Bioethics Curriculum Research Articles

The Time Is Now: Bioethics and LGBT Issues.

Our goal in producing this special issue is to encourage our colleagues to incorporate topics related to LGBT populations into bioethics curricula and scholarship. Bioethics has only rarely examined the ways in which law and medicine have defined, regulated, and often oppressed sexual minorities. This is an error on the part of bioethics. Medicine and law have served in the past as society's enforcement arm toward sexual minorities, in ways that robbed many people of their dignity. We feel that bioethics has an obligation to discuss that history and to help us as a society take responsibility for it. We can address only a small number of topics in this special issue of the Hastings Center Report, and we selected topics we believe will stimulate discourse. Andrew Solomon offers an elegant overview of the challenges that bioethics faces in articulating a solid basis for LGBT rights. Timothy F. Murphy asks whether bioethics still faces issues related to lesbian, gay, and bisexual people, given the deletion of homosexuality as a disease and the progress toward same-sex marriage. Jamie Lindemann Nelson's essay addresses the search for identity for transgender persons and the role of science in that search. Two articles, those by Brendan S. Abel and by Jack Drescher and Jack Pula, take up the complex issue of medical treatment for children who reject their assigned birth gender. Celia B. Fisher and Brian Mustanski address the special challenges of engaging LGBT youth in research, balancing the need for better information about this vulnerable group against the existing restrictions on research involving children. Tia Powell and Edward Stein consider the merits of legal bans on psychotherapies intended to change sexual orientation, particularly in the light of current research on orientation. Mary Beth Foglia and Karen I. Fredricksen-Goldsen highlight health disparities and resilience among LGBT older adults and then discuss the role of nonconscious bias in perpetuating disparities. Stephan Davis and Nancy Berlinger assess the challenges of access to care and health policy for transgender persons. Edward J. Callahan et al. tackle the ways in which diverse aspects of medicine should change to better incorporate the needs of LGBT patients, including through use of the electronic medical record, education of health professionals, and recruitment efforts for LGBT health professionals. Virginia Ashby Sharpe and Uchenna S. Uchendu describe multifaceted efforts within Veterans Administration facilities to create change for LGBT veterans across the largest integrated health care network in the United States. Lance Wahlert and Autumn Fiester find a mixed record in the use of case studies in teaching about LGBT issues.

Doctors, Dioceses, and Decisions: Examining the Impact of the Catholic Hospital System and Federal Conscience Clauses on Medical Education

In a time when health care reform and the limits on First Amendment freedom of religion are persistent subjects of debate, Catholic restrictions on health care have made it to the forefront of public concern. Catholic providers prohibit a variety of medical procedures traditionally viewed by the Church as contrary to the tenet of respect for human life and dignity. Many Americans view this as an unconstitutional restriction on care. As a result, the growing presence of Catholic providers, namely hospitals, has become a major point of contention in many communities. The potential barrier to medical services raises concern not only for potential patients, but also for medical students whose chosen specialty may include a prohibited service. This article identifies some difficulties that may emerge for current and prospective medical students and advocates that both groups should be required to contemplate (1) their personal beliefs as they pertain to religiously-restricted care, and (2) the effects those beliefs will have on their medical education and training. This article also gives a comprehensive background of the history of the Catholic hospital system in America and analyzes the federal "conscience clauses" and their implications for the instruction and practice of medicine. Finally, this article concludes that a mandatory bioethics curriculum is absolutely crucial to ensure adequate ethics training for medical students.

How we developed a bioethics theme in an undergraduate medical curriculum

The 5-year undergraduate medical curriculum at Aga Khan University integrates basic sciences with clinical and community health sciences. Multimodal strategies of teaching and learning, with an emphasis on problem-based learning, are utilized to equip students with knowledge, skills, behaviours, attitudes and values necessary for a high-calibre medical graduate. Bioethics teaching was introduced in the medical curriculum in 1988 and has since undergone several changes. In 2009, a multidisciplinary voluntary group began review of undergraduate bioethics teaching and invested over 350 man-hours in curricular revision. This involved formulating terminal objectives, delineating specific objectives and identifying instructional methodologies and assessment strategies appropriate for the contents of each objective. Innovative strategies were specially devised to work within the time constraints of the existing medical curriculum and importantly, to increase student interest and engagement. The new bioethics curriculum is designed to be comprehensive and robust, and strives to develop graduates who, in addition to being technically skilled and competent, are well-versed in the history and philosophy of ethics and bioethics and are ethical in their thinking and practice, especially in the context of a developing country like Pakistan where health indicators are among the worst in the region, and clinical practices are not effectively regulated to ensure quality of care.

