BackgroundAnatomy Act provides legal ambit to medical educationists for the acquisition of cadavers. The changing medical education scenario, socio-demographic change, and ethical concerns have necessitated an urgent review of its legal and ethical framework. Suitable amendments addressing the current disparities and deficiencies are long overdue.MethodsAnatomy Act in India is a state Act, which ensures the provision of human bodies for medical education and research.The methodology included three components namely: Comparison of various Anatomy Acts clause (...) by clause,Feedback from anatomists, andFormulation of comprehensive model Anatomy Act.ResultsVarious Acts studied showed discrepancies in the purpose of the Act, roles and duties of stakeholders, regulation for body donation, the procedure to handle unclaimed bodies, disposal of dissected bodies, etc. No Act defines a donor and neither addresses the issue of transport of anatomical material. Only ten states have a clause for body donation. Acts of only six states have been amended over the last 50 years. Three states denied having an Act. The whole exercise of review of Acts, extensive feedback received from end-users, and taking into account global good practices, culminated in drafting a comprehensive model Anatomy Act founded on ethical principles.ConclusionIndia, with the largest number of medical colleges, is not only at the forefront but also a hub of medical education in the Southeast Asia region. Legal reform can be a torchbearer to promote ethical and transparent practices for obtaining cadavers for other countries of the region with similar socio-demography and shall also motivate anatomic fraternity across the globe for critical analysis of their respective Anatomy Acts. (shrink)

En la Universidad Médica “Carlos J. Finlay”, se realiza una intervención educativa con el objetivo de valorar la concepción y aplicación de un programa para un curso de preparación de metodólogos en correspondencia con sus funciones en condiciones de universalización de las Ciencias Médicas de Camagüey, en el periodo de septiembre de 2005 a junio de 2007. Se emplean diferentes métodos investigativos: los teóricos, así como la técnica de discusión grupal, permitió diseñar el programa del curso para la preparación de (...) metodólogos en condiciones de universalización y los empíricos, la obtención de algunos datos de interés acerca de los metodólogos que reciben el curso y sus valoraciones en relación con el mismo. Se constata que la preparación pedagógica y experiencia en el desempeño es insuficiente para asumir el rol de metodólogo y valoran de muy importantes los contenidos desarrollados, los métodos y formas organizativas concebidas, por lo que se concluye que el programa del curso cumple con las expectativas del metodólogo al estar diseñado teniendo en cuenta las funciones que estos desempeñan y sus necesidades sentidas A study was carried out about the intervention in education developed to increase teacher's methodological preparation under their new functions due to the fresh conditions of learning within the community applied to medicine training and education in Camagüey. It was carried out in the period of September 2005 to June 2007. Different research methods were used: the theoretical ones and the technique for group discussion help to design the course syllabus and the assessment for those teachers that received the course. It was verified that the methodological preparation and performance experience are insufficient to play their role; but they value as very important the contents, the methods and the organization of the course. The authors conclude that the course meets the expectations of training, because it was designed keeping in mind the teachers' functions and their necessities. (shrink)

El pensamiento ético y bioético es una de las áreas de conocimiento recurrentes en el ejercicio reflexivo del profesional de la salud en Cuba; sin embargo, se detectan insuficiencias relacionadas con imprecisiones y falta de claridad en el pensamiento ético-moral por parte de este personal, según se observa en materiales evaluados para su publicación, en los ejercicios para el proceso de obtención de categorías docentes y en la presentación de las evaluaciones de posgrados. El artículo tiene el objetivo de argumentar (...) precisiones teórico- metodológicas para la elaboración de trabajos en ética y bioética. The ethical and bioethical thought is one of the recurrent areas of knowledge in the reflexive exercise of health professionals in Cuba. However, according to the observations of evaluated materials for their publication, in the exercises for the process of obtaining educational categories and in the presentation of postgraduate evaluations, inadequacies related with imprecision and lack of clarity are detected in the ethical-moral thought on the part of health professionals. The article has the objective of arguing theoretical- methodological precisions for the elaboration of works in ethics and bioethics. (shrink)

