BackgroundThe COVID-19 pandemic introduced new challenges to provide care and educate junior doctors (resident physicians). We sought to understand the positive and negative experiences of first-year resident physicians and describe potential ethical issues from their stories.MethodWe used narrative inquiry (NI) methodology and applied a semistructured interview guide with questions pertaining to ethical principles and both positive and negative aspects of the pandemic. Sampling was purposive. Interviews were audio recorded and transcribed. Three members of the research team coded transcripts (...) in duplicate to elicit themes. Discrepancies were resolved through discussion to attain consensus. A composite story with threads was constructed.Results11 residents participated across several programmes. Three main themes emerged from the participants’ stories: (1) complexities in navigating intersecting healthcare and medical education systems, (2) balancing public health and the public good versus the individual and (3) fair health systems planning/healthcare delivery. Within these themes, participants’ journeys through the first wave were elicited through the threads of (1) engage us, (2) because we see the need for the duty to treat and (3) we are all in this together.DiscussionCases of the ethical issues that took place during the COVID-19 pandemic may serve as a foundation on which ethics teaching and future pandemic planning can take place. Principles of clinical ethics and their limitations, when applied to public health issues, could help in contrasting clinical ethics with public health ethics.ConclusionEfforts to understand how resident physicians can navigate public health emergencies along with the ethical issues that arise could benefit both residency education and healthcare systems. (shrink)

The importance of bioethics education as a valuable tool to be responsive to medicine’s complexities is affirmed by graduate medical education accreditation bodies and professional organizations alike. The Accreditation Council for Graduate Medical Education, the body that accredits the majority of medical residency and fellowship programs in the United States, affirms the importance of ethics training for physicians in training. How this is accomplished is largely left to the prerogative of individual programs to manage, as benchmarks or (...) milestones to ascertain this are not firmly in place. However, there is doubt that significant education in bioethics is being accomplished by individual residency programs. This review searched the PubMed database for relevant articles on the scope and objectives of ethics education in US and Canadian family medicine residency programs. (shrink)

This article argues that because racial inequalities are embedded in American society, as well as in medicine, more evidence-based investigation of the effects and implications of affirmative action is needed. Residency training programs should also seek ways to recruit medical students from underrepresented groups and to create effective mentorship programs.

Medical-legal partnerships (MLPs) support patients and clinicians by streamlining legal and medical care and helping identify and address a subset of social drivers of health (SDOH). Less is known on the effect of MLPs on the competency of residents regarding SDOH. The aim of this study was to identify how integration of an MLP into a pediatric residency training program affected residents’ experience understanding and addressing SDOH.

This study examined knowledge of sea lions for both residents and tourists on San Cristóbal Island in the Galápagos, a famous nature tourism destination. Participants obtained through convenience and snowball sampling answered questionnaires about their knowledge of sea lions. Participants with higher education received higher overall scores, but participants’ education and age influenced answers on only a few questions. Residents and tourists obtained comparable overall scores, exhibiting extensive knowledge of sea lion behavior and life history. Whether participants were (...) residents or tourists influenced answers to several questions, but when only participants with 13 years of education or more were examined, few differences in answers remained between residents or tourists. Participants’ broad knowledge of sea lions may be attributed to the items of knowledge tested, participants’ motivations for travel to the Galápagos, and the fact that sea lions are an engaging and ubiquitous animal. (shrink)

