Medical Ethics Education Research Articles

Development and validation of an instrument to measure physician awareness of bioethics and medical law in Oman

BackgroundA different ethos with respect to the perception of medical ethics prevails in societies in transition such as those in the Arabian Peninsula, which makes it difficult to apply international principles of bioethics in medical practice. This study aimed to develop and psychometrically test an instrument that measures physicians’ awareness of bioethics and medical law and their attitudes towards the practice of medical ethics. Additionally, it examined physician correlates influencing the awareness of bioethics.MethodsFollowing a rigorous review of relevant literature by a panel of experts, a 13-item instrument, the Omani physicians’ bioethics and medical law awareness (OBMLA) questionnaire was developed with the aim of assessing physicians’ awareness of bioethics and medical law. The study tool’s construct validity and internal consistency reliability were examined by exploratory factor analysis (EFA) and Cronbach’s alpha. In a cross-sectional study, the questionnaire was distributed among a random sample of 200 physicians at a tertiary hospital in Muscat, Oman. Participant characteristics that may influence awareness of bioethics and medical law were explored.ResultsThe EFA of the OBMLA questionnaire resulted in three well-loading factors: (1) Physicians’ bioethics practice subscale (2) incentive related bioethics subscale and (3) medical law awareness subscale. Internal consistency reliability ranged between Cronbach’s α: 0.73–0.8. Of the total 200 participants, 52% reported that teaching medical ethics during medical school was inadequate. The overall mean (standard deviation, SD) of the bioethics awareness score and Omani medical law awareness were 27.6 (3.5) and 10.1 (2.1) respectively. The majority of physicians (73%) reported that they frequently encountered ethical dilemmas in their practice and 24.5% endorsed the view that unethical decisions tended to occur in their practice.ConclusionThe study provides an insight into the practice of bioethics, and the awareness of bioethics and medical law among physicians in a teaching hospital in Oman. The OBMLA questionnaire appears to be a valid and reliable tool to assess a physician’s awareness of bioethics and medical law. In this preliminary study, it appears that participants have suboptimal scores on the indices which measure practice and awareness of bioethics and medical law.

Perceptions of a Group of Medical Students Regarding the Issue of Abortion: A Qualitative Analysis.

Aim: The medical ethics education given at the faculty of medicine aims to help prospective physicians develop an ethics awareness as part of their professional identity so that they can evaluate the determinants of patient-physician relationship, identify the ethical issues and problems prevailing in medical practice and researches, and find appropriate solutions to the ethical dilemmas faced while protecting ethical values. The objective of this study was to set forth the perceptions of a group of medical students at Hacettepe University regarding the issue of abortion on the basis of the movie If These Walls Could Talk. We aimed to take students’ opinions on abortion, help them ponder on this issue within the context of professional values of physicians, and investigate whether they have gained a critical perspective in terms of feminist bioethics within the framework of the elective courses “Bioethics and Cinema” and “Representation of Physicians in Cinema”, both of which were offered during undergraduate medical education at Faculty of Medicine, Hacettepe University. Method: The assignments submitted by 178 medical students about the movie “If These Walls Could Talk”, which is used as an educational course material at the Department of Medical History and Ethics, Hacettepe University, were evaluated using thematic analysis method. Before conducting the analyses of the assignments, the necessary permissions for the research were obtained from the Ethics Commission of Hacettepe University on 26.05.2017 with the approval numbered 3861. Findings: The data obtained from student assignments were categorized into main and sub themes. The themes determined upon evaluating the students’ perceptions on abortion were “Human Rights”, “Ethical Justification”, and “The Role of Society”. Conclusion and Suggestions: Our findings have demonstrated that the students have gained awareness on both personal values and professional ethical values. It can be said that the students could discuss abortion – which is an important issue of debate in bioethics – with a feminist bioethics perspective and using their critical thinking skills. Therefore, we suggest that film screenings and follow-up film debates be utilized more often in medical ethics/bioethics education.

Medical Ethics Education: An Important Step in the Teaching of Human Physiology Course for MBBS Undergraduates

At present, the phenomenon of doctor-patient conflict in our country is getting worse. The contradiction between doctors and patients can reflect that there are still many problems in medical ethics education in medical colleges and universities, and the lack of educational functions. In the current medical education process, there is a tendency towards ability education, coupled with the unreasonable design of medical theory courses, which leads to the simplification of teaching methods, and it is impossible to truly teach and educate people and cultivate high-quality skilled medical personnel for the society. Therefore, in order to build a more harmonious doctor-patient relationship, the concept of medical ethics education can be incorporated into the human physiology curriculum, so that the medical ethics education model can be successfully transformed. At the same time, teachers in medical schools should strengthen the innovation of education methods, which can essentially improve the teaching quality of medical ethics education and gradually alleviate the current doctor-patient contradiction.