Partiendo de las deficiencias detectadas en la realización de la discusión diagnóstica por los estudiantes de Medicina, determinadas en un estudio previo realizado en la Facultad de Ciencias Médicas de Camagüey, se diseñó una metodología para perfeccionar la realización de la discusión diagnóstica en la carrera de Medicina, en la cual se incluyeron un sistema de tareas y las acciones que permiten alcanzar el desarrollo de las habilidades relacionadas con la misma. También se reflejaron las formas organizativas de enseñanza y (...) las actividades de educación en el trabajo en las que se deben abordar los elementos de la metodología, así como la propuesta de criterios evaluativos para estas habilidades, y otros aspectos como la ejecución y evaluación de la metodología. Se consideró que esta propuesta metodológica puede constituir una herramienta útil para los profesores en la conducción del proceso de adquisición de las habilidades de razonamiento clínico en los estudiantes. On the basis of the deficiencies identified in the realization of the diagnostic discussion by medical students, which were determined in a previous study carried out in the Faculty of medical sciences of Camagüey, a methodology was designed to improve the realization of the diagnostic discussion in Medicine degree, which included a set of tasks and actions that allow the development of skills related to it. Also, the teaching organization forms and education activities at work that must deal with methodology elements were stated, as well as the proposal of assessment criteria for these skills and other aspects like assessment and implementation of methodology. It was considered that this methodology can be used as a useful tool for teachers as guides in the process of students´ acquirement of clinical reasoning skills. (shrink)

This paper aims to interrogate the potential and challenges in interdisciplinary working across disciplinary boundaries by examining a longitudinal partnership designed to research student experiences of digital technologies in undergraduate medicine established by the two authors. The paper is situated in current methodological trends including the changing value of replicability and evidence based methods and increases in qualitative and mixed methods studies in Medical Education, whilst education research has seen growing encouragement for randomised controlled trials and large-scale (...) quantitative studies. A critical analysis of the partnership interactions is framed by Holland’s positional and imagined identities, negotiated across ‘figured’ worlds and the concept of epistemic games that guide knowledge construction. We consider social, political and cultural challenges and how ‘in between’ sites of knowledge were established where the academic identity of each was shaped by engaging with the other and new theoretical, methodological and ethical understandings were co-constructed. The paper concludes that despite the on-going challenges, ‘bottom up’ partnerships can contribute to a growth in interdisciplinarity which might itself be understood as a boundary object. Interdisciplinarity necessitates improvisation and boundary crossing and can therefore always be considered a matter of negotiation, creativity and collaboration. (shrink)

Se realizó una estrategia para el perfeccionamiento del trabajo educativo en la Universidad de Ciencias Médicas de Camagüey y elevar la preparación científico-pedagógica de los profesores guías de la carrera de Medicina. En el trabajo se presenta como una de sus acciones la realización de talleres metodológicos interactivos, sus funciones y la metodología elaborada para su implementación. Se constató que la preparación y la experiencia de estos profesores es insuficiente para asumir la labor educativa, asimismo, se confirmó la necesidad de (...) asumir los talleres, como una de las formas del trabajo docente metodológico. A strategy in order to improve the educational work at the Medical University of Camagüey and to raise the scientific-pedagogical training of Medicine guide teachers was carried out. The research shows interactive methodological workshops as one of its main actions, its functions and the methodology designed for its implementation. It was found out that teachers training and experience was not enough to assume the educational work; likewise, the need to consider workshops, as one of the ways of the teaching methodological work was confirmed. (shrink)

Introduction The Brazilian national curriculum guidelines for undergraduate medicine courses inspired and influenced the groundwork for knowledge acquisition, skills development and the perception of ethical values in the context of professional conduct. Objective The evaluation of ethics education in research involving human beings in undergraduate medicine curriculum in Brazil, both in courses with active learning processes and in those with traditional lecture learning methodologies. Methods Curricula and teaching projects of 175 Brazilian medical schools were analyzed using a retrospective (...) historical and descriptive exploratory cohort study. Thirty one medical schools were excluded from the study because of incomplete information or a refusal to participate. Active research for information from institutional sites and documents was guided by terms based on 69 DeCS/MeSH descriptors. Curriculum information was correlated with educational models of learning such as active learning methodologies, tutorial discussions with integrated curriculum into core modules, and traditional lecture learning methodologies for large classes organized by disciplines and reviewed by occurrence frequency of ethical themes and average hourly load per semester. Results Ninety-five medical schools used traditional learning methodologies. The ten most frequent ethical themes were: 1 – ethics in research (26); 2 – ethical procedures and advanced technology (46); 3 – ethic-professional conduct (413). Over 80% of schools using active learning methodologies had between 50 and 100 hours of scheduled curriculum time devoted to ethical themes whereas more than 60% of traditional learning methodology schools devoted less than 50 hours in curriculum time to ethical themes. Conclusion The data indicates that medical schools that employ more active learning methodologies provide more attention and time to ethical themes than schools with traditional discipline-based methodologies. Given the importance of ethical issues in contemporary medical education, these findings are significant for curriculum change and modification plans in the future of Brazilian medical education. (shrink)

