IntroductionExperimental research on animals has been guided by principles of the three Rs: reduction, refinement and replacement.1 Recently the fourth R—rehabilitation—has also been incorporated to enhance the welfare of animals that are used in research. With growing scientific curiosity and increasing research, animal use has anything but reduced despite the fact that modern technology has brought to fore many alternatives to animal use.2 ,3 There are many arguments for and against animal use. In India, there has been a proposal to (...) ban the use of animals for training and academic purposes, as reported in two major daily newspapers. This has evoked mixed reactions from the scientific community. We conducted this study to assess the awareness, attitudes and practices regarding the use of animals and their alternatives, in medical training and research amongst medical teachers and students.Study designA …. (shrink)

Problem: Medical student mistreatment, as well as patient and staff mistreatment by all levels of medical trainees and faculty, is still prevalent in U.S. clinical training. Largely missing in interventions to reduce mistreatment is acknowledgement of the abuse of power produced by the hierarchical structure in which medicine is practiced. Approach: Beginning in 2001, Yale School of Medicine has held annual “Power Day” workshops for third year medical students and advanced practice nursing students, to define and (...) analyse power dynamics within the medical hierarchy and hidden curriculum using literature, guest speakers, and small groups. During rotations, medical students write narratives about the use of power witnessed in the wards. In response to student and small group leader feedback, workshop organizers have developed additional activities related to examining and changing the use of power in clinical teams. Outcome: Emerging narrative themes included the potential impact of small acts and students feeling “mute” and “complicit” in morally distressing situations. Small groups provided safe spaces for advice, support, and professional identity formation. By 2005, students recognized residents that used power positively with Power Day awards and alumni served as keynote speakers on the use of power in medicine. By 2010, departments including OB/GYN, surgery, psychiatry, and paediatrics, had added weekly team Power Hour discussions. Next Steps: The authors highlight barriers, benefits, and lessons learned. Barriers include the notion of clinical irrelevance and resistance to the word “power” due to perceived accusation of abuse. Benefits include promoting open dialogue about power, fostering inter-professional collaboration, rewarding positive role modelling by residents and faculty, and creating a network of trainee empowerment and leadership. Furthermore, faculty have started to ask that issues of power be addressed in a more transparent way at their level of the hierarchy as well. (shrink)

During medical training students and residents reconstruct their view of the world. Patients become bodies; both the faults and the virtues of the medical profession become exaggerated. This reconstruction has moral relevance: it is in part a moral blindness. The pain of medical training, together with its narrowness, contributes substantially to these faulty reconstructions. Possible improvements include teaching more social science, selecting chief residents and faculty for their attitudes, helping students acquire communication skills, and helping (...) them deal with their own pain. Most importantly, clearer moral vision requires time and scope for reflection. (shrink)

There is a need to consider the impact of the new resident-hours regulations on the variety of aspects of medical education and patient care. Most existing literature about this subject has focused on the role of fatigue in resident performance, education, and health care delivery. However, there are other possible consequences of these new regulations, including a negative impact on decision ownership. Our main assumption of is that increased shift work in medicine can decrease ownership of treatment decisions and (...) impact negatively on quality of care. We review some potential components of decision ownership in treatment context and suggest possible ways in which the absence of decision ownership may decrease the quality of medical decision making. The article opens with the definition of decision ownership and the overview of some contextual factors that may contribute to the development of ownership in medical residency. The following section discusses decision ownership in medical care from the perspe... (shrink)

