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Kidszun A, Forth FA, Matheisl D, Busch F, Kaltbeitzel L, Kurz S. Ethics education in pediatrics: Implementation and evaluation of an interactive online course for medical students. GMS JOURNAL FOR MEDICAL EDUCATION 2022; 39:Doc55. [PMID: 36540566 PMCID: PMC9733484 DOI: 10.3205/zma001576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 08/04/2022] [Accepted: 09/01/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has catalyzed the development of online learning formats in virtually all areas of medical education. In pediatric ethics, online learning may not only substitute but also offer specific advantages over traditional classroom teaching. Many pediatricians rate their ethics education as poor and medical ethics education lacks evaluation, especially regarding the students' needs. The aim of this project was to implement and evaluate a novel interactive distance learning approach to engage medical students in pediatric ethics education. METHODS An online ethics course was designed and delivered between May and June 2020. Core item of this course was a moderated, written forum discussion spanning several days. Evaluation was mixed methods. We evaluated the effectiveness of the course in terms of quality of the learning environment with a particular focus on relevance to students as well as interactive learning and reflective thinking. The Constructivist On-Line Learning Environment Survey (COLLES) was used to evaluate six different domains of the course. Data are presented as mean (standard deviation [SD]). The respective score range is 1-5, whereby a score of 4 or 5 means that the participants indicated the corresponding item as frequently or almost always present. RESULTS Responses were available from 104 (78.3%) of the 133 participating students. "Relevance" yielded a score of 4.17 (0.83), "reflective thinking" a score of 4.22 (0.83). "Interactivity" was scored 3.76 (0.99) and "tutor support" 4.72 (0.53). "Peer support" and "interpretation" scored 3.87 (0.98) and 4.49 (0.60), respectively. In qualitative analysis, students particularly valued the structure of the course, the relevance for their professional practice, their active participation and the incentive to reflective thinking. Students also indicated that this was an innovative and exciting format, which fills a current educational gap and should hence be continued beyond the pandemic. CONCLUSION In conclusion, students actively engaged in online learning and perceived this ethics course as highly relevant for their professional practice.
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Affiliation(s)
- André Kidszun
- Johannes Gutenberg-University Mainz, University Medical Center, Department of Pediatric and Adolescent Medicine, Division of Neonatology, Germany
- University of Bern, Bern University Hospital, Inselspital, Department of Paediatrics, Division of Neonatology, Bern, Switzerland
| | - Fiona A. Forth
- Johannes Gutenberg-University Mainz, University Medical Center, Institute for the History, Philosophy and Ethics of Medicine, DFG-Research Training Group “Life Sciences – Life Writing”, Mainz, Germany
| | - Daniel Matheisl
- Medical Center-University of Freiburg, Center for Pediatrics, Department of Neonatology and Pediatric Intensive Care, Freiburg im Breisgau, Germany
| | - Franziska Busch
- University of Bern, Bern University Hospital, Inselspital, Department of Paediatrics, Division of Neonatology, Bern, Switzerland
| | - Lara Kaltbeitzel
- Johannes Gutenberg-University Mainz, University Medical Center, Rudolf Frey Lernklinik, Mainz, Germany
| | - Sandra Kurz
- Johannes Gutenberg-University Mainz, University Medical Center, Rudolf Frey Lernklinik, Mainz, Germany
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Forschendes Lernen in der Empirischen Medizinethik. Ethik Med 2022. [DOI: 10.1007/s00481-022-00712-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
ZusammenfassungDer Erwerb von Fach- und Forschungskompetenzen kann im besonderen Maße in Lehrveranstaltungen gefördert werden, die Studierende mit der Bewältigung komplexer Probleme konfrontieren. In diesem Artikel stellen wir didaktische Überlegungen zum Forschenden Lernen in der Empirischen Medizinethik dar. Ausgehend von der Theorie des Pragmatismus zeigen wir auf, wie Forschendes Lernen in Lehrangeboten verwirklicht und für die Förderung medizinethischer Kompetenzen genutzt werden kann. Wir fokussieren dabei auf Lehr- und Lernprojekte, in denen die selbstorganisierte Durchführung empirisch-ethischer Forschung für Studierende prozesshaft erfahrbar gemacht werden kann. Solche Lehrangebote bieten große Potenziale, vor allem im Hinblick auf die Erweiterung von Reflexionskompetenzen der Studierenden. Eine Aufnahme solcher Lehrangebote in die fakultative Medizinethik-Lehre wird im Hinblick auf kontextuelle Herausforderungen diskutiert.
