Introduction: The high degree of religious/spiritual involvement that brings meaning and purpose to a patients’ life, especially when they are weakened by pain, is among the various reasons to consider the spiritual dimension in clinical practice. This involvement may influence medical decisions and, therefore, should be identified in the medical history of a patient.Objective: To verify the opinion of undergraduate medical students of the Paulista School of Medicine – Federal University of São Paulo regarding the use of a patient’s (...) Spirituality/Religiosity as a therapeutic resource in clinical practice.Method: Quantitative approach of the transversal analytical observational type. The sample was composed of academics’ medical program, from the first to the sixth year, regularly enrolled in 2017. Data collection was performed with a standardized questionnaire divided into three sections: sociodemographic profile; Duke University Religious Index; Spirituality/Religiosity in the clinical and academic context.Results: Participated in the survey 72% of the enrolled students, of which 61.4% had religious affiliation, 26.2% declared themselves agnostic and 12.4% atheists. All of them proposed to answer questions about the insertion of Spirituality/Religiosity in the patient care process. Through the Duke Religiosity Index, we evaluated the importance of religiosity in the student’s personal life and the pertinence of religiosity as a therapeutic insertion for medical treatment. Regarding the clinical and academic context, most participants considered relevant the proposition of didactic-pedagogical actions in medical education related to the spiritual dimension of the patient.Conclusion: We conclude, through our research, that the insertion of the Spirituality/Religiosity of the patient as a therapeutic resource in clinical practice is feasible for most undergraduate students in Medicine of the Escola Paulista de Medicina – Universidade Federal de São Paulo. The result of the research, although it shows only the opinion of medical students at a Brazilian university, indicates that Spirituality/Religiosity is already part of the contemporary medical universe. (shrink)

At its inception, the training model in the Graduate School of Clinical Psychology at George Fox University was informed by the approach inaugurated at Fuller Theological Seminary School of Psychology in the 1960s. In the original model, training in Christian religion/spirituality and theology accompanied training in professional psychology. In the interim, our culture, psychological knowledge, perceived psychological needs, and training programs have changed greatly. Here we report changes in religion/spirituality training and integration over the last two decades. We (...) describe our current spiritual formation structure and process, and program evaluation efforts. Over the past several years the GSCP has shifted from relying mainly on a cognitive approach involving Bible and theology courses toward a more personal-experiential approach that includes team teaching of the theology and religion courses, an individualized spiritual direction experience spread over two years, and more intentional integration of R/s and spiritual formation components throughout the program. We anticipate this may be an ongoing area for further development in coming years as we seek to meet the needs of a changing student body with greater R/s diversity and largely postmodern worldviews. (shrink)

Clinical exchange: one model to achieve culturally sensitive care This paper reports on a clinical exchange programme that formed part of a pre‐registration European nursing degree run by three collaborating institutions in England, Holland and Spain. The course included: common and shared learning including two summer schools; and the development of a second language before the students went on a three‐month clinical placement in one of the other base institutions’ clinical environments. The aim of the course was to enable students (...) to become culturally sensitive carers. This was achieved by developing a programme based on transcultural nursing principles in theory and practice. Data were gathered by interview, focus groups, and questionnaires from 79 exchange students, fostering the strategies of illuminative evaluation. The paper examines: how the aims of the course were met; the factors that inhibited the attainment of certain goals; and how the acquisition of a second language influenced the students’ learning about nursing. A model is presented to illustrate the process of transformative learning from the exchange experience. (shrink)

The clinical years of medical student education are an ideal time for students to practise and refine ethical thinking and behaviour. We piloted a new clinical ethics teaching activity this year with undergraduate medical students within the Rural Clinical School at the University of New South Wales. We used a modified teaching ward round model, with students bringing deidentified cases of ethical interest for round-table discussion. We found that students were more engaged in the subject of clinical ethics after (...) attending the teaching sessions and particularly appreciated having structured time to listen to and learn from their peers. Despite this, we found no change in student involvement in managing or planning action in situations that they find ethically challenging. A key challenge for educators in clinical ethics is to address the barriers that prevent students taking action. (shrink)

Background Caring behaviour is critical for nursing quality, and the clinical internship environment is a crucial setting for preparing nursing students for caring behaviours. Evidence about how to develop nursing students’ caring behaviour in the clinical environment is still emerging. However, the mechanism between the clinical internship environment and caring behaviour remains unclear, especially the mediating role of moral sensitivity and the moderating effect of self-efficacy. Research objective This study aimed to examine the mediating effect of moral sensitivity and the (...) moderating function of self-efficacy on the association between the clinical internship environment and caring behaviours. Research design A cross-sectional design used acceptable validity scales. The hypothesised moderated mediation model was tested in the SPSS PROCESS macro. Participants and research context This survey collected data from 504 nursing students in an internship at a teaching hospital in Changsha, China. Ethical considerations This study was pre-approved by the ethics committee of the medical school (No. E2022210). Informed consent was obtained from all students. Results The clinical internship environment ( B = 0.450, 95% CI = [0.371, 0.530]) and moral sensitivity ( B = 1.352, 95% CI = [1.090, 1.615]) had positive direct effects on nursing students' caring behaviours. Clinical internship environment also indirectly influenced students’ caring behaviours via moral sensitivity ( B = 0.161, 95% CI = [0.115, 0.206]). In addition, self-efficacy played a moderating role between the clinical internship environment and caring behaviours ( B = 0.019, 95% CI = [0.007, 0.031]), as well as the relationship between the clinical internship environment and moral sensitivity ( B = 0.006, 95% CI = [0.003, 0.010]). Conclusion Moral sensitivity mediates the effect of the clinical internship environment on caring behaviour, and self-efficacy strengthens both direct and indirect effects. This study emphasises the importance of self-efficacy in developing moral sensitivity and caring behaviours in nursing students. (shrink)