This reflective essay is an attempt to organize trends in feedback I have observed during ten years of coursework, conversations, and correspondence with former students associated with the Medical Humanities Program at Baylor University. Over the years, recurrent themes arise when speaking with alumni about whether and how their medical humanities experience intersects with their current training. I have identified five particular domains in which baccalaureate medical humanities training affects students’ subsequent healthcare professions training (...) and practice: context and complementarity, clinical relevance, reflective practice, professional preparedness and vocational calling. I created an instrument of open-ended questions for each of these categories and posted it to social media with an invitation for alumni to respond. This informal survey was conceived as an exploratory exercise with the intent to help generate a foundation for more formal qualitative research in these five domains. In this essay, I offer my own reflections together with those of former students on the impact of baccalaureate-level medical humanities training in order to illustrate the benefits in each domain for subsequent healthcare training and practice. The need for qualitative research that explores the impact of baccalaureate medical humanities merits collaboration between multiple centers of investigation across many disciplines, and across the divide between premedical and medical educators. (shrink)

An examination of the use of medical simulators shows that they contain traces of the one-sex body model found in pre-Enlightenment anatomies. The simulators present the male body as ‘male including female’ rather than ‘male, not female’. Only when female sex organs are relevant to a practice, as in gynaecology, does a simulator need to become ‘female, not male’. The widely held modernist understanding of sex and gender as binary categories is actually masking local practices which allow varied sex (...) and gender paradigms to coexist in simulator use. This analysis applies the discussions of Laqueur, Schiebinger and Faulkner to simulator practice. The consequences of recognizing the presence of the one-sex body are two-fold. Firstly, seeing that the reification of medical knowledge can still be haunted by conceptual paradigms of the past forces a more nuanced understanding of the variety that localized medical practices contain. Secondly, observing the ease with which the reified knowledge of a one-sex body is embraced by subjects who also exist in a world of binary gender points to the complexity our subjectivities can embrace and forces the researcher to acknowledge the implications of the simulations’ context. (shrink)

This article presents an overview of generally available applications for creating multimedia and interactive educational materials, such as presentations, instructional videos, self-tests and interactive repetitions. With the use of the presented tools, pilot materials were developed to support the teaching of biostatistics at a medical university. The authors conducted surveys among students of faculties of medicine in order to evaluate the materials used in terms of quality and usefulness. The article presents the analysis of the results obtained.

While there is significant consensus that undergraduate medical education 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. (shrink)

This paper suggests that medical education be revised to assist in diffusing potential ethical dilemmas that arise during health care provision. A revised medical education would emphasize the role of the humanities in the training of physicians, especially in light of recent critiques of the canonical scientific model in general, and more specifically in the use of that model for medical training and practice.

Health disparities education is an integral and required part of medical professional training, and yet existing curricula often fail to effectively denaturalize injustice or empower learners to advocate for change. We discuss a novel collaborative intervention that weds the health humanities to the field of health equity. We draw from the health humanities an intentional focus retraining provider imaginations by centering patient narratives; from the field of health equity, we draw the linkage between stigmatized social identities and health (...) disparities. We describe a longitudinal health equity curriculum for the Hospice and Palliative Medicine fellowship in Memphis, Tennessee, to give trainees exposure to the concept of structural violence and how it affects clinical care. The curriculum was developed in partnership with humanities and social sciences faculty who staff a Health Equity academic program at a small liberal arts college in Memphis. This curriculum has been implemented for the past four years in support of 22 hospice and palliative medicine fellows. Group debriefs and a mixed methods survey have revealed widespread and lasting impact towards understanding health equity concepts, enhanced communication and treatment of patients, and empowerment to address the broader needs and policies affecting patients and the communities in which they live. Ultimately, we model an educational initiative that integrates equity across the full scope of healthcare practice and equips learners with skills for sustaining compassionate practices, focusing on equity-oriented, person-centered care across the full scope of healthcare practice. (shrink)