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Andersson H, Svensson A, Frank C, Rantala A, Holmberg M, Bremer A. Ethics education to support ethical competence learning in healthcare: an integrative systematic review. BMC Med Ethics 2022; 23:29. [PMID: 35305627 PMCID: PMC8933936 DOI: 10.1186/s12910-022-00766-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/07/2022] [Indexed: 01/07/2023] Open
Abstract
Background Ethical problems in everyday healthcare work emerge for many reasons and constitute threats to ethical values. If these threats are not managed appropriately, there is a risk that the patient may be inflicted with moral harm or injury, while healthcare professionals are at risk of feeling moral distress. Therefore, it is essential to support the learning and development of ethical competencies among healthcare professionals and students. The aim of this study was to explore the available literature regarding ethics education that promotes ethical competence learning for healthcare professionals and students undergoing training in healthcare professions. Methods In this integrative systematic review, literature was searched within the PubMed, CINAHL, and PsycInfo databases using the search terms ‘health personnel’, ‘students’, ‘ethics’, ‘moral’, ‘simulation’, and ‘teaching’. In total, 40 articles were selected for review. These articles included professionals from various healthcare professions and students who trained in these professions as subjects. The articles described participation in various forms of ethics education. Data were extracted and synthesised using thematic analysis. Results The review identified the need for support to make ethical competence learning possible, which in the long run was considered to promote the ability to manage ethical problems. Ethical competence learning was found to be helpful to healthcare professionals and students in drawing attention to ethical problems that they were not previously aware of. Dealing with ethical problems is primarily about reasoning about what is right and in the patient’s best interests, along with making decisions about what needs to be done in a specific situation. Conclusions The review identified different designs and course content for ethics education to support ethical competence learning. The findings could be used to develop healthcare professionals’ and students’ readiness and capabilities to recognise as well as to respond appropriately to ethically problematic work situations.
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Wong MK, Hong DZH, Wu J, Ting JJQ, Goh JL, Ong ZY, Toh RQE, Chiang CLL, Ng CWH, Ng JCK, Cheong CWS, Tay KT, Tan LHS, Ong YT, Chiam M, Chin AMC, Mason S, Radha Krishna LK. A systematic scoping review of undergraduate medical ethics education programs from 1990 to 2020. MEDICAL TEACHER 2022; 44:167-186. [PMID: 34534043 DOI: 10.1080/0142159x.2021.1970729] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Ensuring medical students are equipped with essential knowledge and portable skills to face complex ethical issues underlines the need for ethics education in medical school. Yet such training remains variable amidst evolving contextual, sociocultural, legal and financial considerations that inform training across different healthcare systems. This review aims to map how undergraduate medical schools teach and assess ethics. METHODS Guided by the Systematic Evidence-Based Approach (SEBA), two concurrent systematic scoping reviews were carried out, one on ethics teaching and another on their assessment. Searches were conducted on PubMed, Embase, PsycINFO and ERIC between 1 January 1990 and 31 December 2020. Data was independently analysed using thematic and content analysis. RESULTS Upon scrutinising the two sets of full-text articles, we identified 141 articles on ethics teaching and 102 articles on their assessments. 83 overlapped resulting in 160 distinct articles. Similar themes and categories were identified, these include teaching modalities, curriculum content, enablers and barriers to teaching, assessment methods, and their pros and cons. CONCLUSION This review reveals the importance of adopting an interactive, multimodal and interdisciplinary team-teaching approach to ethics education, involving community resource partners and faculty trained in ethics, law, communication, professionalism, and other intertwining healthcare professions. Conscientious effort should also be put into vertically and horizontally integrating ethics into formal medical curricula to ensure contextualisation and application of ethics knowledge, skills and attitudes, as well as protected time and adequate resources. A stage-based multimodal assessment approach should be used to appropriately evaluate knowledge acquisition, application and reflection across various practice settings. To scaffold personalised development plans and remediation efforts, multisource evaluations may be stored in a centralised portfolio. Whilst standardisation of curricula content ensures cross-speciality ethical proficiency, deliberative curriculum inquiry performed by faculty members using a Delphi approach may help to facilitate the narrowing of relevant topics.