English

BACKGROUND Medical ethics is a system of moral principles that govern the practice of medicine. Ethical challenges frequently arise within the field of family medicine and may lead to complications. We wanted to assess the existing knowledge, attitude, and practice of family medicine trainees currently engaged in Saudi programs in relation to medical ethics in Riyadh. METHODS A cross-sectional study was carried out which encompassed a population size of 256 trainees from a total of nine different training centres. A self-administrated questionnaire containing 28 items was used. The questionnaires were distributed manually during the month of December 2016. RESULTS 208 subjects returned the completed questionnaires with a response rate of 81.25 %. Eighty-eight percent of those surveyed agreed that a knowledge of medical ethics was important in medical practice. The most common source of knowledge of medical ethics and law of work amongst the trainees was found to be "during training" in both medical ethics (71.2 %) and law of work (60.6 %). Significantly, only thirty-eight percent participants had knowledge about content of a Saudi law of practicing healthcare professions. Meanwhile, 63.9 % were unaware of the content of the Hippocratic Code whilst 88.5 % were unaware of the content of the Nuremberg Code. Finally, 93.8 % were unaware of the Helsinki Declaration. In measuring the total scores of answers in relation to ethical problems for different values, the mean score for all respondents was 34.98 out of 50, and 51.92 of residents, got a score ≤ 35. CONCLUSIONS The knowledge, attitude, and practice of trainees toward medical ethics was found to be inadequate. It is, therefore, essential to incorporate teaching of medical ethics into future residency program for trainees as a structured course. KEY WORDS Ethics, Bioethics, Family Medicine, Training, Residency

Medical Education, Ethics, Educational Technologies, Research & Practice: Ethics in Medical Education and Practice-A Book Review

Ethics in medical research and practice has been at the forefront and a matter of debate in recent times. There have been suggestions for the inclusion of ethics as a subject in the medical graduate curriculum. This could well be due to the increasing commercialization of healthcare services throughout the world, and especially in the developing world including India.

Importance of Teaching Medical Ethics at Undergraduate Level in Medical Colleges

Importance of Teaching Medical Ethics at Undergraduate Level in Medical Colleges

ВИКЛАДАННЯ МЕДИЧНОЇ ЕТИКИ В ПЕРЕДОВИХ УНІВЕРСИТЕТАХ КИТАЮ

The article examines the issue of teaching medical ethics in leading Chinese universities in the training of medical professionals and found that medical ethics courses for physicians are an innovation for Chinese medical high schools. Due to different cultural traditions, researchers of Chinese medical ethics hold conflicting views on the scientific importance and practical necessity of medical ethics and bioethics. The study found that medical ethics education in China has gradually adapted the experience of leading countries such as the United States and the United Kingdom in teaching ethics. China is now in the process of discussing how to develop its own traditional ethics in the context of globalization. It is established that in the program of masters in medicine the formation of ethical knowledge is a mandatory subject. The teaching of medical ethics takes place not only while studying in Chinese universities, but is a long-term lifelong process in which the student summarizes the results of their efforts, combining moral reflection, learning and leadership. The article analyzes the methods and content of teaching medical ethics, which include relevant cultural, social and personal development, and the education of masters in medicine at Chinese universities.Teaching ethics in medical universities is a relatively new area of medical education in China, ethics curricula have different levels of development. In order to determine the peculiarities in the contents of curricula, teaching and learning methods, forms of evaluation and quality of teaching ethics in China, it was analyzed ethical education in several leading medical universities in China: Wuhan University School of Medicine, Guangzhou Medical University and Peking University School of Medicine. In the process of scientific research on the teaching of ethics in universities, it was found that medical ethics for some time was part of the mandatory course of disciplines, with a strong tendency to emphasize the correct ideological thinking of future physicians.Key words: specialist in medicine, medical ethics, master’s degree, higher medical education in China, professional competence of doctor.