This present article explores the effects of cultural value, economic prosperity, and community mental wellbeing through multi-sectoral infrastructure growth projects under the Belt and Road Initiative. The implications of the social exchange theory are applied to observe the support of the local community for the China-Pakistan Economic Corridor. This study explores the CPEC initiative, it’s direct social, cultural, economic development, and risk of environmental factors that affect residents’ lives and the local community’s wellbeing. CPEC is a multibillion-dollar project to uplift (...) economic growth and free trade between Pakistan, China, and other regional stakeholders. Although CPEC is still in its initial phases with partial startups, policymakers and government officials claim this mega project as a “game-changer” in the region, mainly for Pakistan and China. This gigantic project offers the significant potential to generate business slews and employment opportunities with international outreach. Due to the term’s newness, numerous studies have recently explored the macro and microeconomic benefits of the CPEC initiatives; still, these projects are theoretical. The existing literature insufficiently explored how helpful CPEC would be to a specific group and how residents perceive its advantages. This study fills in the literature gaps and explores the likely advantageous potential of the CPEC for the regional states. The study applied a convenient sampling technique for the data collection process. It used a mixed-method approach to gain scientific results, with a standardized questionnaire survey of 459 people from five major cities of Pakistan. The study results designate that residents believe that CPEC infrastructure projects will significantly improve residents’ life quality through more job openings and community poverty reduction. Still, they raised their concerns regarding environmental protection issues in the region. The findings specified that residents had an optimistic approach to better educational productivity by adopting environment-oriented policies. Policymakers should establish new CPEC study centers in different areas, and investors should be encouraged to participate in the industrial sector. Officials can overwhelm community worries about environmental degradation. Government officials in both countries can utilize the findings to raise public awareness about CPEC’s social, economic, cultural, mental wellbeing, and ecological implications. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Response to Alexandra Kertz-Welzel’s “Two Souls, Alas, Reside within My Breast”: Reflections on German and American Music Education Regarding the Internationalization of Music EducationPhilosophy of Music Education Review, 21, no.1 (Spring 2013): 52–65Leonard TanAs a Singaporean who, like Kertz-Welzel, spent four years residing in the United States, I read the article with great interest. Born to traditional Chinese parents, I was raised steeped in Confucian values, savored (...) Chinese operas, and spoke Mandarin as a child. When I went to school in postcolonial Singapore, however, the medium of instruction was primarily English. I read Enid Blyton in primary school, Shakespeare in secondary school, and Chaucer in Junior College. My university studies in music were Western-centric. All seemed fine until my doctoral studies in the United States when I was inspired by my music education professor to revisit my cultural roots and to read Chinese philosophy. It was [End Page 113] no easy task reading the original texts—they were written on bamboo slips more than two thousand years ago in classical Chinese, and I needed tuition from my mother. Nevertheless, as I worked my way slowly but surely through each character, one thing became unmistakably clear: although I had read more Western than Asian philosophy, many ideas in the ancient Chinese texts resonate with the innermost recesses of my being and are unmistakably a part of who I am as a Chinese Singaporean, albeit one schooled in Western ways.Two souls, alas, have been residing within my breast! Like Kertz-Welzel, I had to find a way to reconcile my two scholarly identities. How may one negotiate the seeming chasm between the Chinese and Western philosophical worlds? In this paper, I sketch some insights gleaned from my journey into the world of comparative philosophy, specifically, classical Chinese philosophy and American pragmatism. In particular, I address two obstacles to the internationalization of music education identified by Kertz-Welzel, namely, the tendency for researchers to know only one scholarly tradition well, and the use of English as an international language. I then proffer Dewey’s metaphor of “friendship” as a way of charting a new “silk road”—one that blends Eastern and Western ideas—for the philosophy of music education.As noted by Kertz-Welzel, many researchers only know one scholarly tradition well. Dangers lurk when scholars have limited knowledge of foreign philosophical enterprises. To begin with, one may fall into the trap of stereotypical preconceptions. For example, I have been asked if it were methodologically sound to juxtapose Chinese philosophical aphorisms with the closely argued texts of the American pragmatists. The basis of this critique is understandable: think Confucius and aphoristic phrases that teach humans how to lead moral lives immediately spring to mind; think Dewey and one is reminded of the depth and breadth of his philosophical arguments. Chinese philosophical texts, however, are by no means mere aphorisms. While the Analects of Confucius may, prima facie, appear as if it were a random collection of brief sayings, many passages relate to one another and cohere as a philosophy. The rich commentarial tradition that spans over two thousand years further augment the range of insights embedded in the Analects. Post Confucius, Xunzi, the philosopher best known for his argument that human nature is evil and ought to be cultivated through ritual (li 禮) and music (yue 乐), articulated his philosophy through thirty-two books that rival Dewey in richness and complexity.1 For two souls to reside within one breast, one has to remain vigilant against potential stereotypes.The tendency to know only one scholarly tradition well may also inadvertently cause one to judge a foreign philosophical tradition using the standards of the familiar one. When encountering Confucius for the first time, scholars schooled in European philosophy may, as Hegel did, criticize him for being a [End Page 114] shallow moralizer obsessed with rituals (li 禮) rather than a speculative philosopher concerned with theoretical matters.2 Such a judgment is misguided as it ignores the fact that the Chinese philosophical tradition was founded on a set of metaphysical assumptions that differed from its Greek counterpart. Seeing the cosmos in discrete, quantitative, and unchanging terms, the ancient... (shrink)

In recent years, the internationalization of music education has become an important topic. Scholars of various research traditions try to find the best solutions for problems in music education theory and practice by taking a look at what other countries do. English as common language seems to facilitate this recent development. However, in spite of this seemingly unproblematic way of communicating, there are various obstacles which make the mutual understanding and the internationalization of music education difficult. This (...) particularly concerns different scholarly cultures and traditions of presenting research, both in written papers and oral presentations. Most scholars realize that there are difficulties, but because they mostly only know one culture of research well, they are not aware of the reasons for these problems. Therefore, it is important to take a critical look at the scholarly traditions in Germany and the United States, examining reasons and suggesting solutions for an internationalization of music education that takes into account the strengths of various traditions, while at the same time fostering international understanding and the improvement of music education all over the world. (shrink)

Understanding the intersections of science and publics has led to research on how diverse publics interpret scientific information and form positions on science-related issues. Research demonstrates that attitudes toward science, political and religious orientation, and other social factors affect adult interactions with science, which has implications for how adults influence K-12 STEM (science, technology, engineering, and mathematics) education. Based on a statewide survey of adults in Idaho (n = 407), a politically and religiously conservative western state, we demonstrate how (...) attitudes toward science, measured through a composite measure “orientation toward science,” and other social factors are correlated with support for STEM education. Results show that “orientation toward science,” along with political orientation and respondents’ perceptions of feeling informed about science, predicts behavior intentions to support STEM education. Our findings suggest that a nuanced and localized approach to fostering support for K-12 STEM education would resonate with populations regardless of political orientation, and they illuminate new ways of thinking about how political orientation more generally impacts thinking about science in the context of complicated “socio-scientific relations.” In exploring how people think about science in a politically and religiously conservative state, we provide insights on potential outcomes in other states, should conservative ideology spread. We argue that the publics’ relationship with science and, by extension, support for science education, is more fluid, as many of us suspect, than ideological polemics suggest. (shrink)

Background Interest in strengthening residents’ autonomy in nursing homes is intensifying and professional caregivers’ experience ethical dilemmas when the principles of beneficence and autonomy conflict. This increased focus requires expanded knowledge of how residents experience decision-making in nursing homes and how being subject to paternalism affects residents’ dignity. Research question/aim This study explored how residents experience paternalism in nursing homes. Research design This study involved a qualitative interpretive design with participant observations and semi-structured interviews. The interpretations were informed by Gadamer’s (...) hermeneutics. Participants and research context Eleven residents were interviewed after a period of participant observation in two nursing homes. Ethical considerations The study was performed in accordance with the Helsinki declaration. The Regional Ethics Committee (REK) permitted the researcher to perform participant observation in the nursing homes. The use of audio recordings of interviews was registered and supervised by Sikt - Norwegian Agency for Shared Services in Education and Research. The resident’s consent was assessed continuously. Three interviews were terminated for ethical reasons. Findings The resident interviews revealed that residents found it obvious for caregivers to possess the decision-making authority in nursing homes. When residents explained their views, three main themes emerged: (1) To be included even though caregivers make the decisions, (2) Surrender to dependency, and (3) Adherence to nursing home norms. Conclusions Residents submit to their caregivers and give caregivers the responsibility and function as leaders. Paternalism was experienced as dignifying in situations where it contributed to residents being able to live according to second order desires and values, and when it implied respect and appraisal of residents’ capabilities. Paternalism was experienced as debasing when residents felt left out, and when residents felt that their capabilities were underestimated. This also included their capability to withstand paternalistic influence. (shrink)