School Psychology Ethics in the Workplace introduces a pragmatic and user-friendly model that helps readers become proficient ethical decision-makers using the 2020 NASP ethical code and to critically engage the ethical standards and work through ethical dilemmas that often occur in school and clinical settings. This book provides an overview of the National Association of School Psychologists' (NASP) latest Principles for Professional Ethics. It introduces readers to various ethical codes related to psychology, the importance of having ethical (...) codes, the limitations of ethical codes, and an ethical decision-making model that accounts for multicultural and social justice issues. Over 100 ethical case studies are presented in the text that specifically relate to NASP's Principles for Professional Ethics. Readers are provided step-by-step directions on how to use the ethical decision-making model when problem solving each case scenario. School psychology graduate students and their instructors will find this guide invaluable for learning NASP's new ethical code and for being prepared for situations school psychologists are likely to experience in practice. (shrink)

When i was in graduate school, I inadvertently walked in on a fellow student taking his comprehensive exams. He was extremely frustrated because two of the questions asked about conceptual issues in personality and personality disorders. This student was not expecting such questions and considered them to be unfair. I knew other students in that same program who would have considered it a gift to get such “interesting” questions. Those clinical and counseling psychologists with theoretical–philosophical interests are often attracted (...) to the topics of personality and personality disorders. It has, therefore, puzzled me why these same topics are largely ignored by those philosophers who study the conceptual issues of .. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Clinic as Testing Ground for Moral Theory: A European ViewHans-Martin Sass (bio)A Philosopher’s View of Theory in the Clinical SettingThe clinic is a testing ground for theories. I am not clinician; I am a philosopher who has been in the clinic only as a patient or as an ethicist who never has had the final word nor was ever intended to have the final word. I have learned (...) that in the clinical setting general norms and conceptualizations in the Kantian sense must be tailored to real-life situations. From the philosophical schools of analytical reasoning, I learned the skills needed to analyze words and meanings and to dissect problems and so-called “solutions.” But even more impressive are the methodological skills of differential diagnosis, looking at medical problems from different angles and using different methods and instruments. The detail- and patient-oriented work of the clinician provides an excellent model of methodological clarity and professional devotion for a philosopher who assists those working for the “good of the patient.” That model has led to the development of what I call a theory and methodology of differential ethics. [End Page 351]Differential ethics is normative ethics, as it does not give up norms in favor of situational utility. Differential ethics does not venture out empty-handed in order to explore and find principles pre-existing in a given situation; rather it brings basic values and principles along with it and tries to discover the shape they must take and the priority they must be given in the situation at hand. Differential ethics differentiates between general norms and mid-level principles, virtues, and visions that must be introduced and protected effectively and specifically according to different scenarios (Sass 1993). From this European point of view, I shall briefly explain my position and comment on (1) the controversy between principlism and virtue theory, (2) differentiating and balancing, and (3) the importance of trust, both as a principle and as a virtue in the clinical setting.Principlism Versus Virtue Theory: A Mistaken ControversyFrom a European perspective, I find that the debate between the schools of virtue-theory and principlism in the United States is a mistaken controversy. The real conflict between the schools of thought is not methodology, but content. Tom Beauchamp (1995) gives examples of how one language or method can be translated into the other, and Edmund Pellegrino and David Thomasma (1988, p. 206) have formulated a rule for the virtuous physician that, in the language of principlism, reads “respect for autonomy,” but in the language of virtue theory reads “To assist my patients to make choices that coincide with their own values or beliefs, without coercion, deception, or duplicity.”In different situations, however, some systems of reference are more authoritative and effective than others. Appealing to professional virtues would be the most efficacious way to address an audience coherent in attitudes and concerned about personal character. Reaffirmation of personal and professional obligations in secular fraternities or religious communities works best when it includes an appeal to virtues in the language of the humanist tradition, moral theology, or professional ethics.But there are other situations in which authoritative attitudes and expectations are absent and society in general is searching for common, often dormant, principles that will hold it together whatever specific disagreements arise. Such a situation was present in 1978 when the Belmont Report (National Commission 1978) presented principles—respect for autonomy, nonmaleficence, beneficence, justice—and not virtues to guide moral and political reflections on and reactions to the ethical, legal, and social implications of modern biomedicine in a multi-faceted and multi-cultural society.The formal difference between the systems of principlism, virtue theory, and value theory becomes even less important when clinical-ethical questionnaires are used to understand specific scenarios or cases and to assess different options for proceeding. Thus, my first thesis is: Case discussion, scenario assessment, [End Page 352] and open questionnaires, rather than definite guidelines, bridge the difference between virtue theory and principlism, since such processes can employ any one language or a combination of all three.Differentiating and BalancingMy second thesis is: Whatever system of reference is used... (shrink)