Systematic development and refinement of a contextually relevant strategy for undergraduate medical ethics education: a qualitative study

BackgroundDelivery of medical ethics education is complex due to various reasons, compounded by the context-dependent nature of the content. The scarcity of relevant resources in the contexts of some developing countries adds a further layer of difficulty to ethics education in these contexts. We used a consultative approach with students, teachers and external experts to develop a practical approach to medical ethics education. This study aimed to develop and refine a contextually relevant approach to ethics education in the region of Saudi Arabia.MethodsThe study utilised an explorative qualitative methodology to seek views of students and faculty of Rabigh Faculty of Medicine, Saudi Arabia, and international experts in the field of ethics and education to review and enhance a new ethics learning strategy which included a workbook-based tool. Three focus groups with 12 students, in-depth interviews with four faculty members and qualitative feedback from eleven external experts enabled the study participants to objectively critique the WBEL and provide feedback to enhance its quality. Thematic content analysis of the data was done to draw inferences which were used to refine the educational strategy.ResultsThe analysis generated twenty-one sub-themes within four main themes: design features, content, teaching methods and assessment. These findings helped to design the educational strategy to improve its effectiveness in the given context.ConclusionThe study drew on the views of students, faculty and external experts to systematically develop a novel approach to ethics education for countries like Saudi Arabia. It also demonstrated the use of the consultative approach for informing a culturally relevant educational strategy in the Middle East context.

Effectiveness of ethics case based on blended learning approaches on medical students' learning: A quasi-experimental study.

BACKGROUND:The use of active teaching methods in ethics education, instead of being merely teacher centred, can lead students to problem-solving in a practical way. Therefore, this study was conducted with the aim of comprehensive medical ethics education based on educational approaches and the effect of this approach on students’ learning and moral reasoning skills.MATERIALS AND METHODS:This quasi-experimental intervention study was performed on seventy physiopathology medical students who had taken the medical ethics course. The students’ educational program included teaching theoretical concept of medical ethics, discussing ethical cases and clinical reasoning in class, and then discussing in forum environment and individual assignments in the learning management system (LMS) system and completing the portfolio. Student evaluation was associated students’ knowledge, attitu de, and moral reasoning skills and learning. A comprehensive program including forum participation, individual assignments in LMS, theory and objective structured clinical examination (OSCE) tests, and portfolio completion was used to evaluation of students. The students’ learning was compared to students of the previous year, which was conducted through a traditional teacher-centered method. Data analysis was conducted using IBM® SPSS® Statistics 21 at two levels of descriptive statistics and analytic statistics.RESULTS:The results showed that there was a significant difference between the mean learning of students compared with traditional class (P < 0.05). Furthermore, comparison of students’ practical scores through the OSCE test showed its impact on changing students’ knowledge, attitude, and performance in moral reasoning.CONCLUSION:According to research findings, it seems that the mentioned model is one of the important and new issues as a suitable method of teaching medical ethics. Furthermore, it can be suitable model in other medical courses. The more research in multicentral may be need to assess other effects on students’ learning indicators.

Study on Ideological and Political Paradigm Curriculum—Taking Medical English Course as an Example

Ideological and political course is a comprehensive educational idea which regards "cultivating people by virtue" as the fundamental task of education. Based on nursing specialty in our school as an example. This paper analysis the medical English teaching with the combination of curriculum education in English teaching, and put forward to perfect the medical ethics education course content system, the excavation of the English curriculum ideological elements, and strengthen the moral education function of English courses, and help in cultivating have higher cultural quality, moral character of medical workers. Medical English courses should be in the same direction as ideological and political courses, and ideological and political education should run through the whole course of English teaching, so as to realize whole-course education and all-round education. This study is an effective ideological and political exploration of integrating medical humanities into English teaching, which is conducive to cultivating medical students' humanistic quality and humanistic humane sentiments.

Breaking Down Communication: Narrative Medicine and its Distinctions.

In “Communication Breakdown: Probing the Limits of Narrative Medicine and its Discontents” (2019), David J. Leichter engages practical experience teaching medical ethics in the college classroom to explore opportunities—and limits—of narrative engagement within medical ethics and clinical practice. Leichter raises concerns regarding potential epistemic harms, both testimonial and hermeneutical, when individuals, or their pain, cannot be adequately recognized through expressive modes traditionally understood as “narrative.” While I largely agree with Leichter’s worries about narrative authority and limits, I challenge his characterization of “narrative medicine.” In response, I suggest that “narrative medicine” is more than merely narrative engagement in medicine. As theorized by Rita Charon (2001, 2006), “narrative medicine” involves an inclusive approach to what narrative is, and more than mere mastery of “narrative competency.” I argue that at least one way to conceptualize “narrative medicine” is as a technical term, which refers to the process of attention, representation, and affiliation Charon develops as the achievement of narrative medicine. When understood in this technical way, narrative medicine can both resist and respond to the kinds of epistemic harms about which Leichter is rightfully worried.