Recent studies show that psychiatry residents express a relatively greater need for ethics curricula than their colleagues in other specialties. Such studies have been limited in their generalizability because they were conducted at one site. This study of 151 psychiatry residents at seven U.S. psychiatry programs aims to address that limitation. Residents were surveyed on issues pertaining to ethics and professionalism education. Participants were found to support such curricula during training and to value its relevance to the practice of (...) psychiatry. Gender differences and the influence of the “hidden curriculum” on such results merit further study. (shrink)

Formal training in clinical ethics must become a central part of residency curricula to prepare practitioners to manage the ethical dimensions of patient care. Residency educators must ground their teaching in an understanding of the conceptual, biomedical, and psychosocial aspects of the important ethical issues that arise in that field of practice. Four aspects of professional competence in clinical ethics provide a useful framework for curricular planning. The physician should learn to: (1) recognize ethical issues as they arise in clinical (...) care and identify hidden values and unacknowledged conflicts; (2) think clearly and critically about these issues in ways that lead to ethically justifiable courses of action; (3) apply those practical skills needed to implement an ethically justifiably course of action; and (4) judge when the management of a clinical situation requires consultation with individuals or institutional bodies with additional expertise or authority. We argue that these practical goals can be accomplished with a relatively modest emphasis on the theoretical aspects of medical ethics. (shrink)

BackgroundUsing Bourdieu’s cultural capital theory, this paper discusses the inequality of Chinese urban residents’ participation in physical activities caused by cultural capital and explores the relationship and role of residents’ income and self-rated health in cultural capital and physical activity participation.MethodsUsing Chinese social survey data, the proposed assumptions were tested and analyzed by using a linear regression model.ResultsCultural capital can promote the participation of Chinese urban residents in physical activities, and personal income and health self-assessment play an intermediary role in (...) promoting residents’ participation in physical activities.ConclusionPromoting Chinese residents’ participation in physical activities can be realized not only through traditional publicity and sports venue construction but also by increasing residents’ educational level, art appreciation level and health awareness. (shrink)

Background Physicians play a fundamental role in the care of patients at the end of life that includes knowing how to accompany patients, alleviate their suffering and inform them about their situation. However, in reality, doctors are part of this society that is reticent to face death and lack the proper education to manage it in their clinical practice. The objective of this study was to explore the residents’ concepts of death and related aspects, their reactions and actions in (...) situations pertaining to death in their practice, and their perceptions about existing and necessary training conditions. Methods A qualitative approach was used to examine these points in depth based on interviews conducted with seven oncology residents. Results Participants do not have a clear concept of death and, although it is seen as a common phenomenon, they consider it an enemy to beat. The situations to which respondents react more frequently with frustration and sadness after the death of patients were when they felt emotionally involved, if they identify with the patient, in cases of pediatric patients and with patients who refuse treatment. To deal with death, participants raise barriers and attempt to become insensitive. Although residents in this study recognize the importance of training to learn how to better deal with death, it seems they are not fully invested in reaching more of it. Conclusions Participants face death in a daily basis without the necessary training, which appears to impact them more than they are willing to accept. They do not achieve their goals managing situations regarding death as well as they assume they do. Despite recognizing the need of more training and support for better coping with death, they prefer to continue to learn from their experience. Trial registration Not applicable. (shrink)

Training residents to become humanistic physicians capable of empathy, compassionate communication, and holistic patient care is among our most important tasks as physician educators. Narrative medicine aims to foster those highly desirable characteristics, and previous studies have shown it to be successful in fostering self-reflection, emotional processing, and preventing burnout. We aimed to evaluate pediatric residents’ perceptions of a novel narrative medicine curriculum. After the initiation of a longitudinal narrative medicine curriculum, focus groups were conducted with residents who participated in (...) at least one narrative medicine session. The curriculum was viewed positively, and residents found the sessions to be helpful in developing empathy, offering a space for reflection, and introducing new perspectives. Challenges noted were perception of relevance, timing of sessions, and interpretation by non-native English-speaking residents. With attention to linguistics and thematic undertones, narrative medicine is a feasible, replicable, and accepted teaching modality for pediatric residents to foster empathy, process emotions, and participate in self-reflection. (shrink)

Over the past decade, a series of studies have found that physicians-in-training who work extended shifts are at increased risk of experiencing motor vehicle crashes, needlestick injuries, and medical errors. In response to public concerns and a request from Congress, the Institute of Medicine conducted an inquiry into the issue and concluded in 2009 that resident physicians should not work for more than 16 consecutive hours without sleep. They further recommended that the Centers for Medicare & Medicaid Services and (...) the Joint Commission work with the Accreditation Council for Graduate Medical Education to ensure effective enforcement of new work hour standards.The IOM's concerns with enforcement stem from well-documented non-compliance with the ACGME's 2003 work hour rules, and the ACGME's history of non-enforcement. In a nationwide cohort study, 84% of interns were found to violate the ACGME's 2003 standards in the year following their introduction. (shrink)

