyzed from the perspective of role modeling by faculty and in the context of the learning environment. CONCLUSIONS Medical students witnessed a lapse of professionalism involving both fellow students as well as faculty and administrative staff, in several domains. Results from this study emphasize the importance of role modeling and the need for faculty development, to improve the learning environment. This study adds to the limited emerging literature on the forces that influence medical student professional identity formation.
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Affiliation(s)
- Walter Hendelman
- Department of Cellular & Molecular Medicine, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5, Canada
| | - Anna Byszewski
- Professor of Medicine, Director of Professionalism, undergraduate curriculum, Faculty of Medicine, University of Ottawa, Division of Geriatrics, The Ottawa Hospital, Affiliate Investigator, Ottawa Hospital Research Institute (OHRI), Ottawa, Canada
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Spike JP. Teaching white-coat ethics to clerks: the long and short of it. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2014; 89:961. [PMID: 24979160 DOI: 10.1097/acm.0000000000000298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Jeffrey P Spike
- Samuel Karff Professor, John McGovern Center for Humanities and Ethics, UT-Health, Houston, Texas;
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Rees CE, Monrouxe LV, McDonald LA. 'My mentor kicked a dying woman's bed…' analysing UK nursing students' 'most memorable' professionalism dilemmas. J Adv Nurs 2014; 71:169-80. [PMID: 24916272 DOI: 10.1111/jan.12457] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2014] [Indexed: 12/01/2022]
Abstract
AIM To provide depth and breadth in the analysis of nursing students' written narratives of 'most memorable' professionalism dilemmas. BACKGROUND While nursing students are taught professionalism through formal curricula, they commonly experience workplace-based professionalism dilemmas. Although non-UK studies have begun to explore students' lived experiences of dilemmas, they lack detail about when and where dilemmas occur, who is involved, what students do and why and how students feel. DESIGN Online survey of healthcare students including 294 nursing students from 15 UK nursing schools. METHOD Nursing students provided a written narrative of their most memorable dilemma (December 2011-March 2012) as part of a survey examining the impact of professionalism dilemmas on moral distress. We conducted thematic and discourse analysis of all narratives and narrative analysis of one exemplar. FINDINGS The most common themes were patient care dilemmas by healthcare personnel or students, student abuse and consent dilemmas. Of the dilemmas, 49·6% occurred over 6 months previously, 76·2% occurred in hospitals and 51·9% of perpetrators were nurses. 79·3% of students reported acting in the face of their dilemma. Of the narratives, 88·4% contained negative emotion talk and numerous significant relationships existed between types of emotion talk and dilemmas. Our narrative analysis demonstrates the impact of dilemma experiences through emotion talk and more subtle devices like metaphor. CONCLUSION Findings extend previous research with nursing and medical students. Nurse educators should help students construct emotionally coherent narratives to make sense of their experiences, actions and identities and to better prepare them for future professionalism dilemmas.
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Affiliation(s)
- Charlotte E Rees
- Education Research/Centre for Medical Education, College of Medicine, Dentistry and Nursing, University of Dundee, Scotland, UK
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Gaufberg E, Hirsh D, Krupat E, Ogur B, Pelletier S, Reiff D, Bor D. Into the future: patient-centredness endures in longitudinal integrated clerkship graduates. MEDICAL EDUCATION 2014; 48:572-82. [PMID: 24713035 DOI: 10.1111/medu.12413] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 11/05/2013] [Accepted: 11/29/2013] [Indexed: 05/13/2023]
Abstract
OBJECTIVES This study was intended to determine if previously identified educational benefits of the Harvard Medical School (HMS) Cambridge Integrated Clerkship (CIC) endure over time. METHODS The authors' earlier work compared the 27 graduates in the first three cohorts of students undertaking the CIC with a comparison group of 45 traditionally trained HMS students; CIC graduates emerged from their clerkship year with a higher degree of patient-centredness and felt more prepared to deal with numerous domains of patient care. Between April and July 2011, at 4-6 years post-clerkship, the authors asked these original study cohorts to complete an electronic survey which included measures used in the original study. The authors also reviewed data from the National Residency Match Program to compare career paths in the two groups. RESULTS The response rate was 62% (42/68). The immediate post-clerkship finding that CIC students held more patient-centred attitudes was sustained over time (p < 0.035). Reflecting retrospectively on their clerkship experiences, CIC graduates continued to report that their clerkship year had better prepared them in a wide variety of domains. Graduates of the CIC attained awards and published papers at the same rates as peers, and were more likely to engage in health advocacy work. Both groups chose a wide range of residency programmes. Among those expressing a preference, no CIC graduates said they would choose a traditional clerkship, but 6 (27%) of the traditionally trained graduates said they would choose a longitudinal integrated clerkship. CONCLUSIONS This paper indicates that benefits of longitudinal integrated clerkship training are sustained over time across multiple domains.