Over the last 80 years, a major goal of medical educators has been to improve the quality of applicants to medical school and, hence, the resulting doctors. To do this, academic standards have been progressively strengthened. The Medical College Admission Test (MCAT) in the United States and the undergraduate science grade point average (GPA) have long been correlated with success in medical school, and graduation rates have been close to 100 percent for many years. Recent studies (...) have noted that some doctors having difficulties in practice were found to have had similar problems while in school. In this essay, we present a brief historical account of attitudes and approaches to admissions requirements, then discuss basic broad areas of accomplishment in clinical practice: academic mastery, clinical acumen, and professionalism. We then review data that suggest that lack of competency can often be detected very early in a student’s career and may or may not be immune to remediation efforts. We end with a recommendation for a course of action that upholds and fulfills the profession’s social responsibility. This will be a moral argument, defending an aggressive but equitable approach to maintaining both public accountability and trust. (shrink)

Aim: Explore nurses’ values and perceptions regarding the practice of medical aid in dying. Background: Medical aid in dying is becoming increasing legal in the United States. The laws and American Nurses Association documents limit nursing involvement in this practice. Nurses’ values regarding this controversial topic are poorly understood. Methodology: Cross-sectional electronic survey design sent to nurse members of the American Nurses Association. Inductive thematic content analysis was applied to open-ended comments. Ethical Considerations: Approved by the institutional (...) review board (#191046). Participants: 1213 nurses provided 3639 open-ended comments. More than 80% of participants self-identified as white 58% held a graduate degree; and half were of Christian faith. Results: Values ranged on a continuum expressed through four themes: “Honoring Patient Autonomy without Judgment,” “Honoring with Limitations,” “Not until...,” and “Adamantly against.” Some felt it was a duty to honor the patients’ wishes, set aside own beliefs, and respect patients’ choices often with a spiritual connotation. Nurses held concerns about the process, policy, potential psychological harm, legal risk, and the need to learn more about MAID. Nurse who were adamantly against MAID associated the practice with murder/suicide and against religious beliefs. Disparate values were expressed about changing the MAID legislation to allow patient support with taking MAID medications and allowing MAID via advance directive. Conclusions: Nurses desire more education on MAID. There is not one universally held position on the nurse’s role during MAID. Healthcare policy/standards need to accommodate the wide variation in nurses’ values. Implications: Nurses desire education regarding their role in MAID. Nurses are encouraged to participate in policy discussions as the practice becomes increasingly legal. Managers need to expect that nurses, patients, and families will need psychological support to participate in MAID. Careful construction of policy/standards is needed to minimize conflict, moral distress, and psychological harm amongst nurses. Further research is needed. (shrink)

The American Journal of Bioethics, Volume 11, Issue 10, Page 39-41, October 2011.

This paper describes the medical ethics scene in Britain. After giving a brief account of the structure of British medical ethics and of the roles of the different groups involved it mentions some of the important medico-moral events and issues of the fairly recent past, and describes in greater detail four important examples of professional, legal, governmental and media concerns with medical ethics, themselves illustrating the wide variety of interests wishing to influence the British medical profession's (...) ethics. The examples offered are the development of research ethics committees, the Sidaway case concerning informed consent, the Warnock Committee's Report on in vitro fertilisation and associated issues, and the 1980 Reith Lectures on Unmasking Medicine. In the final section a fairly new methodological development in British medical ethics is described in which the medical profession is increasingly recognising the need to add to traditional medical ethics education, with its longstanding history of the inculation and enforcement of ethical norms, an element of philosophical or critical medical ethics, at the heart of which is justification of substantive medico-moral claims in the light of counterarguments. (shrink)