The residency years comprise the last period of a physician’s formal training. It is at this stage that trainees consolidate the clinical skills required for independent practice and achieve a level of ethical development essential to their work as physicians, a process known as professional identity formation (PIF). Ethics education is thought to contribute to ethical development and to that end the Royal College of Physicians and Surgeons of Canada (RCPSC) requires that formal ethics education be integrated within (...) all postgraduate specialty training programs. However, a formal ethics curriculum can operate in parallel with informal and hidden ethics curricula, the latter being more subtle, pervasive, and influential in shaping learner attitudes and behavior. This paper reports on a study of the formal, informal, and hidden ethics curricula at two postgraduate psychiatry programs in Canada. Based on the analysis of data sources, we relate the divergences between the formal, informal, and hidden ethics curricula to two aspects of professional identity formation (PIF) during psychiatry residency training. The first is the idea of group membership. Adherence to the hidden curriculum in certain circumstances determines whether residents become part of an in-group or demonstrate a sense of belonging to that group. The second aspect of PIF we explore is the ambiguous role of the resident as a student and a practitioner. In ethically challenging situations, adherence to the messages of the hidden curriculum is influenced by and influences whether residents act as students, practitioners, or both. This paper describes the hidden curriculum in action and in interaction with PIF. Our analysis offers a complementary, empirical perspective to the theoretical literature concerning PIF in medical education. This literature tends to position sound ethical decision-making as the end result of PIF. Our analysis points out that the mechanism works in both directions: how residents respond to hidden curriculum in ethics can be a driver of professional identity formation. (shrink)

The health crisis due to the outbreak of Coronavirus since the beginning of 2020 has strongly exposed the effect of decades of public service cuts in France, especially in the fields of education or health. Although the French President has recently declared that the living conditions of people with disabilities were a “national priority”, this issue has not been addressed by public authorities while managing the current crisis. This article analyses and helps to understand the situation of young people (...) with disabilities living in student residences in lockdown for about two months, an issue that has been overlooked. The case study is based on a series of interviews with Joseph, a blind Master’s student, and some of his relatives. It looks back on Joseph’s experience and academic career, his living conditions in lockdown, his difficulties in coping with distance learning, as well as the resources and support he gets to be able to live and get through. (shrink)

This study analyzes the influence of grandmothers’ household residency on the presence of low height-for-age and excessive fat, waist circumference, and sum of triceps and subscapular skinfolds in a sample of 247 6- to 8-year-old urban Maya children from Yucatan, Mexico. Between September 2011 and January 2014, we obtained anthropometric and body composition data from children and mothers, as well as socioeconomic characteristics of participants and households. Grandmothers’ place of residence was categorized as either in the same household as their (...) grandchildren or in separate households. Multiple logistic regression models were used to analyze the association between grandmothers’ residency and outcome variables. Models were adjusted for maternal anthropometric characteristics and the following socioeconomic variables: family size, location, maternal education, monthly family income, and household crowding. Models showed that the presence of grandmothers in their grandchildren’s households was not associated with any of the outcome variables. In contrast, larger family size, overcrowding in the household, and lower family income predicted low height-for-age in children. Larger family size decreased the risk for being overweight based on the three parameters of body composition. Overcrowding in the household increased the risk for greater skinfolds thickness, while low family income increased the risk for higher fat mass index. The residency of grandmothers in their adult daughters’ households is not significantly associated with the outcome variables in this sample of urban Maya families. Instead, maternal anthropometric characteristics and socioeconomic conditions of the family have a greater influence on the overall growth of children. (shrink)

Training in ethics and professionalism is a fundamental component of residency education, yet there is little empirical information to guide curricula. The objective of this study is to describe empirically derived ethics objectives for ethics and professionalism training for multiple specialties. Study design is a thematic analysis of documents, semi-structured interviews, and focus groups conducted in a setting of an academic medical center, Veterans Administration, and community hospital training more than 1000 residents. Participants were 84 informants in 13 specialties (...) including residents, program directors, faculty, practicing physicians, and ethics committees. Thematic analysis identified commonalities across informants and specialties. Resident and nonresident informants identified consent, interprofessional relationships, family interactions, communication skills, and end-of-life care as essential components of training. Nonresidents also emphasized formal ethics instruction, resource allocation, and self-monitoring, whereas residents emphasized the learning environment and resident-attending interactions. Conclusions are that empirically derived learning needs for ethics and professionalism included many topics, such as informed consent and resource allocation, relevant for most specialties, providing opportunities for shared curricula and resources. (shrink)

Abstract‘We just do not have enough time’. A statement uttered too often in the field of education. Having taught in K-12 schools, universities, and accelerated K-12 and higher education classes, I am no stranger to the myriad of conversations on time that swirl in these spaces. All too frequently, I heard statements like: ‘there is not enough time in the schedule to do this work’, ‘time is our enemy’, ‘do the best you can with the limited time you (...) have’, and witnessed many discussions of entanglements with time, be they individual, institutional, or structural. This article explores issues of time within hybrid/third-space working groups embedded within a teacher residency in an urban Southeastern city of the United States. In exploring the question: what role does time play in hybrid teacher residency work? This article demonstrates how time operates as a structural constraint, as a nonhuman agent, and/or is mobilized to escape/evade the nuanced and complex work of doing/thinking anti-racist abolitionist residency work across practice and theory. (shrink)

In this article Elias Hemelsoet questions the way irregular migrants are approached in educational policymaking. In most cases, estimations of the number of irregular migrants serve—despite large methodological problems—as a starting point for policymaking. Given the very diverse composition of this group of people, the question is whether residence status is an appropriate benchmark for dealing with the social problems related to these people. There seems to be a homogenizing tendency at work that reduces the complexity of irregular migration. Preferable (...) distinctions are overlooked or even denied. Inclusive education seems to provide an alternative that does not reduce individuals to a group they belong to, claiming that differences only matter at the individual level. The question is whether such an approach entails a new form of homogenization. Using the case of Roma people, Hemelsoet argues here that group differences do matter for educational practice, theory, and policy. Qualitative data on the social practices of groups can help provide insight into the particularity of situations. This “insight” or “understanding,” in its turn, is a requirement in order for policymakers to make well‐considered choices. (shrink)

