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)

Through the 1960s, many people claimed that drug advertising was educational and physicians often relied on it. Continuing Medical Education (CME) was developed to provide an alternative. However, because CME relied on grants, industry funders chose the subjects offered. Now policymakers worry that drug firms support CME to promote sales and that commercial support biases prescribing and fosters inappropriate drug use. A historical review reveals parallel problems between advertising and industry-funded CME. To preclude industry influence and improve (...) CME, we should ensure independent funding by taxing medical industries, facilities and physicians. Independent public and professional authorities should create CME curricula. An independent agency should allocate all funds to educational institutions for approved curricula. (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)

There are at present 28 Jesuit colleges and universities in the United States, which together offer more than 50 health sciences degree programs. But as the Society's membership is shrinking and the financial risks involved in sponsoring health sciences education are rising, the question arises whether the Society should continue to sponsor health sciences degree programs. In fact, at least eight Jesuit health sciences schools have already closed their doors. This paper attempts to contribute to the resolution of this (...) urgent question by reexamining Ignatius' own views on health sciences education and, more specifically, his prohibition of the Society's sponsoring medical education. It concludes on the basis of an historical analysis of Ignatius' views that there is insufficient support for today's ,Jesuits to maintain their engagement in medical and health care education. (shrink)

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)

Over several decades, ethics and law have been applied to medical education and practice in a way that reflects the continuation during the twentieth century of the strong distinction between facts and values. We explain the development of applied ethics and applied medical law and report selected results that reflect this applied model from an empirical project examining doctors’ decisions on withdrawing/withholding treatment from patients who lack decision-making capacity. The model is critiqued, and an alternative “constitutive” model (...) is supported on the basis that medicine, medical law, and medical ethics exemplify the inevitable entanglement of facts and values. The model requires that ethics and law be taught across the medical education curriculum and integrated with the basic and clinical sciences and that they be perceived as an integral component of medical evidence and practice. Law, in particular, would rank as equal in normative authority to the relevant clinical scientific “facts” of the case, with graduating doctors having as strong a basic command of each category as the other. The normalization of legal knowledge as part of the clinician’s evidence base to be utilized in practice may provide adequate consolation for clinicians who may initially resent further perceived incursions on their traditional independence and discretion. (shrink)

As early as the 1960s and 1970s, astute commentators began to call into question the degree of influence that the pharmaceutical industry was exercising over all aspects of medical research, education, and practice in the U.S. More recently, a spate of books and articles demonstrates that the issue has only become more serious in the last decade or two.My focus in this paper will be on the industry’s influence on medical education. The influence that the industry (...) exerts on undergraduate and graduate medical education often occurs through the system of pharmaceutical sales representatives, who also “detail” drugs to practitioners; or through the influence that the industry exerts over medical research. I will therefore devote my attention here primarily to the system of continuing medical education by which practitioners receive information about medical advances. The pharmaceutical industry currently supports about one-half of the costs of CME in the U.S., so it seems appropriate to question the degree of industry influence over the content of CME. (shrink)

Incivility among physicians, between physicians and learners, and between physicians and nurses or other healthcare professionals has become commonplace. If allowed to continue unchecked by academic leaders and medical educators, incivility can cause personal psychological injury and seriously damage organisational culture. As such, incivility is a potent threat to professionalism. This paper uniquely draws on the history of professional ethics in medicine to provide a historically based, philosophical account of the professional virtue of civility. We use a two-step method (...) of ethical reasoning, namely ethical analysis informed by pertinent prior work, followed by identifying the implications of clearly articulated ethical concepts, to meet these goals. The professional virtue of civility and the related concept of professional etiquette was first described by the English physician-ethicist Thomas Percival (1740–1804). Based on a historically informed philosophical account, we propose that the professional virtue of civility has cognitive, affective, behavioural and social components based on a commitment to excellence in scientific and clinical reasoning. Its practice prevents a dysfunctional organisational culture of incivility and sustains a civility-based organisational culture of professionalism. Medical educators and academic leaders are in a pivotal and powerful position to role model, promote and inculcate the professional virtue of civility as essential to an organisational culture of professionalism. Academic leaders should hold medical educators accountable for discharge of this indispensable professional responsibility. (shrink)