Selected by Choice Magazine as an Outstanding Academic Title What is so special about human life? What is the relationship between flesh and blood and the human soul? Is there a kind of life that is worse than death? Can a person die and yet the human organism remain in some real sense alive? Can souls become sick? What justifies cutting into a living human body? These and other questions, writes neurosurgeon and philosopher Grant Gillett, pervade hospital wards, clinical offices, (...) and operating rooms. In Bioethics in the Clinic: Hippocratic Reflections, Gillett brings the tools of philosophy to bear on some of the most pressing issues confronting bioethicists today. Gillett draws on many schools of thought, including analytic, moral, and postmodern philosophy; utilitarianism; classical ethical theory; phenomenology; and metaphysics. He engages the reasoning of such philosophers as Aristotle, Nietzsche, Wittgenstein, Foucault, Habermas, Levinas, and Martha Nussbaum, and offers both practical and clinical insights into such topics as the principle of "Do no harm," informed consent, confidentiality, cloning, and euthanasia. Opening with an explanation of the axioms to be traced throughout succeeding discussions, with special emphasis on Hippocratic principles, Gillett focuses on general and specific problems of clinical practice, particularly as they affect the physician-patient relationship. The author then goes on to address ethical problems related to both the end of life, including euthanasia, and the beginning of life, such as embryo and stem cell research. Rigorous and elegant, this book will be of interest to those in medical fields, to students and scholars of philosophy, and to lay readers interested in the profound ethical dramas played out in hospitals and doctors' offices every day. (shrink)

This essay describes an example of how we—one professor of the elective course Art, Medicine, and Clinical Moral Perception at Creighton University School of Medicine, one Director of Adult Programs at the Joslyn Museum of Art in Omaha, Nebraska, and fourth year medical students—practice perception skills using art objects. This essay presents one example of the journal assignments to which students respond in written narratives about their own perception habits. We also share questions any health professions educator can use (...) to guide students’ study of their habits of perception using art objects. (shrink)

According to a contemporary school of thought there is a specific female approach to ethics which is based not on abstract “male” ethical principles or rules, but on “care”. Nurses have taken a keen interest in these female approaches to ethics. Drawing on the views expounded by Carol Gilligan and Nel Noddings, nurses claim that a female “ethics of care” better captures their moral experiences than a traditional male “ethics of justice”. This paper argues that “care” is best understood (...) in a dispositional sense, that is, as sensitivity and responsiveness to the particularities of a situation and the needs of “concrete” others. While “care”, in this sense, is necessary for ethics, it is not sufficient. Ethics needs “justice” as well as “care”. If women and nurses excessively devalue principles and norms, they will be left without the theoretical tools to condemn some actions or practices, and to defend others. They will, like generations of nurses before them, be condemned to silence. (shrink)

According to a contemporary school of thought there is a specific female approach to ethics which is based not on abstract “male” ethical principles or rules, but on “care”. Nurses have taken a keen interest in these female approaches to ethics. Drawing on the views expounded by Carol Gilligan and Nel Noddings, nurses claim that a female “ethics of care” better captures their moral experiences than a traditional male “ethics of justice”. This paper argues that “care” is best understood (...) in a dispositional sense, that is, as sensitivity and responsiveness to the particularities of a situation and the needs of “concrete” others. While “care”, in this sense, is necessary for ethics, it is not sufficient. Ethics needs “justice” as well as “care”. If women and nurses excessively devalue principles and norms, they will be left without the theoretical tools to condemn some actions or practices, and to defend others. They will, like generations of nurses before them, be condemned to silence. (shrink)

School administrators are mandated to take the instructional leadership roles. On this premise, a study assessed the extent of instructional leadership practices of public elementary school administrators in El Salvador City Division, Philippines. Also, it explored their actual practices, challenges encountered, and the ways they overcome the challenges in practicing instructional leadership. It employed a mixed-method research design. It administered the adopted assessment tool on instructional leadership to 15 school administrators and 12 of them were involved in (...) the individual interviews. This was conducted between the last quarter of 2019 and the first quarter of 2020. Descriptive statistics were used to describe the extent of instructional leadership practices. Also, it analyzed the actual practices, the challenges encountered, and the ways of overcoming these challenges using thematic narrative analysis. Results revealed that public school administrators have always practiced the four domains or strands of instructional leadership to a very high extent. Providing the technical assistance, conducting clinical supervision, and innovating teaching and learning emerged as themes of their actual practices. These administrators had encountered challenges in dealing with teachers’ attitudes, conflicting schedules and activities, and teachers’ resistance to changes. They overcome the challenges by trying to meet the competency standards, adapting and modifying the existing programs, contextualizing teaching and learning, and inculcating the value and benefits of class observation. Looking at the findings from the lens of deliberate practice theory, it was concluded that school administrators have indicated they have acquired knowledge and a high level of understanding of their instructional leadership roles. But despite of this, they still met challenges and have tried their best to manage them. This study presented some doable and practical recommendations to the Department of Education (DepEd) and concerned offices which may benefit both the internal and external stakeholders of the schools. (shrink)

The clinical clerkships in medical school are the first formal opportunity for trainees to apply bioethics concepts to clinical encounters. These clerkships are also typically trainees’ first sustained exposure to the “reality” of working in clinical teams and the full force of the challenges and ethical tensions of clinical care. We have developed a specialized, embedded ethics curriculum for Vanderbilt University medical students during their second year to address the unique experience of trainees’ first exposure to clinical care. Our (...) embedded curriculum is centered around core “ethics competencies” specific to the clerkship: for Medicine, advanced planning and end-of-life discussions; for Surgery, informed consent; for Pediatrics, the patient-family-provider triad; for Obstetrics and Gynecology, women’s autonomy, unborn child’s interests, and partner’s rights; and for Neurology/Psychiatry, decision-making capacity. In this paper, we present the rationale for these competencies, how we integrated them into the clerkships, and how we assessed these competencies. We also review the additional ethical issues that have been identified by rotating students in each clerkship and discuss our strategies for continued evolution of our ethics curriculum. (shrink)