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Affiliation(s)
- Mun Kit Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Palliative Medicine, National Cancer Centre Singapore, Singapore, Singapore
| | - Daniel Zhi Hao Hong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Palliative Medicine, National Cancer Centre Singapore, Singapore, Singapore
| | - Jiaxuan Wu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Palliative Medicine, National Cancer Centre Singapore, Singapore, Singapore
| | - Jacquelin Jia Qi Ting
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Palliative Medicine, National Cancer Centre Singapore, Singapore, Singapore
| | - Jia Ling Goh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Palliative Medicine, National Cancer Centre Singapore, Singapore, Singapore
| | - Zhi Yang Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Palliative Medicine, National Cancer Centre Singapore, Singapore, Singapore
| | - Rachelle Qi En Toh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Palliative Medicine, National Cancer Centre Singapore, Singapore, Singapore
| | - Christine Li Ling Chiang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Palliative Medicine, National Cancer Centre Singapore, Singapore, Singapore
| | - Caleb Wei Hao Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Palliative Medicine, National Cancer Centre Singapore, Singapore, Singapore
| | - Jared Chuan Kai Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Palliative Medicine, National Cancer Centre Singapore, Singapore, Singapore
| | - Clarissa Wei Shuen Cheong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Palliative Medicine, National Cancer Centre Singapore, Singapore, Singapore
| | - Kuang Teck Tay
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Palliative Medicine, National Cancer Centre Singapore, Singapore, Singapore
| | - Laura Hui Shuen Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Palliative Medicine, National Cancer Centre Singapore, Singapore, Singapore
| | - Yun Ting Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Palliative Medicine, National Cancer Centre Singapore, Singapore, Singapore
| | - Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
| | | | - Stephen Mason
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, Liverpool, United Kingdom
- Cancer Research Centre, University of Liverpool, Liverpool, United Kingdom
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Palliative Medicine, National Cancer Centre Singapore, Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, Liverpool, United Kingdom
- Cancer Research Centre, University of Liverpool, Liverpool, United Kingdom
- Duke-NUS Medical School, Singapore, Singapore
- Centre of Biomedical Ethics, National University of Singapore, Singapore, Singapore
- PalC, The Palliative Care Centre for Excellence in Research and Education, Singapore, Singapore
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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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DeFoor MT, Chung Y, Zadinsky JK, Dowling J, Sams RW. An interprofessional cohort analysis of student interest in medical ethics education: a survey-based quantitative study. BMC Med Ethics 2020; 21:26. [PMID: 32268890 PMCID: PMC7140336 DOI: 10.1186/s12910-020-00468-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 03/20/2020] [Indexed: 11/25/2022] Open
Abstract
Background There is continued need for enhanced medical ethics education across the United States. In an effort to guide medical ethics education reform, we report the first interprofessional survey of a cohort of graduate medical, nursing and allied health professional students that examined perceived student need for more formalized medical ethics education and assessed preferences for teaching methods in a graduate level medical ethics curriculum. Methods In January 2018, following the successful implementation of a peer-led, grassroots medical ethics curriculum, student leaders under faculty guidance conducted a cross-sectional survey with 562 of 1357 responses received (41% overall response rate) among students enrolled in the School of Medicine, College of Nursing, Doctor of Physical Therapy and BS/(D) MD Professional Scholars programs at The Medical College of Georgia at Augusta University. An in person or web-based questionnaire was designed to measure perceived need for a more in-depth medical ethics curriculum. Results The majority of respondents were female (333, 59.3%), white (326, 58.0%) and mid-20s in age (340, 60.5%). Almost half of respondents (47%) reported no prior medical ethics exposure or training in their previous educational experience, while 60% of students across all degree programs reported an interest in more medical ethics education and 92% noted that an understanding of medical ethics was important to their future career. Over a quarter of students (28%) were interested in pursuing graduate-level training in medical ethics, with case-based discussions, small group peer settings and ethics guest lectures being the most desired teaching methods. Conclusions The future physician, nursing and physical therapist workforce in our medical community demonstrated an unmet need and strong interest for more formal medical ethics education within their current coursework. Grassroots student-driven curricular development and leadership in medical ethics can positively impact medical education. Subsequent integration of interprofessional training in medical ethics may serve as a vital curricular approach to improving the training of ethically competent healthcare professionals and overcoming the current hierarchical clinical silos.
