Postgraduate ethics training programs: a systematic scoping review

Daniel Zhihao Hong,Mun Kit Wong,Jia Ling Goh,Laura Hui Shuen Tan,Caleb Wei Hao Ng,Jared Chuan Kai Ng,Zhi Yang Ong,Min Chiam,Gillian Li Gek Phua,Alexia Sze Inn Lee,Rachelle Qi En Toh,Kuang Teck Tay,Jibin Wu ,Shu Hui Neo ,Annelissa Chin ,Clarissa Wei Shuen Cheong,Yun Ting Ong,Limin Wijaya,Warren Fong,Christine Li Ling Chiang,Xiu Hui Tan,Jacquelin Jia Qi Ting,Lalit Kumar Radha Krishna

doi:10.1186/s12909-021-02644-5

Abstract

BackgroundMolding 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.MethodsWith 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.ResultsThe 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).ConclusionsOur 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.

Highlights

Seen as a means of ensuring that “obligations of moral nature which govern the practice of medicine” [1] are maintained, ethics training amongst physicians have evolved to contend with ethical issues facing medical practice
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 professional identity formation (PIF) and micro-credentialling in ethics practice
Whilst basic levels of ethics knowledge and skills have been stipulated by accreditation bodies such as The Royal College of Physicians and Surgeons of Canada, The General Medical Council, the American Academy of Family Physicians (AAFP) and the Accreditation Council for Graduate Medical Education (ACGME), many ethics programs have struggled to keep pace with change whilst remaining sensitive to the demands of clinical practice

Summary

Introduction

Seen as a means of ensuring that “obligations of moral nature which govern the practice of medicine” [1] are maintained, ethics training amongst physicians have evolved to contend with ethical issues facing medical practice. The need for this review To guide this process of retooling ethics education programs for physicians, a systematic scoping review is proposed to analyse current postgraduate medical ethics training and assessment programs in peer-reviewed literature. 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

Results

Discussion

Conclusion