PP-257. Development of a bioethics curriculum in a neonatal–perinatal medicine fellowship program

PP-257. Development of a bioethics curriculum in a neonatal–perinatal medicine fellowship program

Medical Student Attitudes about Bioethics

Professionalism is demonstrated through attitudes and behaviors. Medical education is concerned with teaching and evaluating it among students. It is often bioethicists who teach professionalism to medical students. Most bioethics curricula use lectures and group discussions to introduce principles and theories, but there is variation in number of credit and contact hours, placement in the curriculum (which year(s) and alongside which courses bioethics is placed), the extent of individual mentoring, and the emphasis placed on any particular philosophical approach. Bioethics curricula also vary in whether and how explicitly and extensively they address topics, including professionalism, cultural competence, medical humanities, spirituality, death and dying, and community service, and in the number and topics of vignettes, controversies, assignments, and course activities.

Teaching Military Medical Ethics: Another Look at Dual Loyalty and Triage

Military medical ethics is garnering growing attention today among medical personal in the American and other armies. Short courses or workshops in “battlefield ethics” for military physicians, nurses, medics, social workers, and psychologists address the nature of patient rights in the military, care for detainees, enemy soldiers and local civilians, problems posed by limited resources, ethical questions arising in humanitarian missions, as well as end-of-life issues, ethics consultations, care for veterans, advance directives, and assisted suicide. Although many of these issues are the core subjects of any bioethics curriculum, military medical ethics presents unique challenges to bioethics educators.

Guarding the guardians: Bioethics curricula for psychiatrists-in-training in developing countries

A good physician must be both clinically and ethically competent. High ethical standards are especially important in psychiatry in which several unique challenges present due to a vulnerable patient population, intimate physician–patient relationships, diagnoses made on signs and symptoms rather than irrefutable laboratory investigations, and therapeutic options directed at altering thinking and behaviour. It is critical that psychiatric training equip practitioners with the ability to identify ethical dilemmas in clinical practice and research and respond appropriately. Despite a call to action and the development of guidelines for ethical practice by several regulatory bodies, formal ethics teaching in psychiatry training programmes is still in embryonic stages in the developed world and virtually non-existent in the developing world. Here we highlight the current status of bioethics teaching in psychiatry residency programmes in Pakistan, an example of a developing country where such training is vital, as unethical practices abound in resource-poor settings where clinical and research practices are non-transparent and there are no effective regulatory, legal and accountability bodies. It is critical and urgent that needs-responsive bioethics curricula are developed, institutionalized and implemented in medical schools and post-graduate training programs across the developing world.“Take-home” points• Bioethics teaching should be a key, assessed component of all psychiatric training programmes• Bioethics curricula should be culturally contextual, responsive to stakeholder needs and geared towards preparing psychiatrists for ethical clinical practice and research, bioethics teaching and institutional leadershipFuture directions• Comprehensive needs assessment studies should be conducted to document current bioethics-related knowledge and attitudes in psychiatry training programmes in developing countries• Development, institutionalization and dissemination of needs-responsive bioethics curricula for psychiatry programmes in developing countries

Disability in the Bioethics Curriculum

Disability in the Bioethics Curriculum

Identifying Bioethics Learning Needs: A Survey of Canadian Emergency Medicine Residents

Emergency medicine (EM) postgraduate training programs must prepare residents for the ethical challenges of clinical practice. Bioethics curricula have been developed for EM residents, but they are based on expert opinion rather than resident learning needs. Educational interventions based on identified learning needs are more effective at changing practice than interventions that are not. The goal of this study was to identify the bioethics learning needs of Canadian EM residents. A survey-based needs assessment of Canadian EM residents was performed between July 2000 and June 2001. Residents were asked to identify their learning needs by rating bioethics topics and by relating their clinical experiences. Physicians and nurses who work with residents were surveyed in a similar manner and also asked to identify the residents' bioethics learning needs. A total of 129 EM residents (77% of eligible residents), 94 physicians, and 87 nurses responded. Residents, physicians, and nurses all identified issues in end-of-life care as the greatest bioethics learning needs of the residents. Other areas identified as learning needs included negotiating consent, capacity assessment, truth telling, and breaking bad news. A learning need identified by nurses, but not residents, was the manner in which residents interact with patients and colleagues. This needs assessment provides valuable information about the ethical challenges EM residents encounter and the ethical issues they believe they have not been prepared to face. This information should be used to direct and shape ethics education interventions for EM residents.