Evidence‐based medicine has become both the mantra of clinical practice and the dominant contemporary approach to patient care. Gordon Guyatt et al. first proposed applying the concept to medical education in the early 1990s, arguing for training that “de‐emphasizes intuition, unsystematic clinical experience, and pathophysiologic rationale” in favor of “examination of evidence from clinical research”; over the following twenty‐five years, nearly every medical school and residency program in the United States incorporated these methods into its training. During this same (...) period, admissions requirements and protocols have continued to rely on subjective, non‐evidence‐based ideals largely developed a century earlier. In light of the continued underrepresentation of certain demographic groups among matriculants, as well as the national controversy surrounding admissions standards at undergraduate institutions—most notably embodied in the lawsuit by Students for Fair Admissions against Harvard University—the moment may be ripe for a radical reexamination of those requirements. (shrink)

BackgroundThe diagnosis of Attention deficit hyperactivity disorder is primarily dependent on parents’ and teachers’ reports, while children’s own perspectives on their difficulties and strengths are often overlooked.GoalTo further increase our insight into children’s ability to reliably report about their ADHD-related symptoms, the current study examined the associations between children’s self-reports, parents’ and teachers’ reports, and standardized continuous performance test data. We also examined whether the addition of children’s perceptions of ADHD-symptoms to parents’ and teachers’ reports would be reflected by objective (...) and standardized data.MethodsThe study included 190 children with ADHD, aged 7–10 years, who were referred to a pediatric neurologic clinic. A retrospective analysis was conducted using records of a clinical database. Obtained data included children’s self-reports of their attention level and ADHD-related symptoms, parent, and teacher forms of the Conners ADHD rating scales, Child Behavior Checklist, Teacher’s Report Form, and CPT scores.ResultsChildren’s self-evaluations of their functioning were globally associated with their teachers’ and parents’ evaluations, but not uniquely. Children’s self-reports of ADHD symptoms were not uniquely linked to a specific CPT impairment index, but to a general likelihood of having an impaired CPT. The CPT performance successfully distinguished between the group of children who defined themselves as inattentive and those who did not.ConclusionPrimary school children with ADHD are able to identify their limitations and needs difficulties and that their perspectives should inform clinical practice and research. The clinical and ethical imperative of taking children’s perspectives into account during ADHD diagnosis and treatment is highlighted. (shrink)

Many ethics faculty in medical schools do not include abortion in their required curriculum. On the face of it, this is a singular failure since abortion is certainly an important ethical issue. Th...

In this article we report the findings of a randomised control clinical trial that assessed the impact of a Philosophy for Children program and replicated a previous study conducted in Scotland by Topping and Trickey. A Cognitive Abilities Test was administered as a pretest and a posttest to randomly selected experimental groups and control groups. The students in the experimental group engaged in philosophy lessons in a setting of structured, collaborative inquiry in their language arts classes for one hour per (...) week for a number of weeks. The control group received the standard language arts curriculum in that one hour. The study found that the seventh grade students who had experienced the P4C program showed significant gains relative to those in the seventh grade control group at a high level of statistical significance, but the eighth grade students in the experimental group did not show such gains over the eighth grade control group. It was discovered that the seventh grade teachers started the program early in the school year and continued it for a period of 22 to 26 weeks, while the eighth grade teachers started much later and used the program for only 4 to 10 weeks. Our findings suggest that the P4C program must involve students in activities for a significant period of time before the program shows results, but that a meaningful impact on students’ cognitive abilities can be achieved in about 24 weeks of lessons, less than half the time evidenced by the study by Topping and Trickey. (shrink)

This book offers a case-study approach to stakeholder theory that moves beyond theoretical analysis to the applied. As stakeholder theory has moved into the mainstream of management thinking in business ethics and a number of the management disciplines, there is an increasing need to explore the subtleties of stakeholder engagement via examples from practice. The case studies in this volume explore a number of aspects of the idea of stakeholder engagement, via the method of clinical case studies. Edited by leading (...) scholars in the field of business ethics and stakeholder theory, this text affords a solid grounding in theory, brought to new levels of applied understanding of stakeholder engagement. (shrink)

Gerrit Lindeboom’s biography, Herman Boerhaave: The Man and His Work, presents a heroic account of Herman Boerhaave’s life and his many contributions to medicine and medical education. He is portrayed as an outstanding eighteenth century educator who introduced into Leiden’s Medical School a novel method of clinical teaching that was to be widely adopted and today remains at the centre of medical student instruction. Lindeboom’s historiography induced a resurgence of interest in Boerhaave, a renewal of the myth concerning Boerhaave’s (...) innovative teaching and the publication of many acclamatory articles and false epithets, and several critical analyses. Such varying responses prompted this critical examination of the extant Boerhaavian literature, an appraisal of Lindeboom’s objectivity and an assessment of his representations of Boerhaave’s clinical teaching. In doing so, the moral nature of his historiography and that of those who were to sustain his assertions will be established, and the myth that surrounds the novelty and excellence of Boerhaave’s clinical teaching will be evident. (shrink)

