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Kalevor S, Uveges MK, Meyer EC. Using Everyday Ethics to Address Bias and Racism in Clinical Care. AACN Adv Crit Care 2022; 33:111-118. [PMID: 35259217 DOI: 10.4037/aacnacc2022566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Shika Kalevor
- Shika Kalevor is a Fellow at the Bioethics Center at Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO 64108
| | - Melissa Kurtz Uveges
- Melissa Kurtz Uveges is Assistant Professor, Boston College William F. Connell School of Nursing, Boston, Massachusetts
| | - Elaine C Meyer
- Elaine C. Meyer is Senior Attending Psychologist, Boston Children's Hospital, and Associate Professor of Psychology, Harvard Medical School Center for Bioethics, Boston, Massachusetts
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2
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Schnall JA, Drewett G, Heynemann S, McDougall R, Ko D. Junior doctors voice strong desire for clinical ethics teaching. Intern Med J 2022; 52:160-161. [DOI: 10.1111/imj.15618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/11/2021] [Indexed: 11/30/2022]
Affiliation(s)
| | - George Drewett
- Department of Infectious Diseases Austin Hospital Melbourne Victoria Australia
| | - Sarah Heynemann
- Department of Medical Oncology Chris O'Brien Lifehouse Sydney New South Wales Australia
| | - Rosalind McDougall
- Melbourne School of Population and Global Health University of Melbourne Melbourne Victoria Australia
| | - Danielle Ko
- Department of Palliative Care Austin Hospital Melbourne Victoria Australia
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3
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Hong DZ, Goh JL, Ong ZY, Ting JJQ, Wong MK, Wu J, Tan XH, Toh RQE, Chiang CLL, Ng CWH, Ng JCK, Ong YT, Cheong CWS, Tay KT, Tan LHS, Phua GLG, Fong W, Wijaya L, Neo SHS, Lee ASI, Chiam M, Chin AMC, Krishna LKR. Postgraduate ethics training programs: a systematic scoping review. BMC MEDICAL EDUCATION 2021; 21:338. [PMID: 34107935 PMCID: PMC8188952 DOI: 10.1186/s12909-021-02644-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 03/30/2021] [Indexed: 05/17/2023]
Abstract
BACKGROUND Molding competent clinicians capable of applying ethics principles in their practice is a challenging task, compounded by wide variations in the teaching and assessment of ethics in the postgraduate setting. Despite these differences, ethics training programs should recognise that the transition from medical students to healthcare professionals entails a longitudinal process where ethics knowledge, skills and identity continue to build and deepen over time with clinical exposure. A systematic scoping review is proposed to analyse current postgraduate medical ethics training and assessment programs in peer-reviewed literature to guide the development of a local physician training curriculum. METHODS With a constructivist perspective and relativist lens, this systematic scoping review on postgraduate medical ethics training and assessment will adopt the Systematic Evidence Based Approach (SEBA) to create a transparent and reproducible review. RESULTS The first search involving the teaching of ethics yielded 7669 abstracts with 573 full text articles evaluated and 66 articles included. The second search involving the assessment of ethics identified 9919 abstracts with 333 full text articles reviewed and 29 articles included. The themes identified from the two searches were the goals and objectives, content, pedagogy, enabling and limiting factors of teaching ethics and assessment modalities used. Despite inherent disparities in ethics training programs, they provide a platform for learners to apply knowledge, translating it to skill and eventually becoming part of the identity of the learner. Illustrating the longitudinal nature of ethics training, the spiral curriculum seamlessly integrates and fortifies prevailing ethical knowledge acquired in medical school with the layering of new specialty, clinical and research specific content in professional practice. Various assessment methods are employed with special mention of portfolios as a longitudinal assessment modality that showcase the impact of ethics training on the development of professional identity formation (PIF). CONCLUSIONS Our systematic scoping review has elicited key learning points in the teaching and assessment of ethics in the postgraduate setting. However, more research needs to be done on establishing Entrustable Professional Activities (EPA)s in ethics, with further exploration of the use of portfolios and key factors influencing its design, implementation and assessment of PIF and micro-credentialling in ethics practice.