BackgroundBurnout is being experienced by medical students, residents, and practicing physicians at significant rates. Higher levels of Hardiness and Emotional Intelligence may protect individuals against burnout symptoms. Previous studies have shown both Hardiness and Emotional IntelIigence protect against detrimental effects of stress and can be adapted through training; however, there is limited research on how training programs affect both simultaneously. Therefore, the objective of this study was to define the association of Hardiness and Emotional Intelligence and their (...) potential improvement through hyper realistic immersion simulation training in military medical students.MethodsParticipants in this study consisted of 68 second year medical students representing five medical schools who were concurrently enrolled in the United States military scholarship program. During a six day hyper-realistic surgical simulation training course, students rotated through different roles of a medical team and responded to several mass-casualty scenarios. Hardiness and Emotional Intelligence were assessed using the Hardiness Resilience Gauge (HRG) and the Emotional Quotient Inventory (EQ-I 2.0) respectively, at two time points: on arrival (pre-event) and after completion of the course (post-event).ResultsHardiness and Emotional Intelligence scores and sub scores consistently improved from pre-event to post-event assessments. No difference in training benefit was observed between genders but differences were observed by age where age was more often associated with Emotional Intelligence. In addition, factor analysis indicated that the HRG and EQ-I 2.0 assessment tools measured predominately different traits although they share some commonalities in some components.ConclusionThis study indicates that Hardiness and Emotional Intelligence scores can be improved through immersion training in military medical students. Results from this study support the use of training course interventions and prompt the need for long term evaluation of improvement strategies on mitigating burnout symptoms. (shrink)

To achieve accreditation standards and train residents for clinical practice, ACGME placed a lot of emphasis on ethical competence and professionalism. A crucial requirement for enhancing the standard of future medical practice is ethics education. This study sought to identify the requirement for ethics knowledge in clinical training from the perspective of the residents and determine the most effective methods for education. A cross-sectional descriptive study was conducted between March and May 2023. Participants included Lebanese postgraduate medical (...) students, 210 completed a Google Forms survey via WhatsApp. A validated questionnaire adapted from a previous study was used, focusing on demographics, ethical experience, attitudes, educational goals, and training effectiveness. Analyses were performed on IBM SPSS Statistics software (version 26.0) and R software. 210 residents representing a range of specialties participated in the survey. predominantly in internal medicine (54.8%). Residents strongly affirmed the importance of professionalism and ethics education. Participants overwhelmingly agreed that it should improve patient care and clinical decision-making (_p_. (shrink)

Cowardice asks the question, is it safe? Expediency asks the question, is it politic? Vanity asks the question, is it popular? But conscience asks the question, is it right? And there comes a time when one must take a position that is neither safe, nor politic, nor popular, but he must take it because conscience tells him it is right.Your burden is not to clear your conscience but to learn how to bear the burdens on your conscience.Since the time of (...) hippocrates, Western medicine has assumed that the exercise of conscience is fundamental to its sound practice. Despite significant changes to medical training in the intervening millennia, this emphasis on conscience remains. "The Physician's Pledge" of the World... (shrink)

Background: It has been widely reported that medical trainees experience situations with profound ethical implications during their clinical rotations. To address this, most U.S. medical schools include ethics curricula in their undergraduate programs. However, the contents of these curricula vary substantially. Our pilot study aimed to discover, from the students’ perspective, how ethics pedagogy prepares medical students for clerkship and what gaps might remain. Methods: This qualitative study organized focus groups of third- and fourth-year medical students. (...) Participants recounted ethical concerns encountered during clerkship rotations and reflected on how their medical school ethics curriculum informed their responses to these scenarios. Transcripts of the focus-group sessions were analyzed using a grounded theory approach to identify common themes that characterized the students’ experiences. Results: While students’ accounts demonstrated a solid grasp of ethical theory and attunement to ethical concerns presented in the clinic, they also consistently evinced an inability to act on these issues given clerks’ particular position in a complex learning hierarchy. Students felt they received too little training in the role-specific application of medical ethics as clinical trainees. We found a desire among trainees for enhanced practical ethics training in preparation for the clerkship phase of medical education. Conclusion: We recommend several strategies that can begin to address these findings. The use of roleplaying with standardized patients can enable students to practice engagement with ethical issues. Conventional ethics courses can focus more on action-based pedagogy and instruction in conflict management techniques. Finally, clear structures for reporting and seeking advice and support for addressing ethical issues can lessen students’ apprehension about acting on ethical concerns. (shrink)

