Abstract
BackgroundIn recent years, medical practice has followed two different paradigms: evidence-based medicine (EBM) and values-based medicine (VBM). There is an urgent need to promote medical education that strengthens the relationship between these two paradigms. This work is designed to establish the foundations for a continuing medical education (CME) program aimed at encouraging the dialogue between EBM and VBM by determining the values relevant to everyday medical activities.MethodsA quasi-experimental, observational, comparative, prospective and qualitative study was conducted by analyzing through a concurrent triangulation strategy the correlation between healthcare personnel-patient relationship, healthcare personnel's life history, and ethical judgments regarding dilemmas that arise in daily clinical practice.In 2009, healthcare personnel working in Mexico were invited to participate in a free, online clinical ethics course. Each participant responded to a set of online survey instruments before and after the CME program. Face-to-face semi-structured interviews were conducted with healthcare personnel, focusing on their views and representations of clinical practice.ResultsThe healthcare personnel's core values were honesty and respect. There were significant differences in the clinical practice axiology before and after the course (P <0.001); notably, autonomy climbed from the 10th (order mean (OM) = 8.00) to the 3rd position (OM = 5.86). In ethical discernment, the CME program had an impact on autonomy (P ≤0.0001). Utilitarian autonomy was reinforced in the participants (P ≤0.0001). Regarding work values, significant differences due to the CME intervention were found in openness to change (OC) (P <0.000), self-transcendence (ST) (P <0.001), and self-enhancement (SE) (P <0.019). Predominant values in life history, ethical discernment and healthcare personnel-patient relation were beneficence, respect and compassion, respectively.ConclusionsThe healthcare personnel participating in a CME intervention in clinical ethics improved high-order values: Openness to change (OC) and Self Transcendence (ST), which are essential to fulfilling the healing ends of medicine. The CME intervention strengthened the role of educators and advisors with respect to healthcare personnel. The ethical values developed by healthcare professionals arise from their life history and their professional formation.
Highlights
We seek to address the following questions: (1) What are the values of a group of healthcare professionals participating in continuing medical education (CME) in clinical ethics? (2) Why and how do participants respond to values in their clinical practice? (3) How does CME in clinical ethics impact the pairing of evidence-based medicine (EBM)-values-based medicine (VBM)? Here, we describe the successful use of CME to engineer networks between EBM and VBM
The rise of vocation and its consolidation When qualitatively tracing the most salient values in the life history of the individuals interviewed, we found that healthcare personnel referred to a core of values, where beneficence is dominant together with tradition, incentivizing, achievement and conformity, and that those traits led them to choose a career in the medical field (Figure 7A)
Our results demonstrate that the healthcare personnel participating in a CME intervention in clinical ethics improved high-order values Openness to Change and SelfTranscendence, as observed through a concurrent triangulation approach (Figures 6A, Band 7A-C and Table 2)
Summary
Continuing medical education (CME) promotes career-long competence with respect to medical advances (EBM); it can support fine-tuning of professional values and principles (VBM) [1,2,4,5,7,9,10,11,12]. Values are normative guidelines that allow us to consider actions, objects or situations as good, desirable, pleasant, convenient or useful towards certain aims [13]. These aims and the values that guide us towards them lend a mindful sensibility to our life and our professional practice [14]. Devices and technical/scientific biomedical scenarios present increasing uncertainty and pose exponential risks that underscore the necessity of promoting an analytical-empirical axiology that places practice along a horizon of wisdom [7,17,18,19,20,21,22]
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