Medical ethics and law for doctors of tomorrow: the consensus statement restructured and refined for the next decade

The General Medical Council’s (GMC) Outcome for Graduates, published in 2018,1 is the latest guidance for medical schools on the GMC’s expectations of the undergraduate medical curriculum. One of its...

Team-Based Learning in Medical Ethics Education: Evaluation and Preferences of Students in Oman

Objectives: The purpose of this study was to explore the impact of integrating team-based learning sessions in undergraduate medical ethics education. Though used effectively in other pre-clinical courses, team-based learning is not frequently used in medical ethics education. Student’s accountability for learning, preference for team-based learning, and satisfaction were studied. Methods: Three team-based learning sessions covering focal topics in medical ethics was introduced in the pre-clinical Health Care Ethics course for students at the College of Medicine and Health Sciences, National University of Science and Technology. On the completion of three modules, the team-based learning student assessment instrument (TBL-SAI) by Heidi Mennenga was used to evaluate student perceptions. To this aim, 118 students who had registered for the Health Care Ethics course completed the survey. Results: The findings indicated that students reported a positive experience of team-based learning in medical ethics education. Students also indicated high accountability for their learning, a high preference for team-based learning to lectures in the medical ethics course, and high satisfaction. Conclusions: Team-based learning is thus preferred by students to cover topics and courses in medical ethics. Integrating team-based modules in medical ethics education will enhance self-directed learning, improve teamwork, and help students effectively recall and apply information. It is therefore recommended to integrate team-based learning sessions in medical ethics education.

Changing the channel on medical ethics education: systematic review and qualitative analysis of didactic-icebreakers in medical ethics and professionalism teaching.

As medical ethics and professionalism education continues to equip medical students and residents with long-lasting tools, educators should continue to supplement proven teaching strategies with engaging, relatable, and generationally appropriate didacticsupplements. However, popular teaching aids have recently been criticized in the literature and summative information on alternatives is absent. The purpose of this review is to evaluate and assess the functional use and application of short form audiovisual didactic supplements or "icebreakers" in medical ethics and professionalism teaching. A systematic review of both the medical and humanities literature (i.e., PubMed/MEDLINE, Cochrane Library, and JSTOR) was conducted from inception to August 1, 2019. Final articles were subjected to a qualitative appraisal and thematic analysis. Thirteen articles were included forfinal analysis. Sixty-nine percent (n = 9) of the studies were published after 2000. Two studies were qualitative, one study was quantitative,and the remaining articleswere commentaries. Short form audiovisual media was most popular outside of the United States (n = 10). Sixty-nine percent (n = 9) of articles advocated for self-contained media in the form of trigger films or short films/videos, while the remaining articles (n = 4) discussedthe use of TV/film clips. Producibility of media was exclusive to short/trigger films. Nine themes were identified in the content analysis: adaptability, conversation catalyst, effective, engaging, nuance, practice, producibility, real, and subject diversity. The three most common themes in descending order of frequency were: conversation catalyst, realness, and adaptability. Trigger films represent an effective and unique pedagogical strategy in supplementing current medical ethics and professionalism teaching at the medical school level.

Ethical Pricing: a Confucian Perspective.

Based on an analysis of a landmark case Lim Mey Lee Susan v Singapore Medical Council in Singapore where a doctor was professionally disciplined for over-charging a wealthy patient, a judgement upheld by the Singapore High Court, this paper will discuss the notion of an 'ethical price' (EP) and its determination with respect to the provision of healthcare services. It will first examine the limitations of a legal approach for setting an ethical limit to pricing. From there, it will argue that Confucian philosophy provides a useful ethical framework to explore EP, with focus on the context of Singapore. The following question is addressed: What is an ethical pricing standard for medical practice from a Confucian perspective? The strengths and limitations of a Confucian value base as regards the determination of an objective EP will be analysed through an examination of the shortcomings of the doctor's behaviour in the Susan Lim case as well as other case scenarios. The paper will conclude with some practical suggestions on how Confucian-based ideas can be applied to decision-making on pricing and the importance of this for medical professionalism and ethics teaching.