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Affiliation(s)
- Elizabeth Gaufberg
- Harvard Medical School, Boston, Massachusetts, USA; Cambridge Health Alliance, Cambridge, Massachusetts, USA
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Monrouxe LV, Rees CE, Endacott R, Ternan E. 'Even now it makes me angry': health care students' professionalism dilemma narratives. MEDICAL EDUCATION 2014; 48:502-17. [PMID: 24712935 DOI: 10.1111/medu.12377] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Revised: 04/22/2013] [Accepted: 09/06/2013] [Indexed: 05/21/2023]
Abstract
CONTEXT Medical students encounter situations during workplace learning in which they witness or participate in something unprofessional (so-called professionalism dilemmas), sometimes having a negative emotional impact on them. Less is known about other health care students' experiences of professionalism dilemmas and the resulting emotional impact. OBJECTIVES To examine dental, nursing, pharmacy and physiotherapy students' narratives of professionalism dilemmas: the types of events they encounter ('whats') and the ways in which they narrate those events ('hows'). METHODS A qualitative cross-sectional study. Sixty-nine health care students (29 dentistry, 13 nursing, 12 pharmacy, 15 physiotherapy) participated in group/individual narrative interviews. Data were analysed using framework analysis (examining the 'whats'), linguistic inquiry and word count software (examining the 'hows' by dilemma type and student group) and narrative analysis (bringing together 'whats' and 'hows'). RESULTS In total, 226 personal incident narratives (104 dental, 34 nursing, 39 pharmacy and 49 physiotherapy) were coded. Framework analysis identified nine themes, including 'Theme 2: professionalism dilemmas', comprising five sub-themes: 'student abuse', 'patient safety and dignity breaches by health care professionals', 'patient safety and dignity breaches by students', 'whistleblowing and challenging' and 'consent'. Using Linguistic Inquiry and Word Count (liwc) software, significant differences in negative emotion talk were found across student groups and dilemma types (e.g. more anger talk when narrating patient safety and dignity breaches by health care professionals than similar breaches by students). The narrative analysis illustrates how events are constructed and the emotional implications of assigning blame (an ethical dimension) resulting in emotional residue. CONCLUSION Professionalism dilemmas experienced by health care students, including issues concerning whistleblowing and challenging, have implications for interprofessional learning. By focusing on common professionalism issues at a conceptual level, health care students can share experiences through narratives. The role-playing of idealised actions (how students wish they had acted) can facilitate synergy between personal moral values and moral action enabling students to commit and re-commit to professionalism values together.
