Enhancing medical ethics instruction with a classroom response system

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Context and setting The objectives of medical ethics education are to familiarise doctors with the concepts and principles of medical ethics in medical practice and, more importantly, to allow them to develop analytical skills for resolving ethical issues in medicine. In Taiwan, postgraduate Year 1 residents (PGY1) are required to receive at least 8 hours of training in medical ethics. In China Medical University Hospital (CMUH), a classroom response system (CRS) was used to assist the delivery of instruction in medical ethics and to facilitate discussion among residents. Why the idea was necessary The ability to make decisions in circumstances of medical ethical dilemma is developed through social communication. In the classroom context, however, the majority of students are reluctant to voice their opinions because they are shy, lack confidence in their answers, or are distracted. Only a small portion of students are actively involved in discussion. CMUH used CRS in medical ethics courses for PGY1 residents to encourage their participation in classroom discussion. What was done In these medical ethics education sessions, the instructor explained the concepts and principles of medical ethics. This was followed by CRS-assisted case discussions. These cases were presented and shown on a screen along with possible decisions and the ethical principles that were applied, and students selected their choices by clicking with their CRS remote controls. The instructor was able to conduct immediate descriptive analyses of student responses and show them on the screen. Both the instructor and students were able to see the response patterns and students could compare their own responses with those of the class. The instructor was able to select different students to explain why and how they had made their decisions. This allowed the class to learn about the making of different decisions for the same case and enabled the instructor to coach the group on which decisions conformed to medical ethics. Such social constructive processes allowed for opportunities, through CRS, to help students develop their ability to make decisions in circumstances of medical ethical dilemma. In October 2007, 25 PGY1 residents (19 males, six females) at CMUH received CRS-assisted medical ethics instruction. A questionnaire was administered at the end of the instruction to collect their responses to the course. Evaluation of results and impact We found that 84% of participants agreed that the course improved their critical thinking ability, 80% agreed that the course was helpful for resolving medical ethics issues they might encounter in the future, and 72% agreed that CRS helped to enhance their learning motivation, improve the instructor−student relationship and encourage communication among students. In summary, CRS-assisted medical ethics education provided students with a channel for deep-level thinking and discussion and helped them to gain confidence in applying the concepts and principles of medical ethics to medical practice.