BackgroundThe emphasis on ethics and professionalism in medical education continues to increase. Indeed, in the United States the ACGME will require residency programs to include professionalism training in all curricula by 2007. Most courses focus on cases generated by the course instructors rather than on cases generated by the trainees. To date, however, there has been no assessment of the utility of these two case discussion formats. In order to determine the utility of instructor-generated cases (IGCs) versus resident-generated (...) cases (RGCs) in ethics and professionalism training, the author developed an innovative course that included both case formats. The IGCs were landmark cases and cases from the experience of the course instructors, while the RGCs were selected by the residents themselves. Residents were then surveyed to assess the strengths and weaknesses of each format.ResultsOf twenty-two second and third year residents, fourteen completed surveys (response rate 64%). Residents were nearly evenly split in preferring RGCs (38%), IGCs (31%), or not preferring one to the other (31%). 29% stated that they learn more from the RGCs, 21% stated that they learn more from the IGCs, and 50% stated that they did not find a difference in their learning based on format. In general, residents surveyed prefer a mix of formats. Residents tended to find the RGCs more relevant and interesting, and felt the IGCs were necessary to ensure adequate breadth of cases and concepts.ConclusionBased on our relatively small sample at a single institution, we believe that educators should consider incorporating both instructor-generated and resident-generated cases in their ethics and professionalism curricula, and should evaluate the utility of such a model at their own institution. Further work is needed to illuminate other potential improvements in ethics and professionalism education. (shrink)

One antidote to moral distress is stronger moral agency—that is, an enhanced ability to act to bring about change. The Clinical Ethics Residency for Nurses, an educational program developed and run in two large northeastern academic medical centers with funding from the Health Resources and Services Administration, intended to strengthen nurses’ moral agency. Drawing on Improving Competencies in Clinical Ethics Consultation: An Education Guide, by the American Society for Bioethics and Humanities, and on the goals of the nursing profession, (...) CERN sought to change attitudes, increase knowledge, and develop skills to act on one's knowledge. One of the key insights the faculty members brought to the design of this program is that knowledge of clinical ethics is not enough to develop moral agency. In addition to lecture‐style classes, CERN employed a variety of methods based in adult learning theory, such as active application of ethics knowledge to patient scenarios in classroom discussion, simulation, and the clinical practicum. Overwhelmingly, the feedback from the participants (sixty‐seven over three years of the program) indicated that CERN achieved transformative learning. (shrink)

Medical residency—specialty training after the completion of medical school—is an essential component of medical education and is required in order to be a licensed, independent medical practitioner in most jurisdictions. As things currently stand in the United States, the match between medical school graduates and residency programs is governed by a match between rank-order lists prepared by candidates and residencies alike. An applicant picks a number of residency programs and ranks them according to order of interest. The residency program (...) prepares a similar list, ranking the candidates it most wants in its program. A computer program compares the rankings and makes assignments according to a certain algorithm. Using these lists, the match system assigns approximately 24,000 applicants to approximately 21,000 training positions in pediatrics, obstetrics and gynecology, internal medicine, and the rest. These assignments are then announced to all parties on specific days. The system has been in place since 1952 and is overseen by the National Residency Match Program, a nonprofit organization. This system has several advantages. First of all, it standardizes the timetable for decisions, and applicants are in no position to tie up offers while waiting to hear from other institutions. Institutions are not held captive, either, in making assignments while waiting to hear from particular parties. (shrink)

Background: The Clinical Ethics Residency for Nurses was offered selectively to nurses affiliated with two academic medical centers to increase confidence in ethical decision-making. Research Question/Aim: To discover how effective the participants perceived the program and if their goals of participation had been met. Research design: A total of 65 end-of-course essays (from three cohorts) were analyzed using modified directed content analysis. In-depth and recursive readings of the essays by faculty were guided by six questions that had been posed to (...) graduates. Ethical considerations: Institutional review board approval was granted for the duration of the program and its reporting period. Confidentiality was maintained via the use of codes for all evaluations including the essays and potentially identifying content redacted. Findings: An umbrella theme emerged: participants had developed ethical knowledge and skills that provided a “moral compass to navigate the many gray areas of decision-making that confront them in daily practice.” Six major themes corresponding to questions posed to the participants included the ability to advocate for good patient care; to support and empower colleagues, patients, and families; they experienced personal and professional transformation; they valued the multimodal nature of the program; and were using their new knowledge and skills in practice. However, they also recognized that their development as moral agents was an ongoing process. Discussion: Findings support that enhancing nurse confidence in their moral agency with a multimodal educational approach that includes mentored practice in ethical decision-making, enhancing communication skills and role-play can mitigate moral distress. A majority found the program personally and professionally transformative. However, they recognized that ongoing ethics discussion involvement and supportive environments would be important in their continued development of ethical agency. Conclusion: Multimodal ethics education programs have potential to be transformative and enhance nurse confidence in their ethical decision-making. (shrink)

If the new and rapidly expanding discipline of neuroethics is to have a signii cant impact on patient care, the neuroscience clinicians must become familiar with the discipline, and be competent and comfortable in applying its cognitive base and principles to clinical decisionmaking. Familiarity with and practical experience in the application of basic biomedical knowledge and principles to clinical decision- making in the neurosciences becomes the essential foundation on which to begin to integrate neuroethics into medical education. The place (...) where the building of this foundation and the initial exposure to neuroethics must begin is in the residency program. This article describes the approach developed in the neurology residency education program at the University of Calgary to move toward achieving this goal. The key elements for the development and successful implementation of the program are outlined and a brief overview of the topics covered in the sessions is described. (shrink)