Giving Voice to Values as a Professional Physician provides students with the theoretical background and practical applications for acting on their values in situations of ethical conflict. It is the first medical ethics book that utilizes the Giving Voice to Values methodology to instruct students in medical ethics and professionalism. In doing so, it shifts the focus of ethics education from intellectually examining ethical theories and conflicts to emphasizing moral action. Each section of the book explains (...) how moral decision-making and action can be implemented in the healthcare arena. Medical ethics cases are provided throughout in order to assist students in giving voice to their values and developing skills for professional action. The Giving Voice to Values methodology, and the cases in this book, do not focus on the big questions of academic ethics, but rather on the ethics of the everyday, even if the challenges presented are difficult. In other words, the ethical questions students will have to face, in this book and in medical education and practice, are about how to interact with others, whether they be patients or colleagues, who might have different ethical positions. The book provides a unique guide for professional identity formation and the teaching of ethics in medical schools. (shrink)

Background: Ethical leadership is important for developing ethical healthcare practice. However, there is little research-based knowledge on how to stimulate and educate for ethical leadership. Objectives: The aim was to develop and investigate the feasibility of a 6-week web-based, ethical leadership educational programme and learn from participants’ experience. Training programme and research design: A training programme was developed consisting of (1) a practice part, where the participating middle managers developed and ran an ethics project in their own departments aiming at (...) enhancing the ethical mindfulness of the organizational culture, and (2) a web-based reflection part, including online reflections and coaching while executing the ethics project. Focus group interviews were used to explore the participants’ experiences with and the feasibility of the training. Participants and research context: Nine middle managers were recruited from a part-time master’s programme in leadership in Oslo, Norway. The research context was the participating leaders’ work situation during the 6 weeks of training. Ethical considerations: Participation was voluntary, data anonymized and the confidentiality of the participating leaders/students and their institutions maintained. No patient or medical information was involved. Findings: Eight of the nine recruited leaders completed the programme. They evaluated the training programme as efficient and supportive, with the written, situational feedback/coaching as the most important element, enhancing reflection and motivation, counteracting a feeling of loneliness and promoting the execution of change. Discussion: The findings seem consistent with the basic assumptions behind the educational design, based partly on e-health research, feedback studies and organizational ethics methodology, partly on theories on workplace learning, reflection, recognition and motivation. Conclusion: The training programme seems feasible. It should be adjusted according to participants’ proposals and tested further in a large-scale study. (shrink)

The author discusses the contribution of humanities teaching in medical education. Five "qualities of mind" specifically engendered by the humanistic disciplines are isolated, delineated, and illustrated: critical abilities, flexibility of perspective, nondogmatism, discernment of values, and empathy and self-knowledge. Keywords: humanities, humanities and medicine, medical education CiteULike Connotea Del.icio.us What's this?

At the outset of this chapter, I want to echo the praise offered by all of the contributors to this volume for Finder’s outstanding, thoughtful and self-critical narrative of the case of 83 year old Mrs. Hamadani and her fiercely devoted children. The brocade account is carefully woven, like a fine Persian tapestry, to convey the rich complexity of an actual ethics consultation as it transpires not over hours, but rather over days, weeks, months and even, as in this case, (...) years. Mrs. Hamadani’s narrative so told is replete with questions worthy of critical reflection. What is an appropriate role for ethics consultation in healthcare? How can an autonomy-centric culture accommodate community-centric cultural difference? How can or should the voice of the patient be heard when she cannot speak for herself and the much louder and anguished voices of others demand to be heard? What are the bounds of acceptable medical treatment and how should care teams respond when patient or family demands threaten to push care givers to cross those bounds? What is an appropriate response for ethics consultants when they are asked to take over a case or prevent a colleague from interacting with an unwilling family? Do the motivations of patients, family, or members of the care team in calling ethics consultants necessarily shape the consultant’s role? And so the list goes on, as the variety of commentaries which comprise the majority of this volume, as well as the multitude of discussions that you, the readers, will inevitably have with colleagues, students, and friends make abundantly clear. (shrink)