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Affiliation(s)
- Daniel Zhihao Hong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228 Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Jia Ling Goh
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228 Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Zhi Yang Ong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228 Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Jacquelin Jia Qi Ting
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228 Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Mun Kit Wong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228 Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Jiaxuan Wu
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228 Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Xiu Hui Tan
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228 Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Rachelle Qi En Toh
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228 Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Christine Li Ling Chiang
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228 Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Caleb Wei Hao Ng
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228 Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Jared Chuan Kai Ng
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228 Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Yun Ting Ong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228 Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Clarissa Wei Shuen Cheong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228 Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Kuang Teck Tay
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228 Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Laura Hui Shuen Tan
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228 Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Gillian Li Gek Phua
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857 Singapore
| | - Warren Fong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228 Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857 Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, 16 College Road, Block 6 Level 9, Singapore General Hospital, Singapore, 169854 Singapore
| | - Limin Wijaya
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857 Singapore
- Department of Infectious Diseases, Singapore General Hospital, Outram Road, Singapore, 169608 Singapore
| | - Shirlyn Hui Shan Neo
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Alexia Sze Inn Lee
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Annelissa Mien Chew Chin
- Medical Library, National University of Singapore Libraries, Blk MD6, Centre, 14 Medical Dr, #05-01 for Translational Medicine, Singapore, 117599 Singapore
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228 Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
- Palliative Care Institute Liverpool, Cancer Research Centre, University of Liverpool, 200 London Rd, L3 9TA Liverpool, UK
- Centre of Biomedical Ethics, National University of Singapore, 21 Lower Kent Ridge Rd, Singapore, 119077 Singapore
- PalC, The Palliative Care Centre for Excellence in Research and Education, PalC c/o Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436 Singapore
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Kretz AM, deSante-Bertkau JE, Boland MV, Guo X, Collins ME. Teaching Ethics and Professionalism: A National Survey of Ophthalmology Residency Program Directors. JOURNAL OF ACADEMIC OPHTHALMOLOGY 2021. [DOI: 10.1055/s-0040-1722741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Abstract
Background While ethics and professionalism are important components of graduate medical education, there is limited data about how ethics and professionalism curricula are taught or assessed in ophthalmology residency programs.
Objective This study aimed to determine how U.S. ophthalmology residency programs teach and assess ethics and professionalism and explore trainee preparedness in these areas.
Methods Directors from accredited U.S. ophthalmology residency programs completed an online survey about components of programs' ethics and professionalism teaching curricula, strategies for assessing competence, and trainee preparedness in these areas.
Results Directors from 55 of 116 programs (46%) responded. The most common ethics and professionalism topics taught were informed consent (38/49, 78%) and risk management and litigation (38/49, 78%), respectively; most programs assessed trainee competence via 360-degree global evaluation (36/48, 75%). While most (46/48, 95%) respondents reported that their trainees were well or very well prepared at the time of graduation, 15 of 48 (31%) had prohibited a trainee from graduating or required remediation prior to graduation due to unethical or unprofessional conduct. Nearly every program (37/48, 98%) thought that it was very important to dedicate curricular time to teaching ethics and professionalism. Overall, 16 of 48 respondents (33%) felt that the time spent teaching these topics was too little.
Conclusion Ophthalmology residency program directors recognized the importance of an ethics and professionalism curriculum. However, there was marked variation in teaching and assessment methods. Additional work is necessary to identify optimal strategies for teaching and assessing competence in these areas. In addition, a substantial number of trainees were prohibited from graduating or required remediation due to ethics and professionalism issues, suggesting an impact of unethical and unprofessional behavior on resident attrition.