Curricular design that addresses residency physician competencies in communication skills and professionalism remains a challenge. Graphic Medicine uses comics, a medium combining text and images, to communicate healthcare concepts. Narrative Medicine, in undergraduate medical education, has limited reported usage in Graduate Medical Education. Given the time constraints and intensity of GME, we hypothesized that comics as a form of narrative medicine would be an efficient medium to engage residents.The authors created a novel curriculum to promote effective communication and (...) professionalism, focusing on empathy, compassion and cultural competency. A four-week curriculum was delivered in a neurology residency program. Excerpts from non-fiction graphic memoirs about neurological conditions were read, discussed, and paired with prompt-driven drawing exercises. Qualitative surveys were used to assess acceptability of comics, usefulness of comics to convey patient illness experience, and perception of patient needs for physician-patient communication.Ninety-seven percent of residents reported the sessions were a good use of their time. Residents identified new symptoms of neurologic disorders, articulated patient communication needs, and expressed increased empathy after participation. Residents participated in drawing exercises, but these were not formally analyzed. Graphic medicine is a well received format that may build communication skills and increase empathy. (shrink)

This article examines the global and worsening problem of research misconduct as it relates to bio-medico-legal education. While research misconduct has serious legal implications, few adequate legal remedies exist to deal with it. With respect to teaching, research ethics education should be mandatory for biomedical students and physicians. Although teaching alone will not prevent misconduct, it promotes integrity, accountability, and responsibility in research. Policies and law enforcement should send a clear message that researchers should adhere to the highest (...) standards of ethics in research. It is vital that researchers and physicians understand basic aspects of law and the legal system in order to develop understanding of the medico-legal issues not just in the legal context, but with a sound grounding in ethics, social and theoretical contexts so that they can practice good medicine. Routine and holistic research ethics education across the curriculum for medical students and resident physicians, and continuing medical education for practicing doctors, are probably the best ways to accomplish this goal. (shrink)

Over the last 30 years, colleges of education across the nation have examined and deliberated how best to educate pre-service history teachers for the challenges of the modern classroom. Specifically, they sought to create and refine teacher preparation programs that foster within the pre-service history teacher the propensity to use authentic teaching practices once they are licensed and instructing independently in the classroom. Using a situated learning theoretical framework, this research study adds to the literature on this topic by (...) examining how a semester-long pre-service residency at a historic site, archive, library, or museum influences in-service history teacher pedagogy. Utilizing an ex post facto qualitative research methodology with a questionnaire, interviews, and analysis of lesson plans, this study pursued the objective of evaluating the nuances of a residency and how those experiences influence in-service pedagogical dispositions. The findings of the study conclude pre-service history teacher residencies offer valuable and unique learning spaces for the pedagogical development of pre-service history teachers by promoting authentic-based teaching models that participants carry into their in-service teaching. (shrink)

Bioethics education in residency helps trainees achieve many of the Accreditation Council for Graduate Medical Education milestones and gives them resources to respond to bioethical dilemmas. For this purpose, The Providence Center for Health Care Ethics has offered a robust clinical ethics rotation since 2000. The importance of bioethics for residents was highlighted as the COVID-19 pandemic raised significant bioethical concerns and moral distress for residents. This, combined with significant COVID-19-related practical stressors on residents led us to develop (...) a virtual ethics rotation. A virtual rotation allowed residents flexibility as they were called to help respond to the unprecedented demands of a pandemic without compromising high quality education. This virtual rotation prioritized flexibility to support resident wellbeing and ethical analysis of resident experiences. This article describes how this rotation was able to serve residents without overstraining limited bandwidth, and address the loci of resident pandemic distress. As pandemic pressures lessened, The Providence Center for Health Care Ethics transitioned to a hybrid rotation which continues to prioritize resident wellbeing and analysis of ongoing stressors while incorporating in-person elements where they can improve learning. This article provides a description of the rotation in its final form and resident feedback on its effectiveness. (shrink)

This book is about values education in early years settings and discusses theory and concepts, as well as methodological and empirical perspectives. It explores issues such as the kinds of values that are communicated between educators and children and the kind of future citizens we foster in early childhood settings. It illustrates by way of cases involving many participants, including children, educators, and researchers, who have their roots in diverse contexts, and reside in different parts of the world, including (...) Australia, Denmark, Finland, Iceland, Norway, Slovenia, and Sweden. The book carefully considers the contextualized character of the cases presented, yet argues that the questions, theories, and methodologies emphasized do inform the international debate in manifold ways. Communication of values in a broad and diverse sense is central in any pedagogy, especially for the youngest children in the educational system. Still, values education has been neglected as a research field, in education in general and particularly in the early years. This book addresses this lack of knowledge by scrutinizing various questions about values education in ECEC settings. (shrink)

This article is concerned with the educational value of raising the human body at school. Drawing inspiration from the work of Giorgio Agamben, I develop a new perspective that explores the possibility of taking the concept of physical education in a literal sense. This is to say that the specific educational content of physical education (in contradistinction to organized sporting life outside school) resides in its concentration on the physical ?as such?. This is not an obvious path to (...) explore, because defenders of physical education as a rule have to compete against the (dualist) prejudice that this discipline is merely an instrument to train the body or to keep it fit, and that it therefore should not be considered as a serious endeavour. Therefore, more often than not, apologists try to justify the relevance of physical education on the very ground that it is a practice that is concerned with something ?beyond? the merely physical that is at stake in movement activity. I argue, however, that this line of thought excludes the possibility of conceiving an alternative approach that relates the concentration on ?entirely physical? activities (as opposed to ?merely physical? activities) to an experience of potentiality. I develop this idea on the basis of an analysis of repetitive, rhythmical and collective body-exercise (e.g. running in a group or basic callisthenics). (shrink)

A limiting factor in ethics education in medical training has been difficulty in assessing competence in ethics. This study was conducted to test the concept that content analysis of pediatric residents’ personal reflections about ethics experiences can identify changes in ethical sensitivity and reasoning over time. Analysis of written narratives focused on two of our ethics curriculum’s goals: 1) To raise sensitivity to ethical issues in everyday clinical practice and 2) to enhance critical reflection on personal and professional values (...) as they affect patient care. Content analysis of written reflections was guided by a tool developed to identify and assess the level of ethical reasoning in eight domains determined to be important aspects of ethical competence. Based on the assessment of narratives written at two times (12 to 16 months/apart) during their training, residents showed significant progress in two specific domains: use of professional values, and use of personal values. Residents did not show decline in ethical reasoning in any domain. This study demonstrates that content analysis of personal narratives may provide a useful method for assessment of developing ethical sensitivity and reasoning. (shrink)