During the Nazi era, physicians provided expertise and a veneer of legitimacy enabling crimes against humanity. In a creative educational initiative to address current ethical dilemmas in clinical medicine, we conduct ethics learning missions bringing senior physicians to relevant Nazi era sites in either Germany or Poland. The tours share a core curriculum contextualising history and medical ethics, with variations in emphasis. Tours to Germany provide an understanding of the theoretical origins of the ethical violations and crimes of Nazi (...) physicians. Tours to Poland address the magnitude of the Nazi physician’s atrocities as well as displays of heroism by Jewish and righteous among the nations' physicians. Exemplary as well as shameful physician behaviour is analysed from an ethical perspective. A combination of unique educational methodologies maximises learning and personal growth, enabling participants to examine ethically complex clinical situations with extrapolation to modern-day medical practice. Learning is designed with relevance to contemporary medical ethics dilemmas such as beginning and end-of-life issues, providing tenets from which participants can develop as more ethical and informed physicians. Participant feedback confirms efficacy and worth of these growth-promoting ethics learning tours which should be expanded to other international groups and settings. (shrink)

The biomedicalist conceptualization of disablement as a personal medical tragedy has been criticized by disability studies scholars for discounting the difference between disability and impairment and the ways disability is produced by socio-environmental factors. This paper discusses prospects for partnerships between disability studies teaching/research and medical education; addresses some of the themes around the necessity of critical disability studies training for medical students; and examines a selection of issues and themes that have arisen from disability (...) class='Hi'>education courses within medical schools globally. The paper concludes that providing there is a commitment from senior management, universities are well positioned to apply both vertical and horizontal approaches to teaching disability studies to medical students. (shrink)

Although the teaching of medical ethics and law in medical education is an old story that has been told many times in medical literature, recent studies show that medical students and physicians lack confidence when faced with ethical dilemmas and medico-legal issues. The adverse events rates and medical lawsuits are on the rise whereas many medical errors are mostly due to negligence or malpractices which are preventable. While it is true that many (...) class='Hi'>medical schools teach their students medical law and ethics, there are wide variations in what is being taught because there is no universally agreed syllabus. Yet the knowledge of medical law and ethics is closely relevant to the medical profession and that failure in abiding the law may result in serious civil or even criminal consequences. While this paper does not propose to lay detailed analysis of the relevant areas of law or ethics, it proposes to cover some legal areas so as to highlight and bring to attention the need for a medical law and ethics course. This article also considers the problems faced and recommendation as to future directions to be taken with respect to teaching medical law and ethics. It concludes with a suggested course outline for the teaching of medical law and ethics. (shrink)

Pain is one of the most frequent presenting symptoms for patients who come to a physician's office. Despite the frequency of this presentation, little consistent, systematic information is provided to medical students or physicians about the treatment of pain. In addition, relatively little information is given about the recognition and prevention of drug abuse and about how to prescribe analgesics rationally to minimize the chances for abuse. This lack of educational preparation for both pain and addiction contributes to significant (...) fear and inability on the part of health professionals to diagnose and treat both conditions. It creates a barrier of fear to prescribe adequate doses of pain medications for patients who present with both acute and chronic pain problems. Inadequate medicating can be caused by the physician's overriding worry about creating addiction in a patient. Morgan has called this problem “opiophobia.”. (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)

In her 2018 book, What the Eyes Don’t See, Dr. Mona Hanna-Attisha wrote that it is the duty of doctors to speak out against injustice. In fact, no other physician or institution in Flint had done the research and spoken out, as a whistleblower, against the poisoning of Flint’s children by Michigan government. Why had Dr. Hannah-Attisha? Unfortunately, in the absence of a medical education system that teaches community-oriented primary health care in the tradition of the 1978 Alma (...) Ata Declaration, there is little reward in doing so. This article focuses on three movements that are challenging medical education orthodoxy: 1) primary health care 2) the medical humanities and 3) “Study Up your Town” medicine. How can we create a radical health pedagogy – one that draws the links between several pandemics raging across the planet: capitalist collapse, climate disruption, Covid-19, racism, and an emergent neoliberal fascism – to enable doctors, health professionals and citizens to see them as all of one piece? Medical educators must employ critical pedagogy to create legions of “constructive troublemakers” who challenge the social-structural obstacles that are driving millions to premature death. We have reached the “end times.” A new “planet medicine” is finally emerging. (shrink)