In calling for the transformation of military medical education and training, the 2005 Base Realignment and Closure Commission recommended relocating basic and specialty enlisted medical training to a single site to take advantage of economies of scale and the opportunity for joint training. As a result, a joint medical education and training campus (METC) has been established at Fort Sam Houston, Texas. Two of METC's primary long-term goals are to become a high-performing learning (...) organization and to seek accreditation as a community college. Such goals require a clear model of organizational improvement with well-defined metrics for measuring its performance and using research and evaluation to assess and improve that performance. Lessons learned from a review of practices at institutions with similar missions -- such as community colleges, corporate universities, the UK's Defence Medical Education and Training Agency, and other federal agencies, such as the Veterans Health Administration -- establish a clear need for an office of institutional research to help METC attain its organizational goals. They also provide useful recommendations regarding the METC office's structure, scope, and governance. (shrink)

Research suggests that people tend to overweight arguments accompanied by neuroscientific terminology, which is dubbed as the seductive allure of neuroscience explanations (SANE) in the literature. Such an effect might be of particular significance when it comes to physicians and mental health professionals (MHP), given that it has the potential to cause significant bias in their understanding as well as their treatment approaches toward psychiatric symptoms. In this study, we aimed to test the SANE effect among Turkish medical students, (...) and assess its uniqueness by comparing it with a discipline that still maintains an important role in contemporary psychiatric training in Turkey: psychoanalysis. 109 medical students with a basic level of knowledge of psychiatry and clinical neuroscience were asked to rate the credibility of explanations of differing quality (good vs. circular) for psychological phenomena, followed by three types of information: none, neuroscientific (SNI) or psychoanalytical (SPI). Our findings showed that SNI significantly increased the judged quality of explanations for both conditions with the effect being more prominent for circular explanations. On the other hand, SPI had no effect on good explanations but enhanced the judged quality of circular explanations in a level comparable to that of SNI. For the first time, the SANE effect was replicated among medical students and provided preliminary data in favor of a similar effect for psychoanalytically oriented information. (shrink)

To achieve accreditation standards and train residents for clinical practice, ACGME placed a lot of emphasis on ethical competence and professionalism. A crucial requirement for enhancing the standard of future medical practice is ethics education. This study sought to identify the requirement for ethics knowledge in clinical training from the perspective of the residents and determine the most effective methods for education. A cross-sectional descriptive study was conducted between March and May 2023. Participants included Lebanese postgraduate medical (...) students, 210 completed a Google Forms survey via WhatsApp. A validated questionnaire adapted from a previous study was used, focusing on demographics, ethical experience, attitudes, educational goals, and training effectiveness. Analyses were performed on IBM SPSS Statistics software (version 26.0) and R software. 210 residents representing a range of specialties participated in the survey. predominantly in internal medicine (54.8%). Residents strongly affirmed the importance of professionalism and ethics education. Participants overwhelmingly agreed that it should improve patient care and clinical decision-making (_p_. (shrink)

There is no co-ordinated focus on liabilities arising from nurses’ medical interventions in terms of occupational, administrative, civil legal and criminal activities. However, the Turkish Criminal Code, the Turkish Medical Ethics Code of Practice, and guidelines for patients’ rights offer some framework for the relevant ethical principles and responsibilities of nurses. The aim of this study was to investigate the evaluation of nursing students’ training in their legal liabilities. The sample consisted of 309 students who were taking (...) a course entitled ‘Nurses’ legal liabilities under Turkish criminal and civil law arising from medical interventions’. Data were obtained by means of self-administered questionnaires and McNemar’s test was used to evaluate the answers. In conclusion, after their training, a great majority of the students demonstrated an improvement in terms of their percentage of correct answers relating to malpractice. This does not, however, mean that they will not face malpractice charges after graduating, but their increased awareness of the issue may encourage them to make more effort to reduce the risk of mistakes. It is recommended that nursing faculty carry out studies into medical malpractice, that they focus more on this subject in nursing education, and that all nursing schools review their curricula from the point of view of malpractice. (shrink)