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Affiliation(s)
- Mikalyn T DeFoor
- School of Medicine, Medical College of Georgia at Augusta University, Augusta, GA, 30909, USA.
| | - Yunmi Chung
- Institute of Public and Preventative Health, Augusta University, Augusta, GA, 30909, USA
| | | | - Jeffrey Dowling
- Augusta University Rehabilitation, Augusta, GA, 30909, USA.,Center for Bioethics and Health Policy, Medical College of Georgia at Augusta University, Augusta, GA, 30909, USA
| | - Richard W Sams
- Center for Bioethics and Health Policy, Medical College of Georgia at Augusta University, Augusta, GA, 30909, USA.,Department of Family Medicine, Medical College of Georgia at Augusta University, Augusta, GA, 30909, USA
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DeFoor MT, East L, Mann PC, Nichols CA. Implementation and evaluation of a near-peer-facilitated medical ethics curriculum for first-year medical students: a pilot study. MEDICAL SCIENCE EDUCATOR 2020; 30:219-225. [PMID: 34457662 PMCID: PMC8368783 DOI: 10.1007/s40670-019-00873-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION The primary objectives of this study were to implement a novel near-peer-facilitated case-based medical ethics curriculum intended for the audience of a large cohort of first-year medical students (n = 193) and to objectively evaluate the immediate efficacy of the curriculum based on pre- and post-session survey responses to ethical quandaries. METHODS Two near-peer-facilitated medical ethics case discussion sessions were included in the first-year curriculum during the 2017-2018 academic year. The sessions were designed and led by second-year medical student facilitators under the direction of a faculty mentor and were presented as a year-long curricular thread. First-year students were asked to complete pre- and post-session surveys with ethical questions relevant to each case and session. Students were additionally asked to measure the contribution of discussion sessions to their development as a future physician. RESULTS Post-session survey results showed that students had a better understanding of specific ethical issues immediately following discussion sessions (p<0.0001). Over three-quarters of students indicated that the near-peer-led medical ethics case discussions contributed somewhat or very much to their development as a future physician. Anecdotal feedback from second-year medical students also suggested that their involvement as facilitators was beneficial to their educational development. CONCLUSION Near-peer-facilitated case discussions were an effective strategy for teaching medical ethics to first-year medical students with demonstrated objective improvements in ethical decision-making. Additionally, near-peer discussions of ethical cases and principles with first-year medical students aided in subjective measures of professional development.
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Affiliation(s)
- Mikalyn T. DeFoor
- Medical College of Georgia, Augusta University, Augusta, Georgia 30912 USA
| | - Lauren East
- Medical College of Georgia, Augusta University, Augusta, Georgia 30912 USA
| | - Paul C. Mann
- Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, Georgia 30912 USA
- Center for Bioethics and Health Policy, Augusta University, Augusta, Georgia 30912 USA
| | - Carol A. Nichols
- Department of Cellular Biology and Anatomy, Medical College of Georgia, Augusta University, Augusta, Georgia 30912 USA
- Office of Academic Affairs, Medical College of Georgia, Augusta University, Augusta, Georgia 30912 USA
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Sullivan BT, DeFoor MT, Hwang B, Flowers WJ, Strong W. A Novel Peer-Directed Curriculum to Enhance Medical Ethics Training for Medical Students: A Single-Institution Experience. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2020; 7:2382120519899148. [PMID: 32030354 PMCID: PMC6977198 DOI: 10.1177/2382120519899148] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 12/10/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND The best pedagogical approach to teaching medical ethics is unknown and widely variable across medical school curricula in the United States. Active learning, reflective practice, informal discourse, and peer-led teaching methods have been widely supported as recent advances in medical education. Using a bottom-up teaching approach builds on medical trainees' own moral thinking and emotion to promote awareness and shared decision-making in navigating everyday ethical considerations confronted in the clinical setting. OBJECTIVE Our study objective was to outline our methodology of grassroots efforts in developing an innovative, student-derived longitudinal program to enhance teaching in medical ethics for interested medical students. METHODS Through the development of a 4-year interactive medical ethics curriculum, interested medical students were provided the opportunity to enhance their own moral and ethical identities in the clinical setting through a peer-derived longitudinal curriculum including the following components: lunch-and-learn didactic sessions, peer-facilitated ethics presentations, faculty-student mentorship sessions, student ethics committee discussions, hospital ethics committee and pastoral care shadowing, and an ethics capstone scholarly project. The curriculum places emphasis on small group narrative discussion and collaboration with peers and faculty mentors about ethical considerations in everyday clinical decision-making