Use of humanities content in American medical education has been debated for well over 60 years. While many respected scholars and medical educators have purported the value of humanities content in medical training, its inclusion remains unstandardized, and the undergraduate medical curriculum continues to be focused on scientific and technical content. Cited barriers to the integration of humanities include time and space in an already overburdened curriculum, and a lack of consensus on the exact content, (...) pedagogy and instruction. Edmund Pellegrino, physician and scholar of the latter twentieth century, spent much of his professional life promoting the value and importance of the humanities in medical education, seeking the best way to incorporate and teach this content in clinically relevant ways. His efforts included the founding of multiple enterprises starting in the 1960s and 1970s to promote human values in medical education, including the Society for Health and Human Values and its Institute on Human Values in Medicine. Regardless of his efforts and those of many others into the current century, the medical humanities remains a curricular orphan, unable to find a lasting home in medical education and training. (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)

Presently, the pharmaceutical industry funds about half of the costs of continuing medical education programs in the U.S. This contributes to the ethical problems that pervade the relationship between medicine and the pharmaceutical industry: trustworthiness and conflicts of interest. The problems are exacerbated by rationalizations prevalent on both sides that deny the ethical concerns. Commercialism and commercial bias are highly visible at large CME gatherings, and available data, while scanty, back up the view that physician attendees' subsequent (...) prescribing practices are influenced by the commercial message. The industry believes that it will recoup $3.56 in increased sales for every dollar that it invests in CME. New guidelines instituted by the Accreditation Council for Continuing Medical Education in 2004 may succeed in reducing excessive commercial influence, especially since the Department of Health and Human Services has also warned the industry of possible anti-kickback violations if firewalls are not erected between CME funding and marketing of drugs. Critics counter that early indicators of improvement are lacking. (shrink)

The idea that ethics is a matter of personal feeling is a dogma widespread among medical students. Because emotivism is firmly rooted in contemporary culture, the authors think that focusing on personal feeling can be an important point of departure for moral education. In this contribution, they clarify how personal feelings can be a solid basis for moral education by focusing on the analysis of compassion by the French phenomenologist Emmanuel Housset. This leads to three important issues (...) regarding ethics education: the necessity of a continuous attention for and interpretation of the meaning of language, the importance of examining what aspect of “the other” touches one and what it is that evokes the urge to act morally and the need to relate oneself to the community, both to the medical community and to collectively formulated rules and laws. These issues can have a place in medical education by means of an ethical portfolio that supports students in their moral development. First, keeping a portfolio will improve their expression of the moral dimension of medical practice. Second, the effects of self-knowledge and language mastery will limit the pitfalls of emotivism and ethical subjectivism and will stimulate the inclination to really encounter the other. Third, it will show medical students from the start that their moral responsibility is more than following rules and that they are involved personally. (shrink)

This paper aims to position the birth of the Medical Humanities movement in a greater historical context of twentieth century American medical education and to paint a picture of the current landscape of the Medical Humanities in medical training. It first sheds light on the model of medical education put forth by Abraham Flexner through the publishing of the 1910 Flexner Report, which set the stage for defining physicians as experimentalists and rooting the (...) profession in research institutions. While this paved the way for medical advancements, it came at the cost of producing a patriarchal approach to medical practice. By the late 1960s, the public persona of the profession was thus devoid of humanism. This catalyzed the birth of the Medical Humanities movement that helped lay the framework for what has perpetuated as the ongoing incorporation of humanistic subjects into medical training. As we enter a time in medicine in which rates of burnout are ever-increasing and there are growing concerns about a concomitant reduction in empathy among trainees, the need for instilling humanism remains important. We must consequently continue to consider how to ensure the place of the Medical Humanities in medical education moving forward. (shrink)