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Desalegn AA, Berhan A. Cheating on examinations and its predictors among undergraduate students at Hawassa University College of Medicine and Health Science, Hawassa, Ethiopia. BMC MEDICAL EDUCATION 2014; 14:89. [PMID: 24885973 PMCID: PMC4023498 DOI: 10.1186/1472-6920-14-89] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 04/25/2014] [Indexed: 05/28/2023]
Abstract
BACKGROUND Cheating on examinations in academic institutions is a worldwide issue. When cheating occurs in medical schools, it has serious consequences for human life, social values, and the economy. This study was conducted to determine the prevalence of cheating and identify factors that influence cheating among students of Hawassa University College of medicine and health science. METHODS A cross sectional study was conducted from May through June 2013. A pre-tested self-administered, structured questionnaire was used to collect self-reported data regarding cheating. Data were entered and analyzed using SPSS version 20. Descriptive statistics were used for data summarization and presentation. Degree of association was measured by Chi Square test, with significance level set at p = 0.05. Bivariate and multivariate logistic regression analyses were used to assess associations. RESULTS The prevalence of self-reported cheating was found to be 19.8% (95% CI = 17.4-21.9). About 12.1% (95% CI = 10.2-13.9) of students disclosed cheating on the entrance examination. The majority of students (80.1% (95% CI = 77.9-82.3) disclosed that they would not report cheating to invigilators even if they had witnessed cheating. Analysis by multiple regression models showed that students who cheated in high school were more likely to cheat (adjusted OR = 1. 80, 95% CI = 1. 01-3.19) and that cheating was less likely among students who didn't cheat on entrance examinations (adjusted OR = 0. 25, 95% CI = 0. 14-0.45). Dining outside the university cafeteria and receiving pocket money of Birr 300 or more were strongly associated with cheating (adjusted OR = 3.08, 95% CI = 1.54-6.16 and adjusted OR = 1.69 (95% CI = 1.05-2.72), respectively. The odds of cheating among students were significantly higher for those who went to private high school, were substance users, and didn't attend lectures than for those who attended government schools, were not substance abusers, and attended lectures. CONCLUSION Our findings have important implications for development of an institution's policies on academic integrity. By extension, they affect the policies of high schools. Increased levels of supervision during entrance examination, mandated attendance at lectures, and reduction of substance use are likely to reduce cheating. No significant association was found with background, level of parental education, grade point average, and interest in field of study.
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Affiliation(s)
| | - Asres Berhan
- Pharmacology Unit, School of Medicine, Hawassa University, Hawassa, P.O Box-1560, Ethiopia
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Dell EM, Varpio L, Petrosoniak A, Gajaria A, McCarthy AE. The ethics and safety of medical student global health electives. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2014; 5:63-72. [PMID: 25341214 PMCID: PMC4207171 DOI: 10.5116/ijme.5334.8051] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 03/27/2014] [Indexed: 05/04/2023]
Abstract
OBJECTIVE To explore and characterize the ethical and safety challenges of global health experiences as they affect medical students in order to better prepare trainees to face them. METHODS Semi-structured interviews were conducted with 23 Canadian medical trainees who had participated in global health experiences during medical school. Convenience and snowball sampling were utilized. Using Moustakas's transcendental phenomenological approach, participant descriptions of ethical dilemmas and patient/trainee safety problems were analyzed. This generated an aggregate that illustrates the essential meanings of global health experience ethical and safety issues faced. RESULTS We interviewed 23 participants who had completed 38 electives (71%, n=27, during pre-clinical years) spending a mean 6.9 weeks abroad, and having visited 23 countries. Sixty percent (n=23) had pre-departure training while 36% (n=14) had post-experience debriefing. Three macro-level themes were identified: resource disparities and provision of care; navigating clinical ethical dilemmas; and threats to trainee safety. CONCLUSIONS Medical schools have a responsibility to ensure ethical and safe global health experiences. However, our findings suggest that medical students are often poorly prepared for the ethical and safety dilemmas they encounter during these electives. Medical students require intensive pre-departure training that will prepare them emotionally to deal with these dilemmas. Such training should include discussions of how to comply with clinical limitations.