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Affiliation(s)
- Alyssa M. Kretz
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jennifer E. deSante-Bertkau
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Michael V. Boland
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Xinxing Guo
- Dana Center for Preventive Ophthalmology at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Megan E. Collins
- Dana Center for Preventive Ophthalmology at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland
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Skelly K, Rosenbaum M, Barlow P, Priebe G. Comparing resident-patient encounters and case presentations in a family medicine clinic. MEDICAL EDUCATION 2019; 53:677-686. [PMID: 30761598 PMCID: PMC6570533 DOI: 10.1111/medu.13806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 10/11/2018] [Accepted: 12/07/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Oral case presentations following resident-patient interactions provide the primary mechanism by which faculty supervisors assess resident competence. However, the extent to which these presentations capture the content and quality of resident-patient communication during the encounter remains unknown. We aimed to determine whether: (i) the resident-patient encounter content matched information conveyed in the case presentation; (ii) the quality of resident-patient communication was accurately conveyed, and (iii) supervisors addressed effective and ineffective communication processes. METHODS A total of 22 pairs of resident-patient encounters and family medicine resident case presentations were video- or audiorecorded, transcribed and compared for content. Resident-patient communication was assessed using adapted versions of the Calgary-Cambridge Guide to the Medical Interview and Explanation and Planning Scale. RESULTS Interviews and presentations contained largely congruent content, but social history and the patient's perspective were consistently excluded from case presentations. Although six of 19 specific communication skills were used in over 80% of resident encounters, the effective use of communication skills was widely variable. In most presentations, the quality of resident-patient communication was not explicitly conveyed to the supervisor. Although resident presentations provided 'cues' about communication issues, supervisors rarely responded. CONCLUSIONS This study lends support to direct observation in workplace-based learning of communication skills. When content areas such as the patient's perspective and education are excluded, supervisors cannot address them. In addition, presentations provided minimal insight about the quality of resident-patient encounters and limited the ability to address communication skills. These skills could be enhanced by attending to communication cues during case presentations, making increased use of direct observation and feedback, and promoting faculty development to address these missed teaching opportunities.
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Affiliation(s)
- Kelly Skelly
- Department of Family Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Marcy Rosenbaum
- Department of Family Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Patrick Barlow
- Department of Family Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Garrick Priebe
- Department of Family Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
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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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Dong H, Sherer R, Lio J, Jiang I, Cooper B. Twelve tips for using clinical cases to teach medical ethics. MEDICAL TEACHER 2018; 40:633-638. [PMID: 29058565 DOI: 10.1080/0142159x.2017.1390218] [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
The essential role of clinical case discussions in the teaching of medical ethics is well recognized. Based upon published literature and the authors' curricular development experience, the following 12 tips cover all major aspects of the case method for teaching clinical ethics and offer practical suggestions for designing and conducting case discussions.
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Affiliation(s)
- Hongmei Dong
- a Department of Medicine , University of Chicago , Chicago , IL , USA
| | - Renslow Sherer
- a Department of Medicine , University of Chicago , Chicago , IL , USA
| | - Jon Lio
- a Department of Medicine , University of Chicago , Chicago , IL , USA
| | - Ivy Jiang
- a Department of Medicine , University of Chicago , Chicago , IL , USA
| | - Brian Cooper
- a Department of Medicine , University of Chicago , Chicago , IL , USA
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8
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Fanous A, Rappaport J, Young M, Park YS, Manoukian J, Nguyen LHP. A longitudinal simulation-based ethical-legal curriculum for otolaryngology residents. Laryngoscope 2017; 127:2501-2509. [DOI: 10.1002/lary.26551] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 12/30/2016] [Accepted: 01/30/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Amanda Fanous
- Department of Otolaryngology-Head and Neck Surgery; McGill University; Montreal Quebec Canada
| | - Jamie Rappaport
- Department of Otolaryngology-Head and Neck Surgery; McGill University; Montreal Quebec Canada
| | - Meredith Young
- Center for Medical Education; McGill University; Montreal Quebec Canada
- Department of Medicine; McGill University; Montreal Quebec Canada
| | - Yoon Soo Park
- Department of Medical Education; University of Illinois, Chicago; Chicago Illinois U.S.A
| | - John Manoukian
- Department of Otolaryngology-Head and Neck Surgery; McGill University; Montreal Quebec Canada
| | - Lily H. P. Nguyen
- Department of Otolaryngology-Head and Neck Surgery; McGill University; Montreal Quebec Canada
- Center for Medical Education; McGill University; Montreal Quebec Canada
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Yoo SH, Joo YS, Lee SH. Graduate and postgraduate medical ethics education. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2017. [DOI: 10.5124/jkma.2017.60.1.24] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Sang Ho Yoo