With its roots in clinical and educational psychology, school psychology is an ever-changing field that encompasses a diversity of topics. The Oxford Handbook of School Psychology synthesizes the most vital and relevant literature in all of these areas, producing a state-of-the-art, authoritative resource for practitioners, researchers, and parents.Comprising chapters authored by the leading figures in school psychology, The Oxford Handbook of School Psychology focuses on the significant issues, new developments, and scientific findings that continue to change (...) the practical landscape. The handbook's focuses include:allegiance to the reciprocal relationship between science and practice to promote problem-solving and enrichment modelsservice delivery designed to improve competencies of all studentsthe relationship between general cognitive ability and important life outcomesthe development of viable and enduring educational, family, and community systems to support studentsincreasing student diversity and the necessity of increased sensitivity to the influences of social, cultural, political, and legislative variables of schoolingoutlining tenable reasons why, since the end of World War II, children from kindergarten through the secondary grades have generally not been the recipients of a superior or efficient educational systemall relevant legislation, including the No Child Left Behind Act, and the ongoing question of who or what is responsible for the inadequate academic preparation of inner-city childrenbuilding a cumulative knowledge base to better facilitate students' academic, social, and personal competencies including the promotion of positive mental health and subjective well-beingThe scholarship compiled here is a must-read for practitioners, students, and faculty, and an ideal resource for parents seeking a scientific approach to the efficacy of school psychology practices. In both breadth and depth, this handbook promises to serve as the benchmark reference work for years to come. (shrink)

Professions typically formulate codes of ethics. Medical students are exposed to various codes and often are expected to recite some.

There are very few medical ethics courses in British medical schools which are a formal part of the clinical curriculum. Such a programme is described in the following, along with the way in which the long-term curriculum committee of the University College and Middlesex Hospital Joint Medical School was persuaded to make it compulsory for first-year students. Pedagogical lessons which have been learned in its planning and implementation are outlined and teaching materials are included concerning student and course assessment (...) which should be useful for others engaged in similar work. Finally, some of the institutional obstacles facing such attempts are discussed, particularly problems concerning timetabling, different types of opposition and the consequent importance of building alliances among clinical teaching staff. (shrink)

In this article we report the findings of a randomised control clinical trial that assessed the impact of a Philosophy for Children program and replicated a previous study conducted in Scotland by Topping and Trickey. A Cognitive Abilities Test was administered as a pretest and a posttest to randomly selected experimental groups and control groups. The students in the experimental group engaged in philosophy lessons in a setting of structured, collaborative inquiry in their language arts classes for one hour per (...) week for a number of weeks. The control group received the standard language arts curriculum in that one hour. The study found that the seventh grade students who had experienced the P4C program showed significant gains relative to those in the seventh grade control group at a high level of statistical significance, but the eighth grade students in the experimental group did not show such gains over the eighth grade control group. It was discovered that the seventh grade teachers started the program early in the school year and continued it for a period of 22 to 26 weeks, while the eighth grade teachers started much later and used the program for only 4 to 10 weeks. Our findings suggest that the P4C program must involve students in activities for a significant period of time before the program shows results, but that a meaningful impact on students’ cognitive abilities can be achieved in about 24 weeks of lessons, less than half the time evidenced by the study by Topping and Trickey. (shrink)

This paper explores the adult mindfulness landscape, secular and Buddhist, in order to inform an approach to the teaching of mindfulness in secondary schools. The Introduction explains the background to the project and the significant overlap between secular and Buddhist practices. I explain what mindfulness is and highlight a number of important practical differences between the teaching of mindfulness in the adult world and in schools. ‘Balancing Calm and Insight’ looks at mindfulness through a lens infrequently explored in the therapeutic (...) literature, and suggests that a slight shift in the centre of gravity towards Calm might be appropriate. ‘Defining Objectives’ considers how difficult it is to clearly articulate the objective of mindfulness in schools given a new context in which it functions as neither clinical application nor spiritual practice. A range of alternatives is considered. ‘Building a Scaffolding’ explains the importance of context in both Buddhist and secular practice. To succeed, mindfulness should be nested within a broader framework of understanding, or what Kabat-Zinn calls a ‘scaffolding’. I suggest that perhaps the best ‘scaffolding’ for mindfulness in schools is its sense of possibility. ‘Ethics and Community’ describes how ethics are more important in secular mindfulness than they at first appear. The shape ethics might take in a school context is considered, then an assessment of the role of the teacher and what equivalent there might be for what Buddhists call sa?gha, or Community. (shrink)

Doctoral students in clinical, counseling, and school psychology programs often collaborate with faculty on research projects in their training as scientist-practitioners. Yet, the determination of publications' credit and order of authorship on resulting manuscripts continues to be a major concern and challenging process for professional psychologists and student collaborators. This article describes the use of case-based learning and semi-structured interview approaches to instruct first-year clinical psychology doctoral students in publication ethics during a research seminar. The instructor models ethical decision-making (...) with 1) a discussion of four cases from his own professional experiences and 2) a description of the Authorship Eligibility Assessment form, which he developed for use with junior researchers. The authors advocate for more educational strategies to supplement the APA standards in teaching the ethics of the publication process. Implications in terms of graduate student development and research collaborations in the field of professional psychology were discussed. (shrink)

The aim of this pilot study was to develop a realistic clinical case for identifying Knobe's asymmetric effect, ie, the tendency to ascribe intentions to a larger extent when an act is considered wrong, as well as to compare medical students at the beginning and end of their curriculum. A vignette about a critically ill 72-year-old patient in need of an operation was used, with two different outcomes: the patient dies or the patient recovers. Approximately half of the students received (...) the ‘recovery case’ and half the ‘death case’. The questions asked were whether it was right to perform the risky operation and whether the head of the clinic brought about the patient's death/recovery intentionally. Among students in their first term an asymmetry in response pattern was identified. This asymmetry was not found among students in their final term. The difference between term 1 and term 11 students is believed to be due to the socialisation of medical students towards clinical reasoning regarding the moral role of intentions. Although no Knobe effect could be detected among term 11 students, a related adaptation effect was detected, indicating that students at the end of their medical school also tend to adapt their ascription of intentions to their moral evaluation of the act. By using clinically relevant cases a new effect has thus been identified that might be useful when investigating experienced clinicians and their views on intentions. The cases and effect merit further investigation. (shrink)