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Affiliation(s)
- Evelyn M. Dell
- Department of Medicine, Emergency Medicine, University of Toronto, Toronto, Canada
| | - Lara Varpio
- Department of Medicine, University of Ottawa, Academy for Innovation of Medical Education, Canada
| | - Andrew Petrosoniak
- Department of Medicine, Emergency Medicine, University of Toronto, Toronto, Canada
| | - Amy Gajaria
- Department of Medicine, Psychiatry, University of Toronto, Canada
| | - Anne E. McCarthy
- Department of Medicine, Infectious Disease/Global Health, University of Ottawa, Canada
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Vivekananda-Schmidt P, Vernon B. FY1 doctors' ethicolegal challenges in their first year of clinical practice: an interview study. JOURNAL OF MEDICAL ETHICS 2014; 40:277-281. [PMID: 23538330 DOI: 10.1136/medethics-2011-100391] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND There is little evidence of junior trainee perspectives in the design and implementation of medical ethics and law (MEL) curriculum in UK medical schools. AIM To determine the ethical issues the foundation year 1 (FY1) doctors (first year after graduation) encountered during clinical practice and the skills and knowledge of MEL, which were useful in informing MEL curriculum development. METHOD The National Research Ethics Service gave ethical approval. Eighteen one-to-one interviews were conducted in each school with FY1 doctors. ANALYSIS Interviews were recorded and transcribed verbatim; a thematic analysis was undertaken with the transcriptions and saturation of themes was achieved. KEY FINDINGS Themes closely overlapped between the two study sites. (1) Knowing my place as an FY1 (this theme consisted of four subthemes: challenging the hierarchy, being honest when the team is titrating the truth, taking consent for unfamiliar procedures and personal safety vs competing considerations); (2) Do not attempt resuscitation)/end-of-life pathway and its implications; (3) 'You have to be there' (contextualising ethics and law teaching through cases or role plays to allow students to explore future work situations); and (4) advanced interpersonal skills competency for ethical clinical practice. CONCLUSIONS The data provide a snapshot of the real challenges faced by MEL FY1 doctors in early clinical practice: they may feel ill-prepared and sometimes unsupported by senior members of the team. The key themes suggest areas for development of undergraduate and postgraduate MEL curricula. We will work to develop our own curriculum accordingly. We intend to further investigate the applicability of our findings to UK medical ethics and law curriculum.
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Kulac E, Sezik M, Asci H, Doguc DK. Medical students' participation in and perception of unprofessional behaviors: comparison of preclinical and clinical phases. ADVANCES IN PHYSIOLOGY EDUCATION 2013; 37:298-302. [PMID: 24292905 DOI: 10.1152/advan.00076.2013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We aimed to compare reported observations, participation in, and perceptions of unprofessional behaviors across preclinical and clinical medical students using a 23-item questionnaire that asked participants whether they witnessed or participated in the behavior and considered it unprofessional. Overall, 111 preclinical (year 3) and 104 clinical (year 4) students responded. For all of the behaviors, significant positive correlations were present between participation and affirmative perceptions. Participation rates for several unprofessional behaviors (14 of 23 items) were higher in the clinical phase. Clinical students more frequently perceived unprofessional behaviors as appropriate (17 of 23 items) compared with preclinical students. In conclusion, both preclinical and clinical medical students in our setting commonly witness unprofessional behaviors. Clinical students participate in and tend to rationalize these behaviors more frequently than preclinical students do.