Abortion is among the most widely disagreed upon topics in bioethics and healthcare. Consider how abortion is taught to medical students: while some medical schools incorporate abortion into their standard curriculum, others omit it entirely. In this article, the author argues these discrepancies go against society's interest in producing physicians with comprehensive medical knowledge—especially for common procedures like abortions. The author thus argues all US medical schools have a moral obligation to provide abortion education and clinical (...) training opportunities to their students. For the sake of argumentation, the author attempts to justify this claim remaining morally neutral on abortion. (shrink)

The existing literature in medical ethics does not serve the practical needs of medical students and trainees very well. Medical students or junior doctors often have their own set of ethical concerns and the dilemmas that arise are generally beyond their direct control. The editors have addressed the gap in the literature by compiling a series of case studies from around the world and inviting an international team of leading ethicists and clinicians to comment on them. This (...) volume includes over 80 actual cases that cover the range of possible problems a medical trainee may encounter on the ward. (shrink)

Disclosure of medical and errors to patients has been increasingly mandated in the U. S. and Canada. Thus, some health systems are developing formal disclosure policies. The present study examines how disclosure training may impact staff and the organization. We argue that organizations that support "disclose and apologize" activities, as opposed to "deny and defend," are demonstrating values-based ethics. Specifically, we hypothesized that when health care clinicians are trained and supported in error disclosure, this may signal a valuesbased (...) ethical environment, and staff may be more committed to the organization. We surveyed 325 clinical care providers employed by a large hospital that had recently begun implementing disclosure policies and training. Disclosure training explained significant variance in perceptions of the ethical environment, and the ethical environment mediated the relationship between disclosure training and organizational commitment. Although this study explored disclosure of medical errors, organizational support for error disclosure is a concept that could be relevant for many types of organizations. (shrink)

Previous studies show that medical students in clinical training face ethical problems that are not often discussed in the literature. In order to make teaching timely and relevant for them, it is important to understand what medical students perceive as ethical problems, as various factors may influence their perception, including cultural differences and working environment. The purpose of this qualitative study was to explore students’ perceptions of what an ethical problem is, during their clinical training in (...) the hospital, and compare the results from two different countries. We observed a total of eighteen ethics group discussions and interviewed fifteen medical students at two medical schools, in Indonesia and the Netherlands. Data were interpreted and analyzed using content analysis. We found that students in both settings encounter problems which are closer to their daily work and responsibilities as medical students and perceive these problems as ethical problems. Indonesian students perceived substandard care and inequity in healthcare as ethical problems, while Dutch students perceived that cases which are not matters of life and death are less worthy to discuss. Our study suggests that there might be a gap between ethical problems that are discussed in class with teachers, and problems that students actually encounter in practice. Teachers should be aware of the everyday situations in clinical training which may be perceived by students as ethically problematic and should acknowledge and discuss these ethical problems with students as part of the learning processes in ethics education. (shrink)