This multidisciplinary subject in clinical anthropology was started in April 1996 among 206 students distributed over all Colleges and Schools in the University of Tsukuba with the exception of School of Medical Sciences. After every class students write down their comments on a compulsory attendance slip, and these comments were examined. Female students agreed with the surrogate mothers and homosexuality more than male students. Male students denied childcare by homosexual parents more than female students. Sex selection insemination with the (...) exception for disease prevention was denied by female students significantly more than male students. (shrink)

All investigators funded by the National Institutes of Health are now required to receive training about the ethics of clinical research. Based on a course taught by the editors at NIH, Ethical and Regulatory Aspects of Clinical Research is the first book designed to help investigators meet this new requirement. The book begins with the history of human subjects research and guidelines instituted since World War II. It then covers various stages and components of the clinical trial process: designing the (...) trial, recruiting participants, ensuring informed consent, studying special populations, and conducting international research. Concluding chapters address conflicts of interest, scientific misconduct, and challenges to the IRB system. The appendix provides sample informed consent forms. This book will be used in undergraduate courses on research ethics and in schools of medicine and public health by students who are or will be carrying out clinical research. Professionals in need of such training and bioethicists also will be interested. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Talking Cures, the Clinic, and the Value of the IneffableDaniel Berthold (bio)KeywordsMadness, disease, the normal, the abnormal, the ineffable, Hegel, Kierkegaard, LacanI am most grateful to my readers, James Phillips and Louis Sass, who have led me to several new insights by suggesting ways of complicating my reading of a Lacanian approach to Hegel's and Kierkegaard's conceptions of madness. I am a Kierkegaard and Hegel scholar, with very little (...) pretense to expertise about Lacan and regrettably even less about the theory and practice of psychiatry. In submitting my essay to Philosophy, Psychiatry, & Philosophy, I was hoping to entice a community of practitioners and theoreticians I have great respect for to consider the musings of a philosopher on topics which engage them as thinkers and actors in their professions. I could not possibly have hoped for more intelligent and provocative replies than I have been given by my two respondents.Phillips' framing of his response in terms of the distinction between the "madness of the philosophers" and the "madness of the clinic" is very helpful. It is a distinction that is indeed central to the question of the possibility of dialogue between philosophers and clinicians—so central, in fact, that it is generous of Phillips not to reproach me for failing to mention it. On the one hand, the challenge for philosophers is to show that their descriptions are not merely metaphoric and that their preoccupation with the dark side of human experience connects in some way with the reality of disease, so that there is some way for clinicians to translate their language into the language of psychiatry. Otherwise, philosophers will have only poetic or literary interest for the psychiatrist or psychologist.On the other hand, the challenge for clinicians is the extent to which they are open to moving beyond a reduction of "mental illness" to a purely biological conception of disease. One needn't go so far—nor should we—as Thomas Szasz or Michel Foucault in seeing "mental disease" as itself merely a metaphor. But granting the evidence of underlying organic disorder, symptoms nevertheless display themselves as mental and behavioral states (what Hegel calls "shapes of consciousness") that, as Hegel argued, are paralleled in "normal" experience, so that the distinction between disease and normality (and hence illness and metaphor) is often elusive. Madness "has the healthy consciousness for its presupposition," Hegel writes, because the healthy mind is still grappling with the same sorts of contradictions and feelings of alienation, the same "infinite pain" which characterizes insanity. Madness is not the absolute "other" of rationality, but an echo of it (1978, 3:382, 408).Hegel himself accepted the medicalization of madness that began to occur in the late eighteenth [End Page 325] century, and rejected the metaphysical and theological categories of what was called "romantic medicine." But he also cautioned against the narrowness of the "somatic" school which he felt lacked sufficient explanatory value if not connected to a "speculative" (i.e., philosophic) framework (see Berthold-Bond 1995, ch. 2).It might even be argued that every person seeking therapy is first of all suffering from "philosophic" madness, at least in the sense that initially she does not understand her own suffering as "disease," but experiences her torment in the vocabulary of the philosopher. Thus the philosopher's descriptions are the closest to the subject's own self-understanding, and while the therapist must seek to rephrase these descriptions into the vocabulary of the clinic (just as Hegel, for example, translated his own philosophic description of the madness of his friend Hölderlin in the Phenomenology as the "lost soul" whose "light dies away within it" into the medical category of Wahnsinn—mania or frenzy, which today we would call schizophrenia—in the classificatory scheme of mental disorder he gives in the Encyclopaedia; 1977, 400; 1978, 408)—there is a real question about which vocabulary is a metaphor for the other.The second main point Phillips addresses, which is taken up in different ways by Sass as well, has to do with the relation between speech and silence in madness. Phillips finds that Kierkegaard offers a more complex and subtle view than... (shrink)