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Affiliation(s)
- Esin Kulac
- Department of Medical Education and Informatics, Suleyman Demirel University School of Medicine, Isparta, Turkey
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Myers MF, Herb A. Ethical dilemmas in clerkship rotations. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2013; 88:1609-1611. [PMID: 24072128 DOI: 10.1097/acm.0b013e3182a7f919] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
A sound clinical education should include the opportunity for medical students to engage in a spirited and informed discussion with faculty about the ethical challenges they will undoubtedly face. Unfortunately, in many medical schools today this goal is thwarted by many factors, including denial that a problem exists, relentless system overload, unprofessional behavior, breakdown in communication, and inertia. What is worse is that this problem is not new, and the fallout is not insignificant. Another potential contributing factor is burnout, which is well documented in a high percentage of medical students, residents, and faculty, and two of its most serious consequences are patient dissatisfaction and medical error.The authors draw on hundreds of student reflections on ethical dilemmas submitted during classroom exercises to examine persistent themes. They posit that classroom and didactic teaching is not enough to enable students to face ethical dilemmas. The authors call for a major culture change in medical education: "buy in" from top administration, especially the dean (and associate/assistant deans), chairs of all departments, and clerkship and residency training directors; the appointing of an ombudsperson and/or ethicist to oversee and resolve issues as they arise; instructional workshops and materials to enhance and impart skills for all teachers; remediation or retiring of errant faculty; and ongoing research and dialogue between and among medical centers about novel solutions.
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Affiliation(s)
- Michael F Myers
- Dr. Myers is professor of clinical psychiatry, immediate past vice chair of education, and program director, Department of Psychiatry, and medical student ombudsman, SUNY Downstate Medical Center College of Medicine, Brooklyn, New York. Ms. Herb is clinical professor, Departments of OB/GYN and Family Practice, SUNY Downstate Medical Center College of Medicine, Brooklyn, New York
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Hirsh D, Worley P. Better learning, better doctors, better community: how transforming clinical education can help repair society. MEDICAL EDUCATION 2013; 47:942-9. [PMID: 23931543 DOI: 10.1111/medu.12278] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- David Hirsh
- Department of Internal Medicine, Cambridge Health Alliance, Harvard Medical School, 1493 CambridgeStreet, Cambridge, MA 02139, USA.
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Rees CE, Monrouxe LV, McDonald LA. Narrative, emotion and action: analysing 'most memorable' professionalism dilemmas. MEDICAL EDUCATION 2013; 47:80-96. [PMID: 23278828 DOI: 10.1111/j.1365-2923.2012.04302.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVES Although previous studies have explored medical learners''most memorable' experiences, these have typically focused on patient deaths or mistakes. Drawing on multiple theoretical perspectives to understand the interplay between narrative, emotion and action, this paper aims to explore the whats and hows of written narratives of most memorable professionalism dilemmas: what types of dilemma are most memorable? When and where do they take place? How do students act? What characteristics relate to these dilemmas? How are dilemmas narrated? METHODS A total of 680 students from 29 of 32 UK medical schools provided a written narrative of their most memorable dilemma as part of their responses to an online questionnaire exploring the impact of professionalism dilemmas on moral distress. We employed quantitative thematic and discourse analysis of all narratives using Linguistic Inquiry Word Count software (LIWC) and conducted a narrative analysis of one exemplar. RESULTS The most common themes across all narratives concerned dilemmas that related to issues of patient care with reference to the actions of health care professionals or students, student abuse, and consent and intimate examination. A total of 41.1% of experiences had occurred over 6 months previously and 80.1% had taken place in hospital settings. Overall, 54.9% of narrators reported having done something in the face of their dilemma, although only 13.2% described taking obvious or direct action. Numerous characteristics were related to most memorable dilemmas (e.g. narratives citing intimate examinations were more likely to take place in surgical settings). A total of 92.6% of narratives included negative emotion talk and numerous significant relationships emerged between types of emotion talk and most memorable dilemmas (e.g. more anger talk in abuse narratives). Our narrative analysis of one exemplar illustrates the richness of emotion talk and more subtle devices to establish emotional tone. DISCUSSION Findings extend previous research into issues related to professionalism by exploring relationships between narrative, emotion and action in the context of written narratives of most memorable dilemmas. We encourage medical educators to help students construct coherent and emotionally integrated narratives to make sense of negative professionalism dilemmas.
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Affiliation(s)
- Charlotte E Rees
- Medical Education Institute, School of Medicine, University of Dundee, Dundee, UK.
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