Aims To examine the understanding of the ethical dilemmas associated with Big Data and artificial intelligence (AI) among Jordanian medical students, physicians in training, and senior practitioners. Methods We implemented a literature-validated questionnaire to examine the knowledge, attitudes, and practices of the target population during the period between April and August 2023. Themes of ethical debate included privacy breaches, consent, ownership, augmented biases, epistemology, and accountability. Participants’ responses were showcased using descriptive statistics and compared between groups using t-test (...) or ANOVA. Results We included 466 participants. The greater majority of respondents were interns and residents (50.2%), followed by medical students (38.0%). Most participants were affiliated with university institutions (62.4%). In terms of privacy, participants acknowledged that Big Data and AI were susceptible to privacy breaches (39.3%); however, 59.0% found such breaches justifiable under certain conditions. For ethical debacles involving informed consent, 41.6% and 44.6% were aware that obtaining informed consent posed an ethical limitation in Big Data and AI applications and denounced the concept of “broad consent”, respectively. In terms of ownership, 49.6% acknowledged that data cannot be owned yet accepted that institutions could hold a quasi-control of such data (59.0%). Less than 50% of participants were aware of Big Data and AI’s abilities to augment or create new biases in healthcare. Furthermore, participants agreed that researchers, institutions, and legislative bodies were responsible for ensuring the ethical implementation of Big Data and AI. Finally, while demonstrating limited experience with using such technology, participants generally had positive views of the role of Big Data and AI in complementing healthcare. Conclusion Jordanian medical students, physicians in training and senior practitioners have limited awareness of the ethical risks associated with Big Data and AI. Institutions are responsible for raising awareness, especially with the upsurge of such technology. (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.

The aim of this article is to offer a view of the current status of women in medical physics and biomedical engineering, while focusing on solutions towards gender balance and providing examples of current activities carried out at national and international levels. The International Union of Physical and Engineering Scientists in Medicine is committed to advancing women in science and health and has several initiatives overseen by the Women in Medical Physics and Biomedical Engineering Task Group. Some of (...) the main strategies proposed by the Task Group to attain gender balance are: (a) identify and promote female role models that achieve successful work-life balance, (b) establish programs to develop female leaders, (c) create opportunities for females to increase the international visibility within the scientific community, and (d) establish archives and databases of women in STEM. (shrink)

In 1972, I created the new field of clinical medical ethics (CME) in the Department of Medicine at the University of Chicago. In my view, CME is an intrinsic part of medicine and is not a branch of bioethics or philosophical ethics or legal ethics. The relationship of patients with medically trained and licensed clinicians is at the very heart of CME. CME must be practiced and applied not by nonclinical bioethicists, but rather by licensed clinicians in their routine, (...) daily encounters with inpatients and outpatients. CME addresses many clinical issues such as truth-telling, informed consent, confidentiality, surrogate decision making, and end-of-life care, while also encouraging personal, humane, and compassionate interactions between experienced clinicians and patients.The goals of CME are to improve patient care and outcomes by helping physicians and other health professionals Clinical Medical Ethics: Its History and Contributions to American Medicine Mark Siegler, Guest Editor identify and respond to clinical-ethical challenges that arise in the ordinary care of patients. As Edmund Pellegrino, Peter A. Singer, and I wrote in the first issue of The Journal of Clinical Ethics, 30 years ago: “The central goal of CME is to improve the quality of patient care by identifying, analyzing, and contributing to the resolution of ethical problems that arise in the routine practice of clinical medicine.” Similar to cardiology and oncology consultations, ethics consultations are a small component of a much larger field, and the process of consultations is certainly not at the core of cardiology or oncology or CME.In this article, I intend to discuss the origins of the field of CME, its goals and methods, the relationship between the broad field of CME and the much narrower practice of ethics consultation, the contributions of the MacLean Center at the University of Chicago in developing the field of CME, and, finally, how CME has improved the practice of medicine in the United States. (shrink)

Medical student and resident participation in global health experiences (GHEs) has significantly increased over the last decade. In response to growing student interest and the proven impact of such experiences on the education and career decisions of resident physicians, many medical schools have begun to establish programmes dedicated to global health education. For the innumerable benefits of GHEs, it is important to note that medical students have the potential to do more harm than good in these settings (...) when they exceed their actual capabilities as physicians-in-training. While medical training programmes are beginning to provide students with the knowledge to put their GHEs in context, they must remember that they also bear the responsibility of training their students in a framework to approach these experiences in a principled and professional way. It is necessary that these institutions provide adequate and formalised preparation for both clinical and ethical challenges of working in resource-poor settings. This paper outlines potential benefits and risks of GHEs and delineates recommendations to some of the current issues. (shrink)