Objectives: To evaluate the perceptions of clinical dental students on the role of online education in providing dental education during the COVID-19 crisis.Materials and Methods: A cross-sectional online survey was sent to four Egyptian dental schools from the 20th of January 2021 to the 3rd of February 2021. Survey questions included the demographics, uses, experiences, perceived benefits, and barriers of distance learning in dentistry during the COVID-19 pandemic. Responses were collected from the clinical dental school students. Categorical data were (...) presented as frequencies and percentages and were analyzed using Fisher’s exact test.Results: Three hundred thirty-seven clinical dental students across four Egyptian dental schools responded. Most students used either Google Classroom or Microsoft Teams to access the online content. The data showed that the COVID-19 pandemic affected the academic performance of most participants with varying degrees. On average, students were neutral when asked to rate the online lectures, but did not find online practical education as effective as online theoretical teaching. The commonly described barriers to online teaching included loss of interaction with educators, inappropriateness in gaining clinical skills, and the instability of the internet connection.Conclusion: Despite the reported benefits, clinical dental students in Egypt preferred the hybrid approach in dental education as distance learning represented a prime challenge to gain adequate clinical dental skills. (shrink)

Objective: To determine whether the marks in the third year Objective Structured Clinical Examination were affected by the collusion reported by the students themselves on an electronic discussion board.Design: A review of the student discussion, examiners’ feedback and a comparison of the marks obtained on the 2 days of the OSCE.Participants: 255 third year medical students.Setting: An OSCE consisting of 15 stations, administered on three sites over 2 days at a UK medical school.Results: 40 students contributed to the discussion (...) on the electronic discussion board. The main points raised were perceived inequity between students who did, or did not, have prior knowledge of the station content, and the lack of honesty and professionalism of their peers. Most contributors claimed to have received, or knew of others receiving, prior knowledge, but none confessed to passing on information. No significant difference was observed in the overall mark for the OSCE on day 1 ) and day 2 ). On day 2, marks were considerably greater for four stations and markedly lower for three stations. It was not obvious why collusion should affect these station marks. A clear indication of the effects of collusion could only be obtained from a single subsection of an individual station where 82 students on day 2 incorrectly gave the diagnosis from day 1.Conclusion: Marks do not provide a sound inference of student collusion in an OSCE and may mask the aspects of professional development of students. (shrink)

This article argues that lawyers have personal moral obligations to help ensure that no one who needs legal services goes without and hence that the practice of law should be seen as involving a calling to promote access to justice. One important aim of the law schools should thus be to inculcate in their students a sense of this calling and ideally to ensure that this notion of 'altru-ethical' professionalism becomes part of each lawyer's moral character. Drawing on educational theory, (...) studies on the impact of law clinics on students' ethical values and a survey of the attitudes towards a legal career, this article argues that the most effective way of inculcating such a sense of calling is through lengthy student involvement in live-client law clinics combined with ethics teaching and opportunities for reflection. It then describes a unique new degree, the University of Strathclyde Clinical LLB, which adopts a cradle to grave approach to the integration of ethics teaching and clinical experience into the standard law degree with the aim of increasing the chances of a sense of altruistic calling becoming part of a student's professional moral character. (shrink)

IntroductionDespite the need for trained physician ethicists, fellowships in clinical ethics are limited and primarily offered to thosewho have completed a graduate degree. The standardization of credentialing for clinical ethics consultants (CECs) and the restructuring of undergraduate medical education allow innovative models to train CECs that can provide an expanded opportunity for formal ethics training at an earlier stage.MethodsAt the University of Michigan Medical School we developed, implemented, and evaluated a pre-doctoral clinical ethics fellowship program from 2017 to 2019 (...) for senior medical students, designed to meet established competencies for CECs. Consultation notes from the beginning and end of the fellowship program were randomly selected for each fellow and independently rated by two faculty ethicists who used the validated Ethics Consultation Quality Assessment Tool (ECQAT).1 Inter rater reliability and trends in scores over time were calculated.ResultsThree students successfully completed the fellowship at the University of Michigan Medical School, conducted at least 50 formal ethics consultations, and spent approximately 40 hours a week on service for a minimum of six months. All students finished the fellowship with teaching and policy development experience, first-authored peer-reviewed manuscripts, and national presentations. The fellows demonstrated improvement in their ECQAT overall holistic rating score; all ended their fellowship with a holistic score of adequate or above. There was 92 percent agreement between raters withrespect to the acceptability of the fellows’ ethics consult notes. Two fellows have taken and passed the Healthcare Ethics Consultant-Certification (HEC-C) exam offered by the American Society for Bioethics and Humanities (ASBH).ConclusionsIntegration of a pre-doctoral fellowship model that meets professional certification standards for clinical ethics consultation creates an opportunity for medical students to become trained CECs early in their career. (shrink)

The meaning of the term logagogy is elucidated, and logagogic practices are outlined in the history of medicine. It is shown how the traditional medicine of India, Ayurveda, shows signs of logagogic practices(sattvavajaya), and that not only Ayurveda but also the famous Greek physician Galenus emphasize a philosophical approach to medicine. As Galenus’s logagogic practices have their roots in the tradition of practical philosophy in Greek antiquity, the most important Greek schools of thought that are relevant to logagogic approaches are (...) sketched. It is shown that the Stoics created a rationalistic system emphasizing the importance of the logos for human beings, and that Epicurus made advances in psychoeducation and cognitive reframing that are important for logagogic practices. These logagogic approaches of antiquity have been taken up by modern counseling in philosophical practices. The article closes with an outline of a clinical logagogy. (shrink)