Thinking in medicine is still dominated by the cartesian view of science of the past centuries, dividing individuals into the reasoning mind (res cogitans) and an objective body as part of all non-subjective things of the world (res extensa). This classical scientific paradigm does not take into account the influence the observer exerts on the observed phenomena. Applying this paradigm to medical research and education has consequences regarding the relationship between physicians and patients as well as between (...) class='Hi'>medical teachers and their students. An improvement of medical education towards a broader understanding of complex illnesses with their psycho-social implications must be based on philosophical and epistemological issues. The requirements of modern medicine cannot just be met by adding more psycho-social content to somatic medical education or by changing the didactic approach without reflection on the underlying concepts and the relation of the human being to his world. (shrink)

The modern science of judgment and decision making began to emerge in the 1950s, and was thus unknown when Abraham Flexner wrote Medical Education in the United States and Canada (1910). This did not stop Flexner from highlighting the unique challenges facing the physician as a decision maker, as part of his effort to press for requiring some college education as a prerequisite for medical school:The engineer deals mainly with measurable factors. His factor of uncertainty is (...) within fairly narrow limits. The reasoning of the medical student is much more complicated. He handles at one and the same time elements belonging to vastly different categories: physical, biological, psychological elements are involved in .. (shrink)

Berger and Miller raise important considerations regarding the ongoing relevance and use of cultural competency in medical education. In particular, the authors critique the United States’ L...

Contemporary medical education must train skilled and compassionate health care professionals who are rigorous in their approach to patient care and their pursuit of knowledge and solutions. Problem-based learning has been widely introduced, but there is no evidence that it leads to better outcomes than more traditional programs, and fundamental gaps in conceptual knowledge may result. Recently, emphasis has been placed on a solid grounding in underlying concepts combined with a systems-based approach, and ability to transfer information and (...) solve problems. Integrating traditional scientific and clinical disciplines with progressive and continuous assessment, may be a better means of achieving the combined aims of clinically relevant curriculum design, vertical integration of medical knowledge, and facilitation of the continuum of training. Being adaptable and flexible, cognisant of costs, and driven by evidence are key features of delivering medical education and contemporary medical practice. Educational research should lead to continuous improvement, but innovation without evaluation and attention to costs may create as many, or more, problems as are solved. (shrink)

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)

Medical student learning is dependent on an unwritten agreement between patients and the medical profession, in which students “practise” upon real patients in order that, when they are doctors, those same patients will benefit from the doctors’ skills. Given the increasing propensity for patients to refuse to take part in such learning, there is a danger that doctors will qualify without being truly competent. As patients, we must all ask ourselves, when asked to take part in medical (...) teaching: if this student/trainee doesn’t learn now, on me and under supervision, how will the person be truly competent next time, when this is for real, and the patient might be me or my loved one?We argue that a new and more explicit agreement is needed, in which the default should be that all patients are willing to help in the education of medical students, while we ensure that all such students are already competent in simulation before first practising upon real patients. (shrink)

Cohabiting has been associated with a number of problems including sexually transmitted diseases and HIV and AIDS, abortions, sexual abuse and violence, low academic performance, increased cost of medical care and unwanted pregnancies. However, there is little documented information on the extent and the factors influencing cohabitation among the youth and especially among tertiary education students. This study therefore sought to fill this gap by investigating factors that lead to the prevalence and practice of cohabitation by tertiary (...) class='Hi'>education students. The research adopted the interpretivist philosophy. The qualitative research methodology was employed in order to understand in greater detail the behaviors, attitudes, opinions, and beliefs of the respondents on cohabitation among tertiary education students. The study used the survey research design. Primary research was conducted using questionnaire surveys that were administered to tertiary education students who participated at the Tertiary Education Sports Association of Zimbabwe in July 2016. There were 100 questionnaires distributed and 78 questionnaires were returned making 78% response rate. The respondents were randomly sampled to participate in the study. The study reflects that cohabitation among the Tertiary education students is quite common. The study noted that it is mostly caused by lack of accommodation, problems with roommates, lack of privacy and the need to be close and intimate with one's lover. In results cohabitation exposes students to premarital sex and other consequences such as unwanted pregnancies, abortion, complications and sexually transmitted infections. The study recommends that tertiary education students should be enlightened during orientations about the dangers of cohabitation. Parents should be encouraged to visit their children and find where and whom they live with while in school. (shrink)