- Department of Medical Humanities and Ethics, Hanyang University College of Medicine, Seoul, Korea
| | - Young Sook Joo
- Central Ethics Committee, Korean Medical Association, Seoul, Korea
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Zizzo N, Bell E, Racine E. What are the focal points in bioethics literature? Examining the discussions about everyday ethics in Parkinson’s disease. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/1477750916672400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Natalie Zizzo
- Neuroethics Research Unit, Institut de recherches cliniques de Montréal, Quebec, Canada
- Division of Experimental Medicine and Biomedical Ethics Unit, McGill University, Quebec, Canada
| | - Emily Bell
- Neuroethics Research Unit, Institut de recherches cliniques de Montréal, Quebec, Canada
- Department of Neurology and Neurosurgery, McGill University, Quebec, Canada
| | - Eric Racine
- Neuroethics Research Unit, Institut de recherches cliniques de Montréal, Quebec, Canada
- Division of Experimental Medicine and Biomedical Ethics Unit, McGill University, Quebec, Canada
- Department of Neurology and Neurosurgery, McGill University, Quebec, Canada
- Department of Medicine and Department of Social and Preventive Medicine, Université de Montréal, Quebec, Canada
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Zizzo N, Bell E, Racine E. What Is Everyday Ethics? A Review and a Proposal for an Integrative Concept. THE JOURNAL OF CLINICAL ETHICS 2016. [DOI: 10.1086/jce2016272117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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12
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Doukas DJ, Kirch DG, Brigham TP, Barzansky BM, Wear S, Carrese JA, Fins JJ, Lederer SE. Transforming educational accountability in medical ethics and humanities education toward professionalism. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2015; 90:738-43. [PMID: 25539516 DOI: 10.1097/acm.0000000000000616] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Effectively developing professionalism requires a programmatic view on how medical ethics and humanities should be incorporated into an educational continuum that begins in premedical studies, stretches across medical school and residency, and is sustained throughout one's practice. The Project to Rebalance and Integrate Medical Education National Conference on Medical Ethics and Humanities in Medical Education (May 2012) invited representatives from the three major medical education and accreditation organizations to engage with an expert panel of nationally known medical educators in ethics, history, literature, and the visual arts. This article, based on the views of these representatives and their respondents, offers a future-tense account of how professionalism can be incorporated into medical education.The themes that are emphasized herein include the need to respond to four issues. The first theme highlights how ethics and humanities can provide a response to the dissonance that occurs in current health care delivery. The second theme focuses on how to facilitate preprofessional readiness for applicants through reform of the medical school admission process. The third theme emphasizes the importance of integrating ethics and humanities into the medical school administrative structure. The fourth theme underscores how outcomes-based assessment should reflect developmental milestones for professional attributes and conduct. The participants emphasized that ethics and humanities-based knowledge, skills, and conduct that promote professionalism should be taught with accountability, flexibility, and the premise that all these traits are essential to the formation of a modern professional physician.
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Affiliation(s)
- David J Doukas
- D.J. Doukas is William Ray Moore Endowed Chair of Family Medicine and Medical Humanism and director, Division of Medical Humanism and Ethics, Department of Family and Geriatric Medicine, University of Louisville, Louisville, Kentucky. D.G. Kirch is president and chief executive officer, Association of American Medical Colleges, Washington, DC. T.P. Brigham is chief of staff and senior vice president, Department of Education, Accreditation Council for Graduate Medical Education, Chicago, Illinois. B.M. Barzansky is director, Division of Undergraduate Medical Education, American Medical Association, Chicago, Illinois, and cosecretary, Liaison Committee on Medical Education, Chicago, Illinois. S. Wear is codirector, Center for Clinical Ethics and Humanities in Healthcare, and associate professor, Departments of Medicine, Gynecology-Obstetrics, and Philosophy, University at Buffalo, Buffalo, New York. J.A. Carrese is a core faculty member, Johns Hopkins Berman Institute of Bioethics, and professor of medicine, Johns Hopkins University, Baltimore, Maryland. J.J. Fins is E. William Davis, Jr. MD Professor of Medical Ethics and director, Medical Ethics, New York-Presbyterian Weill Cornell Medical Center, New York, New York. S.E. Lederer is Robert Turell Professor of Medical History and Bioethics and chair, Medical History and Bioethics, University of Wisconsin, Madison, Wisconsin
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Moral distress in medical education and training. J Gen Intern Med 2014; 29:395-8. [PMID: 24146350 PMCID: PMC3912298 DOI: 10.1007/s11606-013-2665-0] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 09/10/2013] [Accepted: 09/20/2013] [Indexed: 10/26/2022]
Abstract
Moral distress is the experience of cognitive-emotional dissonance that arises when one feels compelled to act contrary to one's moral requirements. Moral distress is common, but under-recognized in medical education and training, and this relative inattention may undermine educators' efforts to promote empathy, ethical practice, and professionalism. Moral distress should be recognized as a feature of the clinical landscape, and addressed in conjunction with the related concerns of negative role modeling and the goals and efficacy of medical ethics curricula.