OBJECTIVE: To examine the long-term effects of an innovative curriculum on medical house officers' (HOs') knowledge, confidence, and attitudes regarding medical ethics. DESIGN: Long term cohort study. The two-year curriculum, implemented by a single physician ethicist with assistance from other faculty, was fully integrated into the programme. It consisted of monthly sessions: ethics morning report alternating with didactic conferences. The content included topics such as ethics vocabulary and principles, withdrawing life support, informed consent, and justice. Identical content was offered simultaneously (...) at the largest affiliated community hospital. SETTING: A multi-hospital university training programme from July, 1992 to June, 1994. PARTICIPANTS: Thirty-nine HOs responded in 92. Thirty HOs from the same cohort responded in 94 (response rates = 83% v 71%; P = 0.19). RESULTS: The curriculum was well received, with 96% of HOs finding the sessions stimulating. Previously validated scales of knowledge and confidence were administered at baseline and at follow-up. The average knowledge score improved 14% (P < 0.001). Confidence also improved, rising from 3.3 to 3.8 on a 5-point Likert scale (P < 0.001). These findings were independent of age, gender, religion, and prior education. The only attitudinal change was an increase in the proportion of residents who thought that ethics should be a required part of residency training (57% v 80%, P = 0.05). CONCLUSION: This curriculum appears practical, popular, and effective. It should be readily transferable to other institutions. (shrink)

In October 2012, the Loyola University Chicago Stritch School of Medicine amended its eligibility requirements for admission. In addition to U.S. citizens and permanent residents, persons who qualify for the Deferred Action for Childhood Arrivals program of the United States Citizenship and Immigration Service are now eligible for admission. Simply put, we extended the educational opportunity of medical school to people who are in a particular category of undocumented immigrants. We became the first medical school in the United States to (...) have an intentional, transparent policy of eligibility for persons eligible for the DACA program. This expanded admissions policy has gained some attention in the popular press and brought us many expressions of support. It has also dismayed a few members of our school's circle of faculty and alumni.We wish to walk you through the history of our policy's development. We believe that viewing it as it developed will make clear three pertinent ideas: this policy flows directly from the mission of medical schools, it suits a positive notion of social justice and is also compelled by a duty not to discriminate on arbitrary grounds, and educators who steward educational institutions must have the moral courage to place considerations of institutional mission and social justice above the political views and negative responses of some alumni and donors. (shrink)