Although social justice is an integral component of medical professionalism, there is little discussion in medical education about how to teach it to future physicians. Using adult learning theory and the work of Brazilian educator Paulo Freire, medical educators can teach a socially-conscious professionalism through educational content and teaching strategies. Such teaching can model non-hierarchical relationships to learners, which can translate to their clinical interactions with patients. Freirian teaching can additionally foster professionalism in both teachers and (...) learners by ensuring that they are involved citizens in their local, national and international communities. (shrink)

_For centuries medicine was predominantly a tradition-based "trade" until the introduction of science transformed it into an intellectually rigorous discipline. That transformation contributed heavily to the dominance in medical education of the learning of biomedical concepts ("knowing that") over learning how to translate that knowledge into clinical performance ("knowing how"). The recent emergence of performance-oriented educational initiatives suggests, however, that the balance between these two complementary approaches is changing, a change that has been referred to as "the Flexnerian (...) revolution of the 21 ^st century." Problem-based learning, learning the practice of evidence-based medicine, and learning to use clinical guidelines are among the important initiatives designed to develop high-level performance in the care of individual patients. Initiatives in which learners acquire skill in changing the performance of care systems are also being widely implemented. These trends have received important formal support through recent changes in residency training accreditation standards. Although it is too early to assess the impact of these initiatives or to know whether they will develop further, medical education is unlikely to reach its full potential unless it successfully comes to grips with the challenges of understanding, teaching, and measuring performance._. (shrink)

To determine the attitude of general practitioners towards continuing medical education and reasons motivating or hindering them from attending CME procedures, we conducted a cross-sectional survey from November 2013 to April 2014 in Karachi. Three hundred general practitioners who possessed a medical license for practice in Pakistan filled a pre-designed questionnaire consisting of questions pertaining to attitudes towards CME. Data was entered and analyzed using SPSS v16.0. 70.3% of the participants were males. Mean age was 47.75 ± (...) 9.47 years. Only 67.33% knew about CME and only 52% had attended a CME session. Reasons for attending CME procedures reported were: need for updating knowledge, skills and competencies, opportunity to meet colleagues and presenting scientific papers. Mean Likert score was 1.67 for those who thought CME is worthwhile and 1.44 for those who consider their clinical duties as the major hurdle in attending CME procedures. Most common cause for not attending CME was lack of knowledge followed by time constraint. Most physicians were not sufficiently informed about the potential benefits of CME and had never attended a CME session. Most common reason for attending CME procedures reported was need for updating knowledge, skills and competencies while reasons hindering physicians from attending CME were lack of knowledge and time constraint. (shrink)

Given the money, prestige and power at stake in high-level sports, ethical lapses are hardly surprising. Nor are the rules, people, and organizations we entrust to punish infractions and ensure fair play. Similarly, the high stakes involved in medical education invite ethical slips. Yet, there are not only few referees in this all-important “game,” but also the subject itself has been almost entirely off-limits in the academic literature.

The article traces the forty-year history of the establishment of the Bioethics training course at the Volgograd State Medical University, which turns 85 this year. It is told about those who played a major role in the development of bioethics as a training course, what difficulties and successes were along this path. The logic of the institutionalization of bioethics through the creation of ethical examination procedures is traced. Actual problems of bioethics, as well as ongoing bioethical activities are not (...) covered and are not called, since the materials of the anniversary issue of the journal are devoted to them. (shrink)

We critically evaluate the ways in which competence in medical ethics has been evaluated. We report the initial stage in the development of a relevant, reliable and valid instrument to evaluate core critical thinking skills in medical ethics. This instrument can be used to evaluate the impact of medical ethics education programmes and to assess whether medical students have achieved a satisfactory level of performance of core skills and knowledge in medical ethics, within and (...) across institutions. (shrink)