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Halkoaho A, Matveinen M, Leinonen V, Luoto K, Keränen T. Education of research ethics for clinical investigators with Moodle tool. BMC Med Ethics 2013; 14:53. [PMID: 24330709 PMCID: PMC3867673 DOI: 10.1186/1472-6939-14-53] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 12/10/2013] [Indexed: 11/24/2022] Open
Abstract
Background In clinical research scientific, legal as well as ethical aspects are important. It is well known that clinical investigators at university hospitals have to undertake their PhD-studies alongside their daily work and reconciling work and study can be challenging. The aim of this project was to create a web based course in clinical research bioethics (5 credits) and to examine whether the method is suitable for teaching bioethics. The course comprised of six modules: an initial examination (to assess knowledge in bioethics), information on research legislation, obtaining permissions from authorities, writing an essay on research ethics, preparing one’s own study protocol, and a final exam. All assignments were designed with an idea of supporting students to reflect on their learning with their own research. Methods 57 PhD-students (medical, nursing and dental sciences) enrolled and 46 completed the course. Course evaluation was done using a questionnaire. The response rate was 78%. Data were analyzed using quantitative methods and qualitative content analysis. Results The course was viewed as useful and technically easy to perform. Students were pleased with the guidance offered. Personal feedback from teachers about students’ own performance was seen advantageous and helped them to appreciate how these aspects could be applied their own studies. The course was also considered valuable for future research projects. Conclusions Ethical issues and legislation of clinical research can be understood more easily when students can reflect the principles upon their own research project. Web based teaching environment is a feasible learning method for clinical investigators.
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Affiliation(s)
- Arja Halkoaho
- Research Ethics Committee/Science Service Center, Kuopio University Hospital, P,O BOX 100, Kuopio FI-70029 KYS, Finland.
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Hernández González A, Rodríguez Núñez A, Cambra Lasaosa FJ, Quintero Otero S, Ramil Fraga C, García Palacios MV, Hernández Rastrollo R, Ruiz Extremera MA. [Knowledge of health care ethics in paediatric residents]. An Pediatr (Barc) 2013; 80:106-13. [PMID: 24103240 DOI: 10.1016/j.anpedi.2013.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 06/02/2013] [Accepted: 06/03/2013] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Bioethics has been recently incorporated in to the educational programs of both medical students and medical residents as part of their curriculum. However, its training based on clinical practice is not well structured. OBJECTIVE To evaluate the knowledge of bioethics in Spanish paediatric residents, and to analyse how this relates to the medical education during graduate and post-graduate training. MATERIAL AND METHODS A questionnaire with 20 multiple choice questions was designed to evaluate the knowledge in basic ethics with potential implications in clinical practice. We evaluated the education received during graduate and post-graduate training, and the main ethical conflicts faced. RESULTS A total of 210 completed questionnaires were received from medical residents in paediatrics from 20 different Spanish hospitals, of whom 47 of these were first year residents (R1), 49 were second year residents (R2), 57 were third year residents (R3), and the remaining 57 were final year residents (R4). The mean number of correct answers was 16.8 out of 20. No differences were found between residents in different years of training, nor were there any differences between the group that had received specific training in bioethics versus those who had not. Residents were more likely to give wrong answers related with informed consent, the law on the freedom of the patient, principles of quality of life, the case analysis system, and the dimension of distributive justice. CONCLUSIONS Limitation of therapeutic efforts was identified as the main ethical problem faced in clinical practice by Spanish residents in paediatrics. Most of the knowledge of bioethics is acquired during graduate training, and improved very little throughout the period of medical residence. Our results suggest that efforts are required in organising and structuring the education in bioethics during the training of residents in paediatrics.