Assessment of medical students’ achievement of Najaf Abad Islamic Azad University educational objectives of medical ethics course using manuscript of them from “Extreme Measures” film

Medical ethics is a practical key element in the medical curriculum. Movies can be used as an effective and innovative way to involve students in discussions and reflections on ethical issues. This study aimed to evaluate the appropriateness of medical movies as a tool in medical ethics education. During the last teaching session of the medical ethics courses, the movie “Extreme Measures” was shown to the medical students. The present study is a descriptive-analytical study of 302 students’ manuscripts. The quantitative content analysis of the students’ manuscripts was carried out using a checklist that contained 11 titles and 75 subtitles. Each student’s checklist was compared to the student’s final exam score. The most recognized issue was justice (98%), and the least recognized one was confidentiality and privacy (8%). Nonmaleficence, respecting autonomy and informed consent, honor and integrity, end of life, duty and responsibility, conflict of interest, beneficence, relationship with colleagues and altruism were located in-between. There was a relationship between students’ final exam scores and their manuscripts’ scores. According to our findings, relevant movies with standard categorization can be used as a useful method for medical ethics education and assessment.

Improving global access to medical ethics education: a free self-paced online course on the Peoples-uni website.

In an attempt to increase global access to education about medical ethics, a free fully online course was developed on the Peoples-uni Open Online Courses site. Students came from 60 countries and were more likely to be medical practitioners, have come from the global North, and to have heard about the course through the web than other students enrolled in the Peoples-uni Open Online Courses site. Students scored high marks on the five quizzes. A third of the students gained a certificate of completion. Course feedback was overwhelmingly positive. Students stated that they learned the most from the lesson on professionalism, while other topics such as patient rights and autonomy, legal issues, and healthcare organisation and public health were also frequently mentioned. The course is an example of how open online courses can play a role in increasing awareness of medical ethics. Based on its analysis, the study identifies a need to attract interest in this area from low- and middle-income countries.

懸田賞受賞リレー・エッセイ : 平成12年度 (第5号) 医の倫理教育を長いことしてみて感じること

懸田賞受賞リレー・エッセイ : 平成12年度 (第5号) 医の倫理教育を長いことしてみて感じること

Medical ethics education in Australian and New Zealand (ANZ) medical schools: a mixed methods study to review how medical ethics is taught in ANZ medical programs

The objective of this study was to review the design and delivery of medical ethics (ME) education within medical programs across Australia and New Zealand (ANZ), how current teaching has been informed by the proposed core curriculum published in 2001 by the ATEAM (Braunack-Mayer et al. 2001) and how it could look moving forward. We conducted a mixed methods study using an online questionnaire consisting of 51 items. This included both binary and open-ended questions to categorise and explore similarities and differences in medical ethics curricula in medical programs accredited by the Australian Medical Council (AMC) across ANZ. Participants were asked about curriculum design format, duration, goals, assessments, content areas of their own ME curriculum. Convenors from 18 universities responded (78%). The main commonality was that ME curricula were integrated both longitudinally and laterally with other content. There was also commonality in content areas addressed. The goals, format, educators, and assessments of the ME curricula were highly variable. Most respondents described a curriculum which prioritised knowledge and skill development related to ME. Although the core goals of including knowledge, skills, and attitudinal development in ME curricula are still present, there is no uniformity in terms of format, delivery, or assessment across medical programs in ANZ. This is an area for collaborative development.

Medical Students’ Exposure to Ethics Conflicts in Clinical Training: Implications for Timing UME Bioethics Education

While there is significant consensus that undergraduate medical education (UME) should include bioethics training, there is widespread debate about how to teach bioethics to medical students. Educators disagree about course methods and approaches, the topics that should be covered, and the effectiveness and metrics for UME ethics training. One issue that has received scant attention is the timing of bioethics education during medical training. The existing literature suggests that most medical ethics education occurs in the pre-clinical years. Follow-up studies indicate that medical students in their clinical rotations have little recall or ability to apply ethics concepts that were learned in their pre-clinical training. Trainees also report a desire for medical ethics to be taught in the context of practical application, which would suggest that the timing of pre-clinical ethics education is flawed. However, moving bioethics training to the clinical years should not be assumed to be the solution to the problems of recall and theory application. We argue that the effectiveness of timing bioethics education will depend on when medical students witness or experience particular categories of ethical dilemmas during their training. Our overarching hypothesis is that ethics education will be most effective when the bioethics training on a particular topic correlates to experiential exposure to that ethical issue. The purpose of our current study was to describe medical students exposure to particular categories of ethical conflicts, dilemmas, or issues. Our results may help bioethics educators better strategize about the most effective timing of medical ethics training in UME.