_The Budapest School of Psychoanalysis_ brings together a collection of expertly written pieces on the influence of the Budapest conception of analytic theory and practice on the evolution of psychoanalysis. It touches on major figures Sándor Ferenczi and Michael Balint whilst concurrently considering topics such as Ferenczi’s clinical diary, the study of trauma, the Confusion of Tongues paradigm, and Balint’s perspective on supervision. Further to this, the book highlights Jacques Lacan’s teaching of Ferenczi, which brings a fresh perspective to (...) a relatively unknown connection between them. The book highlights that the Hungarian analysts, influenced by Ferenczi, through their pioneering work developed a psychoanalytic paradigm which became an alternative to the Freudian tradition. That this paradigm has become recognised and admired in its own right underlines the need to clearly outline, as this book does, the historical context and the output of those who are writing and working in the tradition of the Budapest School. The contributions to this volume demonstrate the widespread and enduring influence of the Budapest School on contemporary psychoanalysis. The contributors are amongst the foremost in Budapest School scholarship and the insights they offer are at once profound as well as insightful. This book is an important read for those practitioners and students of psychoanalysis who wish for an insight into the early and developing years of the Budapest School of Psychoanalysis and its impact on contemporary clinical practice. (shrink)

Alongside clinical practice, medical schools now confront mounting reasons to examine nontraditional approaches to ethics. Increasing awareness of systems of oppression and their effects on the experiences of trainees, patients, professionals, and generally on medical care, is pushing medical curriculum into an unfamiliar territory. While there is room throughout medical school to take up these concerns, ethics curricula are well-positioned to explore new pedagogical approaches. Feminist ethics has long addressed systems of oppression and broader structures of power. Some of (...) its established concepts can offer distinct value as medical climates change and adapt in response to increased awareness of the experiences of marginalized individuals and populations. In this essay, we offer a set of concepts from feminist ethics that have a fundamental role to play in medical school curriculum: relationality, relational autonomy, and epistemic justice. Though these concepts are not exhaustive, they can be taught in tandem with the concepts that have historically grounded ethics education in medical school, such as autonomy and beneficence. Ultimately, we contend that these concepts hold particular value in ethics curriculum insofar as they diversify mainstream ethical approaches, directly address the pervasiveness of systems of oppression in medicine, and recognize the voices and concerns that may be marginalized in standard approaches. (shrink)

This book was inspired originally by the debates at the turn of the century about placebo controlled trials of antiretrovirals in HIV positive pregnant women in developing countries. Moving forward from this one limited example, the book includes several additional controversial cases of clinical research conducted in developing countries, and asks probing philosophical questions about the ethics of such trials. All clinical research by its very nature uses people to acquire generalizable knowledge to help future people. But what sorts of (...) "use" are morally permissible? What is it to exploit people? Suppose that a trial conducted in a developing country would not be ethically permissible in the developed world. Can we automatically conclude from this that the trial is unethical, that some sort of morally problematic double standard is in operation? Or might the differences in the two settings justify differences in trial design? This collection of philosophical essays examines these important questions about what exploitation is and when clinical research counts as exploitative. -/- "This is an outstanding contribution to the growing literature on the ethics of research with human subjects and a fine example of what bioethics can offer at its best. Anyone with a serious interest in these issues will need to read this book from start to finish." -Daniel Wikler, Harvard School of Public Health "This book contributes significantly to the literature on exploitation in clinical research conducted in the developing world."--Patricia Marshall, Case Western Reserve University . (shrink)

Rationale and objectives: Medical humanities are becoming increasingly recognized as positively impacting medical education and medical practice. However, the extent of medical humanities teaching in medical schools is largely unknown. We reviewed medical school curricula in Canada, the UK and the US. We also explored the relationship between medical school ranking and the inclusion of medical humanities in the curricula. -/- Methods: We searched the curriculum websites of all accredited medical schools in Canada, the UK and the US (...) to check which medical humanities topics were taught, and whether they were mandatory or optional. We then noted rankings both by Times Higher Education and U.S. News and World Report and calculated the average rank. We formally explored whether there was an association between average medical school ranking and medical humanities offerings using Spearman's correlation and inverse variance weighting meta-analysis. -/- Results: We identified 18 accredited medical school programmes in Canada, 41 in the UK, and 154 in the US. Of these, nine (56%) in Canada, 34 (73%) in the UK and 124 (80%) in the US offered at least one medical humanity that was not ethics. The most common medical humanities were medical humanities (unspecified), history, and literature (Canada); sociology and social medicine, medical humanities (unspecified), and art (UK); and medical humanities (unspecified), literature and history (US). Higher ranked medical schools appeared less likely to offer medical humanities. -/- Conclusions: The extent and content of medical humanities offerings at accredited medical schools in Canada, the UK and the US varies, and there appears to be an inverse relationship between medical school quality and medical humanities offerings. Our analysis was limited by the data provided on the Universities' websites. Given the potential for medical humanities to improve medical education and medical practice, opportunities to reduce this variation should be exploited. (shrink)

In this review article we describe the current scope, methods, and contents of medical ethics education in medical schools in Western English speaking countries (mainly the United Kingdom, the United States, and Australia). We assess the strengths and weaknesses of current medical ethics curricula, and students’ levels of satisfaction with different teaching approaches and their reported difficulties in learning medical ethics concepts and applying them in clinical practice. We identify three main challenges for medical ethics education: counteracting the bad effects (...) of the “hidden curriculum,” teaching students how to apply ethical knowledge and critical thinking to real cases in clinical practice, and shaping future doctors’ right character through ethics education. We suggest ways in which these challenges could be addressed. On the basis of this analysis, we propose practical guidelines for designing, implementing, teaching, and assessing a medical ethics program within a four-year medical course. (shrink)