Background Studies have shown that medical students and residents believe that their ethics preparation has been inadequate for handling ethical conflicts. The objective of this study was to determine the self-perceived comfort level of medical students and residents in confronting clinical ethics issues. Methods Clinical medical students and residents at the University of Maryland School of Medicine completed a web-based survey between September 2009 and February 2010. The survey consisted of a demographic section, questions regarding the respondents’ sense of comfort (...) in handling a variety of clinical ethics issues, and a set of knowledge-type questions in ethics. Results Survey respondents included 129 medical students (response rate of 40.7%) and 207 residents (response rate of 52.7%). There were only a few clinical ethics issues with which more than 70% of the respondents felt comfortable in addressing. Only a slight majority (60.8%) felt prepared, in general, to handle clinical situations involving ethics issues, and only 44.1% and 53.2% agreed that medical school and residency training, respectively, helped prepare them to handle such issues. Prior ethics training was not associated with these responses, but there was an association between the level of training (medical students vs residents) and the comfort level with many of the clinical ethics issues. Conclusions Medical educators should include ethics educational methods within the context of real-time exposure to medical ethics dilemmas experienced by physicians-in-training. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy of Music Education Review 12.2 (2004) 126-138 [Access article in PDF] Music Education for the Twenty-First Century A Philosophical View of the General Education Core Anthony J. Palmer Boston University We are all one species with one brain and neural system, yet consciousness about our existence is highly contextual. Any culturally transcendent view will still be limited to one's personal experience, analytical capabilities, and cultural (...) shaping. Nevertheless, looking beyond our narrow perspectives is essential if we are to find commonality and compatibility with all humankind.Therefore, I find it incumbent that we, as college/university professors, examine our present culture-national and global-to ascertain current conditions and what positive roles each citizen may be able to play on the larger stage of world affairs. Musician-teachers, who are the products of the curriculum, should not be exempt from the responsibilities of contributing solutions. Rather, they should produce a program that is sensitive to the larger context in which we all reside. To be sure, we have no direct control over global events. We do, however, exercise at least a modicum of control over the kind of person emerging from our courses of study.In light of the foregoing, this paper will examine (1) the present global conditions with which we are confronted, (2) responsibilities of the college/university [End Page 126] faculties toward developing students with greater awareness, (3) examination of the general education that all baccalaureate students must satisfy for the degree, (4) the education within the general education courses with a focus on the music education student, and (5) a proposal on general education. The Present Context Today we are at a juncture where no one can predict the future with any assurance of accuracy. The world in the twenty-first century has taken an unexpected turn toward greater chaos and has the potential to end life as we have known it in previous centuries. Although earlier generations experienced many changes and watershed moments, the conditions were never potentially as cataclysmic as they are today because of the explosive power of our so-called defensive weapons. In addition, fed by technology, the pace of change is extremely rapid and multiplies exponentially. Robert Wright states in this regard, Neither biological evolution nor human history is a smooth, steady process. Both pass through thresholds.... To some people, the current era has the aura of a threshold; it has that unsettling, out-of-control feeling that can portend a major shift. Technological, geopolitical, and economic change seem ominously fast, and the fabric of society seems somehow tenuous.1He goes on to say, World currency markets are rocked by the turbulent force of electronically lubricated financial speculation. Weapons of mass destruction are cultivated by rogue regimes and New Age cults. Nations seem less cohesive than before, afflicted by ethnic or religious or cultural friction. Health officials seriously discuss the prospect of a worldwide plague-the unspeakably gruesome Ebola virus, perhaps, or some microbe we don't yet know about, spread around the world by jet-propelled travelers. Even tropical storms seem to have grown more intense in recent decades, arguably a result of global warming.2The foregoing was written in 2000, well before the devastating events of September 11 and subsequent human-initiated disasters, yet it still rings true. Where are we heading? What is our future with a world torn by terror, the continual development of more destructive weapons, and a seeming lack of desire to ameliorate our differences in a peaceful manner? Add to these the inexorable advance of technology that seems to know no end. It is most likely that the world in 2050-perhaps even as early as 2025-will not be recognized by our present population, assuming that we do survive as a civilized world.Of course, the outlook is not exclusively bleak and the continued development of technology is not all on the debit side of the ledger. Advances made in [End Page 127] medicine portend the re-growing of brain cells, repair... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Aesthetics, Education, the Critical Autonomous Self, and the Culture IndustryMarianna Papastephanou (bio)IntroductionE Lucevan le Stelle disconnected both from Tosca and Puccini becomes incidental music and brings strong recollections of the detergent advertisement it once coated. Last Year in Marienbad has caused some of the deepest yawn relief to many hopefuls for the title of the sophisticated who wished to cash out the film's cultural and social capital. A (...) painting by a well-known artist in the living room of a middle-upper-class residence often matches the colors of the carpet, and a piece of African art in the corner testifies to the hosts' cosmopolitan respect for otherness and the proper dose of hybridity in their selfhood. The young of the family are said to search for freedom from the puritan lifestyle in Ecstasis. Or, they rebel against the oppressive order of the system through idolizing music bands of an unconventional style and, as a matter of fact, of "unconventional" wealth accumulated precisely through the systemic exploitation of their idolization. The whole family, including the discontented young, will unite in the enjoyment of a new movie in which, just as in hundreds before it, police detectives can solve cases only after their suspension from duty and foreigners prefer to converse in perfect English when they are alone. What all members of the family are sure of by the end of the day, some of them through the prism of heavy drinking and others in the sober appreciation of the latest reality show, is that they exercised once again their free will in all instances. For they oriented their desires, treated as natural and self-posited, to objects they initially lacked but "autonomously" and "critically" found and selected from a rich and all-encompassing marketplace of culture. [End Page 75]How are art, its education, and its educational ideals of autonomy and critique related to this particular cultural reality that I have highlighted? Pseudo-individualism, escapism, Ersatzbefriedigung, fetishization, reification, and educationalization are some of the terms Adorno employed to approach the reality of artistic production and reception in capitalist times while preserving the distance that art offers for critiquing reality.1 In contrast with the above-sketched reality, in Adorno's ultimate aesthetic vision through art the self is not supposed to "forget in dreams the present world, but to change it by the strength of an image."2 Adorno attacks the drive toward a "totally administered" society—that of late capitalism—which "reduces every aspect of present-day life to the dead level of conformist popular 'taste' as dictated by a wholesale culture industry given over to the purposes of mass indoctrination."3 Fundamentally, the culture industry hinders the formation of autonomous, critical, and independent individuals.4I shall argue that such a theoretical framework gives us additional insight through which to combat what has already been perceived in pedagogical discourse as educational inability to cultivate reflective and critical subjectivities. Instead of autonomy, education nurtures narcissism. and instead of critique, it promotes appeasement5 —all the more so when education succumbs to the culture industry or fails to encourage students' critical stance to its imperatives.My position here is that by reclaiming their own valuable connection to reflective artistic experience and reception, aesthetic theory and art education can contribute to a reconceptualization of autonomy and critique and, perhaps more importantly, to a reorientation of educational practice.6 Adorno's aesthetics is exceptionally relevant to this aim because his work exemplifies in a unique way the necessary awareness of the antinomic qualities of autonomy and critique, their ineluctable dependence on society and culture, and their secret culpability in domination. Moreover, Adorno's cultural criticism comprises an unsurpassable diagnosis of those social pathologies that leads away from critical and reflective subjectivity and offers conceptual means for setting a critical eye on some current impoverished practices of teaching art. Above all, Adorno's aesthetic theory displays a remarkable topicality regarding contemporary positions on purely artistic concerns and contentions. Thus, the current neglect of his work in aesthetic educational theory7 must be dealt with since accommodation of such aesthetics within art educational discourse will serve significantly the latter's... (shrink)

Background: Attending surgeons must maintain balance between promoting education and assuring safe, transparent patient care. This investigation aimed to define ethics that guide surgical training. We hypothesized that resident autonomy in the operating room is influenced by attending approach to patients, specifically patients considered to be vulnerable. Materials and Methods: After IRB approval, surgeons from three institutions were invited to participate in a pilot, survey, exploring how principles of patient autonomy, physician beneficence, nonmaleficence, and justice apply to participant (...) opinions. Responses were transcribed and coded for quantitative and qualitative analysis. Results: 51 attendings and 55 residents completed the survey. We identified that patient autonomy is upheld through transparent consent practices. Intraoperative supervision is a key practice that maintains the principles of physician beneficence and nonmaleficence and mitigates the risk of resident participation. Vulnerable patients were defined by respondents as those unable to participate in their own consent and those limited by social determinants of health and barriers to medical literacy. In contrast, resident participation is not limited in the care of vulnerable patients but is restricted in cases of higher complexity and those procedures deemed to have lower error margins. Conclusions: Although residents measure the success of their training based on their level of intraoperative independence, autonomy afforded to the resident does not only depend on objective skill. There are ethical considerations that the attending must navigate as they decide on effective teaching and safe surgical management, which is especially relevant in the care of complex cases. (shrink)