Public policy tries to promote appropriate drug use by allowing firms to market drugs in interstate commerce only for uses that the Food and Drug Administration has found to be safe and effective. Because of their medical knowledge, physicians are authorized to prescribe drugs even for uses unapproved by the FDA. Nevertheless, physicians have relied on drug firms for information on appropriate prescribing despite the inherent tension between drug firm dissemination of information to promote sales and rational prescribing. In (...) the past, physicians often relied particularly on drug firm advertising for information on drug use. Today, physicians rely on drug firms to finance continuing medical education. A historical review reveals connections between these two different ways commercial interests have influenced the information that physicians receive and points the way to needed reforms. (shrink)

Reflection has been proclaimed as a means to help physicians deal with medicine’s inherent complexity and remedy many of the shortcomings of medical education. Yet, there is little agreement on the nature of reflection nor on how it should be taught and practiced. Emerging neuroscientific concepts suggest that human thought processes are largely nonconscious, in part inaccessible to introspection. Our knowledge of the world is fraught with uncertainty, ignorance and indeterminacy, and influenced by emotion, biases and illusions, including (...) the illusion of not having illusions. Neuroscience also documents that lifelong learning processes may hone nonconscious cognition to high levels of sophistication, allowing rapid and precise perceptions, judgments and actions in complex situations. We argue that knowledge of mechanisms underlying human thought may be useful in designing educational programs to foster desired attributes such as curiosity, critical self-awareness and intuitive acumen in medical professionals. The juxtaposition of neuroscientific insights with ideas from Kant on reflective judgement, van Manen on tact, and Aristotle on phronésis, supports a concept of reflection that manifests as wise practice. We suggest that reflection in medical education should be an imperative for educators seeking to guide learners to manage the complexity and “messiness” of medical practice, and a role-modelling mode of medical practice characterized by self-correcting behaviors that culminate in good and right professional actions. An example illustrates reflective practice in the teaching and learning of physicianship. (shrink)

This book focuses on the history and theories relating to case study methodology. It also examines the implications of utilizing case studies in university settings and explores how case studies prepare professionals for real-life career-related scenarios.

The debate about the appropriate methodology of medical education has been (and still is) dominated by the opposing poles of teaching science versus teaching practical skills. I will argue that this conflict between scientific education and practical training has its roots in the underlying, more systematic question about the conceptual foundation of medicine: how far or in what respects can medicine be considered to be a science? By analyzing the epistemological status of medicine I will show (...) that the internal aim of medicine( promoting health through the prevention and treatment of disease ) differs from the internal aim of science ( the methodological and systematic acquisition of knowledge ). Therefore, medicine as a whole discipline should not be considered as a science. However, medicine can be conceptually and methodologically scientific in so much as it is based on scientific knowledge. There is evidence from cognitive science research that diagnostic reasoning not only relies on the application of scientific knowledge but also — especially in routine cases – on a process of pattern recognition, a reasoning strategy based on the memory of previously encountered patients. Hence, medical education must contain both: the imparting of scientific knowledge and the rich exposure to concrete cases during practical training. Hence, the question of teaching science vs. the apprentice model will not be either-or but rather both — but in which proportion? (shrink)

Ten years ago there was little talk about adding “professionalism” to the medical curriculum. Educators seemed to believe that professionalism was like the studs of a building—the occupants assume them to be present, supporting and defining the space in which they live or work, but no one talks much about them. Similarly, educators assumed that professional values would just “happen,” as trainees spent years working with mentors and role models, as had presumably been the case in the past. To (...) continue the metaphor, when educators did discuss ethics and values, they tended to focus more on external building codes than on the nature of construction materials. Building codes are designed to ensure the public's safety by establishing procedures and standards. Likewise, the “new” bioethics of autonomy and informed consent that entered the medical curriculum in the 1970s and 1980s was oriented primarily toward protecting human rights by codification. In fact, educators explicitly warned students against acting on their personal or professional values in a misguided way—that is, in the absence of adequate ethical constraints, a type of behavior that came to be labeled, pejoratively, as paternalism. (shrink)

This essay announces the inauguration of a section ofTheoretical Medicine and invites submissions on the topic Method and Methodology in Medical Ethics. It offers some sketches of plausible meanings of method and of methodology and their relationships as these might apply to work in biomedical ethics. It suggests a broad range of issues, dilemmas or conflicts that may be addressed for help via method and/or methodology.