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Affiliation(s)
- A Hernández González
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Puerta del Mar, Cádiz, España.
| | - A Rodríguez Núñez
- Unidad de Cuidados Intensivos Pediátricos, Hospital Clínico Universitario de Santiago, Santiago de Compostela, España
| | - F J Cambra Lasaosa
- Unidad de Cuidados Intensivos Pediátricos, Hospital Sant Joan de Déu, Barcelona, España
| | - S Quintero Otero
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Puerta del Mar, Cádiz, España
| | - C Ramil Fraga
- Unidad de Cuidados Intensivos Pediátricos, Complejo Hospitalario Universitario de A Coruña, A Coruña, España
| | - M V García Palacios
- Servicio de Medicina Preventiva, Hospital Universitario Puerta del Mar, Cádiz, España
| | - R Hernández Rastrollo
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Infanta Cristina, Badajoz, España
| | - M A Ruiz Extremera
- Departamento de Pediatría, Hospital Universitario San Cecilio, Granada, España
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Scott Denton J. Ethics Education in Forensic Pathology Fellowship Training: Is there a Need? Acad Forensic Pathol 2013. [DOI: 10.23907/2013.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Relatively little has been written about ethics in the practice of forensic pathology, considering its critical importance to the individual practitioner and the specialty's long-term survival. While the general foundation of highly ethical behavior has hopefully been established prior to entering the fellowship year, the practice of forensic pathology is unique and has its own special ethical issues, requiring active intentional education. The fellowship training year is the best setting in which to formally discuss the ethical behaviors required in the daily practice of forensic pathology. The American Counsel for Graduate Medical Education (ACGME) also requires the demonstration of professionalism and ethical behavior during the fellowship, which includes ethics education. Almost all forensic pathology program directors report that ethics training is conducted on an opportunistic case-based basis as ethical issues arise during training. The majority of forensic pathology program directors would welcome a focused “Ethical Issues in Forensic Pathology” educational module following the Core Curriculum lecture platform and based upon the ACGME Core Competencies and developed by the National Association of Medical Examiners (NAME).
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Abstract
BACKGROUND Medical ethics is a critical component of the curriculum for clinical trainees. Educational initiatives should adapt content to participants' experience in order to ensure relevance and retain their interest. AIM To develop and evaluate an experiential educational program for physicians. SETTING Academic medical center. PARTICIPANTS Senior internal medicine residents (n = 40). PROGRAM DESCRIPTION A case-based didactic program was designed in which each resident shared a difficult ethics case from their clinical experience. We created a curriculum around these cases involving formal didactics as well as open-ended discussion and summarized the ethical issues most relevant to the participants. A course survey was administered based upon the validated Students' Evaluation of Educational Quality (SEEQ). PROGRAM EVALUATION Common issues raised included surrogate decision-making (18 %), refusal of treatment (14 %), capacity/informed consent (10 %), and medical futility (10 %). Mean SEEQ subscale scores for learning value, organization/clarity, group interaction, breadth of coverage, and assignments/readings were 4.5 (maximum possible score 5). Residents unanimously rated the course overall as good/very good, and all agreed or strongly agreed that the course was useful and its structure effective. DISCUSSION An experiential case-based didactic program in medical ethics engaged adult learners and facilitated a comprehensive and clinically relevant educational initiative.
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Caldicott C. Ethics lie in the situation and in the response. MEDICAL EDUCATION 2011; 45:658-660. [PMID: 21649696 DOI: 10.1111/j.1365-2923.2011.04028.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Catherine Caldicott
- Center for Personalized Education for Physicians, 7351 Lowry Boulevard, Suite 100, Denver, Colorado 880230, USA.
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