Bioethics, Social Class, and the Sociological Imagination

Last year I published a short article urging bioethicists to carefully examine the question of what ought to constitute the canonical issues topics and questions driving research and teaching in bioethics. Why some subjects dominate the field whereas other topics are regarded as matters for scholars in other disciplines is a question that has intrigued me for nearly a decade. How are the boundaries of bioethics established? What factors influence research agendas and the creation of bioethics curricula? How do funding agencies, editors, and leading scholars shape the field of bioethics? These questions are increasingly receiving scrutiny from Charles Bosk, Raymond De Vries, and other researchers as they explore the sociology of bioethics and the “construction” of the “ethical enterprise.”

Bioethics curriculum for paediatrics residents: implementation and evaluation

Context and setting At Children's Hospital Boston, residents in paediatrics routinely see patients who are ethically challenging, providing fertile ground for the development of moral quandaries. Approaching an ethical dilemma systematically is a skill that must be learned and cultivated over time. Residents must acquire this proficiency, as well as countless others, during their 3-year training programme. Without deliberate efforts towards this end, it is unreasonable to expect residents to acquire these skills on their own. Residents should learn the principles of bioethics needed to develop a sound approach to moral dilemmas in their educational curriculum. Why the idea was necessary Research shows that residents crave more structured learning on informed consent, the doctor−patient relationship and end-of-life decision making. A needs assessment survey administered to 120 residents in paediatrics at Children's Hospital Boston revealed a desire to know more about medical futility, ethics in medical research, and ethical practice in the age of managed care. Studies indicate that residents gain confidence and feel more competent when addressing moral questions after their programmes establish a formal ethics curriculum. What was done An innovative 12 session, 2-year curriculum in bioethics was developed and implemented in September 2003 such that 6 lunchtime conferences per year are dedicated to teaching in ethics. Each of the 12 conferences addresses ethical issues related to specific hospital services on which residents spend time. Examples include ‘Ethics and the ICU Patient’, ‘Ethics and Primary Care’ and ‘Ethics in the Emergency Room.’ Sessions are led by multidisciplinary teams of faculty in bioethics, attending doctors, nurses and lawyers, all of whom have backgrounds in bioethics. Evaluation of results and impact The curriculum in bioethics is evaluated by 2 methods. Firstly, after each session, residents complete feedback forms. Residents have given high ratings to the curriculum's relevance to a paediatrician's career, its importance to the care of children, and its ability to effectively convey important knowledge. Secondly, a formal research study is underway, aiming to create a new research tool that could then be used to evaluate the efficacy of the new ethics curriculum. Mentored by Dr Steven Joffe from the Dana−Farber Cancer Institute, I designed 5 online ethics vignettes. In May 2004, pilot respondents were asked to identify relevant ethical issues raised by the vignettes and to develop and justify a plan to address the ethical dilemmas. A scoring sheet was also developed and 2 independent readers have scored the pilot responses. Data analysis is underway to determine if the instrument has sufficient interrater reliability to make it a useful tool. To date, no instrument has been developed that will validly and reliably assess learning and competency in ethics. This study hopes to contribute such a tool that may be utilised in future research in ethics education. If successful, this new instrument will then be used in a future cohort study to evaluate the new curriculum in ethics at Children's Hospital Boston in an effort to define and evaluate ethical competency among our paediatricians.

A peer-reviewed collection of reports on innovative approaches to medical education