and provides an intellectual space to self-reflect, explore moral and professional values, and mature one's own professional communication skills. RESULTS The Leadership through Ethics (LTE) program is now in its fourth year with 14 faculty-clinician ethics facilitators and 65 active student participants on track for a distinction in medical ethics upon graduation. Early student narrative feedback showed recurrent themes on positive curricular components including (1) clinician mentorship is key, (2) peer discussion and reflection relatable to the wards is effective, and (3) hands-on and interactive clinical training adds value. As a result of the peer-driven initiative, the program has been awarded recognition as a graduate-level certification for sustainable expansion of the grassroots curriculum for trainees in the clinical setting. CONCLUSIONS Grassroots medical ethics education emphasizes experiential learning and peer-to-peer informal discourse of everyday ethical considerations in the health care setting. Student engagement in curricular development, reflective practice in clinical settings, and peer-assisted learning are strategies to enhance clinical ethics education. The Leadership through Ethics program augments and has the potential to transform traditional teaching methodology in bioethics education for motivated students by offering protected small group discussion time, a safe environment, and guidance from ethics facilitators to reflect on shared experiences in clinical ethics and to gain more robust, hands-on ethics training in the clinical setting.
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Affiliation(s)
- Brian T Sullivan
- Department of Orthopaedics, Johns Hopkins University, Baltimore, MD, USA
- School of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Mikalyn T DeFoor
- School of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
- Center for Bioethics and Health Policy, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Brice Hwang
- School of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
- Department of Ophthalmology, School of Medicine, Georgetown University, Washington, DC, USA
| | - W Jeffrey Flowers
- Center for Bioethics and Health Policy, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - William Strong
- Center for Bioethics and Health Policy, Medical College of Georgia, Augusta University, Augusta, GA, USA
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Mullikin TC, Shahi V, Grbic D, Pawlina W, Hafferty FW. First Year Medical Student Peer Nominations of Professionalism: A Methodological Detective Story about Making Sense of Non-Sense. ANATOMICAL SCIENCES EDUCATION 2019; 12:20-31. [PMID: 29569347 DOI: 10.1002/ase.1782] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 02/17/2018] [Accepted: 02/21/2018] [Indexed: 06/08/2023]
Abstract
This article explores the assessment of professionalism within a cohort of medical students during a sequential 13-week medical school histology and anatomy course. Across seven data points, students were asked to identify a professionalism role model from amongst their peers and to score Likert-structured rationales for their decision. Based on density scores, an initial social network analysis identified six peer-nomination "stars." However, analysis of these stars revealed considerable variability and random-like "noise" in both the nomination and explanation data sets. Subsequent analyses of both data sets explored the possibility of underlying patterns in this noise using tests of reliability, principal components factor analysis, and fixed-effects regression analysis. These explorations revealed the presence of two dimensions (professional vs. supportive) in how students sought to explain their nomination decisions. Although data variability remained quite high, significantly less variability was present in the professional than in the supportive dimension, suggesting that academic helpfulness rationales are both empirically distinct and more mutable than rationales grounded in professionalism-related factors. In addition, data showed that the greater the stability in one's choice of a professionalism role model nomination over the T1-T7 data periods, the more stable one's reasons for that nomination-both for professionalism and supportive dimensions. Results indicate that while peer assessment of professionalism by first-year medical students may not be very reliable, students can differentiate between more personal and professional factors, even at this early stage in their professional development. Formal instruction within the pre-clinical curriculum should recognize and address this distinction. Anat Sci Educ. © 2018 American Association of Anatomists.
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Affiliation(s)
- Trey C Mullikin
- Department of Radiation Oncology Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota
| | - Varun Shahi
- Department of Emergency Medicine, University of California Los Angeles Medical Center, Los Angeles, California
| | - Douglas Grbic
- Association of American Medical Colleges, District of Columbia, Washington
| | - Wojciech Pawlina
- Department of Anatomy Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota
- Program in Professionalism and Values, Mayo Clinic, Rochester, Minnesota
| | - Frederic W Hafferty
- Program in Professionalism and Values, Mayo Clinic, Rochester, Minnesota
- Department of General Internal Medicine, Mayo Clinic, Rochester, Minnesota
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