M Brownell Anderson Using Fetal Alcohol Syndrome as an integrating curricular theme Process of integration of 12 cross-cutting themes Radical curriculum design: an experiment in learner empowerment A business of medicine curriculum for medical students Geriatrics curriculum for clerkship students: implementation and evaluation Widening participation in medicine Patient safety in an interprofessional learning environment Enhancing EBM skills using goal setting and peer teaching Medical student education: Addressing patients' mental health needs A successful format for a breastfeeding advocacy skills workshop Ensuring medical student competency in basic procedural skills Teaching students to use medical notes A student-organised introduction to the clinical rotations Does direct observation improve medical students' clerkship experiences? An innovative advanced patient–doctor course for medical students Deaf awareness and sign language: an innovative special study module All the world's a stage … Does ‘doing art’ inform students' learning of anatomy? Interactive drama: teaching aboriginal health medical education Simulation of paediatric basic life support on the Internet Using web-based technology to teach physical examination Team learning in medical gross anatomy course Reflective teaching: the value of e-mail student journaling Interactive online assessment training for busy practitioners Problem-based learning using a human patient simulator Praxis Pointers: reciprocal publication of practical pearls Online simulations of ambulatory care for medical residents The impact of duty hour restrictions on teaching by surgical residents The OSCE as a formative evaluation tool for substance abuse teaching Bioethics curriculum for paediatrics residents: Implementation and evaluation Are there specific competencies required by prison GPs? Cabin Fever: an innovation in faculty development for rural preceptors A scholarship-generating project for clinician educators Wessex Professional Programme: general professional development for SpRs

The Medical Humanities at the Northeastern Ohio Universities College of Medicine: historical, theoretical, and curricular perspectives.

The Human Values in Medicine Program (HVM) at the Northeastern Ohio Universities College of Medicine is composed of 120 required hours in medical humanities, social sciences, and behavioral sciences. In addition to a required HVM month in the fourth year when the bulk of the course work is completed, students can also choose from lectures, seminars, and short courses during the first, second, and third years. The broad goal of the HVM program as originally conceived was for students to use the content and skills of the humanities disciplines to reflect on their own and others' values, and to appraise their role in the patient-physician relationship, both in the community and in the larger culture. During the past several years, a cultural studies orientation has also been included, particularly the practice of critical analysis aimed at identifying the inequities and injustices within the doctor-patient relationship, in medical training, and in health care access and delivery in the U.S. and beyond. Current program development includes standardizing a bioethics curriculum for all students and developing a required fourth-year course that all students take during their HVM elective month.

Medical ethics education: thoughts on a South African medical bioethics curriculum

Medical ethics is becoming an increasingly integral part of undergraduate medical curricula world-wide. The recent social, educational and political changes in South Africa have emphasised the place of bioethics within the emerging integrated medical curricula in Southern Africa. The bioethics programmes that are designed are often reliant on developed European / western paradigms for their source material and use a number of pedagogic styles to teach the subject within the formal medical curriculum. There has been little development of African syllabi in bioethics that reflect the plasticity of African thought, as well as developing the skills of ethical awareness, moral reasoning and ethical practice that are appropriate for the African context. In this article a possible starting point for such a syllabus is proposed in order to pave the way for open debate among those who are or who wish to be involved with the teaching of bioethics to learners in Africa.

Analysis of clinical bioethics teaching in pediatric surgery residency

Background/Purpose: Although clinical bioethics teaching (CBT) is not a required component of the essential curriculum for pediatric surgery residency, ethical considerations often accompany surgical decision making for infants and children. This study was designed to quantitate CBT during pediatric surgery residency (PSR) and to determine preferences about formal bioethics instruction. Methods: An 80-item questionnaire was mailed to 140 graduates of accredited PSR in the United States and Canada. Questions included demographic data, experience in CBT during and after PSR, preferred topics and teaching methods, and self-assessed and objective competency in bioethics. Results: The response rate was 78% (n = 109); 72% completed PSR between 1990 and 1995 (mean, 1991). Formal CBT within the curriculum of PSR was reported by 9% of respondents; lecture and consultation with an ethicist were the most frequent teaching methods. Informal CBT was noted by 88% of pediatric surgeons; observation of patient cases with ethical dilemmas was the primary mode of instruction. Quality of life, withholding/withdrawal of care, informed consent, child abuse, and economics ranked highest for most important CBT topics, while euthanasia, clinical research trials, and cultural diversity were given low priority. The preferred teaching methods were case-based discussions and consultation with an ethicist. Although 97% favored additional CBT in all postgraduate training, respondents who completed advanced study in medical ethics ( P < .05), were women ( P < .05), or were members of a hospital ethics committee ( P < .05) were more likely to advocate a standardized bioethics curriculum during PSR. A majority (86%) expressed competency in handling ethical problems in clinical practice, however, 47% gave incorrect responses or were unsure about routine bioethics questions. Conclusions: Formal instruction in clinical bioethics is not included in the curriculum of most residencies in pediatric surgery. Recent graduates of PSR favor case-based and practice-oriented teaching in clinical bioethics.