Animals have been and will continue to be used in educational programs, but some concerns about the responsibility for assuring their proper care and humane use need to be discussed. Research animals have been regulated and monitored quite successfully by Institutional Animal Care and Use Committees (IACUC). These Committees are extending their responsibilities to cover animals used in educational programs. Three common roles of these IACUCs are described, including oversight, investigative and training responsibilities. Guidelines developed for faculty using animals at (...) the University of Florida are presented and discussed. (shrink)

The process of continuing education of paramedics is based on gaining educational credits during five-year educational periods. One of the forms of self-improvement are Internet-based educational programs. The lack of regulations concerning the organizational and technical aspects of e-learning made the authors attempt to analyze the phenomenon. The aim of the article is to present an initial analysis of the role of online educational programs in comparison with other forms of professional training of paramedics. One in three respondents (...) has recently used one of the methods of distance learning. Despite the low awareness of the effectiveness of e-learning, almost 70% of the interviewees expressed a positive opinion about it and over 50% were willing to use such forms in the future. The respondents preferred online trainings in the asynchronous version, containing audio-visual materials and providing the possibility to obtain a certificate issued to the participant after completing the course. The demand for topics in the area of professional training included mainly the fields of Drug Therapy, electrotherapy, electrocardiogram evaluation, medical segregation, and help in delivery in pre-hospital conditions. Modern forms of distance learning do not make it possible to acquire practical skills, yet their role in professional training of paramedics is still significant. According to the authors, online educational programs constitute an effective complement to traditional training through the performance of tasks in a mixed form, known as blended-learning. (shrink)

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

Roughly 40% of the sizeable medical research and literature on recently approved drugs is “ghost managed” by the pharmaceutical industry and its agents. Research is performed and articles are written by companies and their agents, though apparently independent academics serve as authors on the publications. Similarly, the industry hires academic scientists, termed key opinion leaders, to serve as its speakers and to deliver its continuing medical education courses. In the ghost management of knowledge, and its dissemination (...) through key opinion leaders, we see the pharmaceutical industry attempting to hide or disguise the interests behind its research and education. (shrink)

Medical ethics changed dramatically in the past 30 years because physicians and humanists actively engaged each other in discussions that sometimes led to confrontation and controversy, but usually have improved the quality of medical decision-making. Before then medical ethics had been isolated for almost two centuries from the larger philosophical, social, and religious controversies of the time. There was, however, an earlier period where leaders in medicine and in the humanities worked closely together and both fields were (...) richer for it. This volume begins with the 18th century Scottish Enlightenment when professors of medicine such as John Gregory, Edward Percival, and the American, Benjamin Rush, were close friends of philosophers like David Hume, Adam Smith, and Thomas Reid. They continually exchanged views on matters of ethics with each other in print, at meetings of elite intellectual groups, and at the dinner table. Then something happened, physicians and humanists quit talking with each other. In searching for the causes of the collapse, this book identifies shifts in the social class of physicians, developments in medical science, and changes in the patterns of medical education. Only in the past three decades has the dialogue resumed as physicians turned to humanists for help just when humanists wanted their work to be relevant to real-life social problems. Again, the book asks why, finding answers in the shift from acute to chronic disease as the dominant pattern of illness, the social rights revolution of the 1960's, and the increasing dissonance between physician ethics and ethics outside medicine. The book tells the critical story of how the breakdown in communication between physicians and humanists occurred and how it was repaired when new developments in medicine together with a social revolution forced the leaders of these two fields to resume their dialogue. (shrink)

Philosophy of medicine has traditionally examined two issues: the scientific ontology for medicine and the epistemic significance of the types of evidence used in medical research. In answering each question, philosophers have typically brought to bear tools from traditional analytic philosophy. In contrast, this volume explores medical knowledge from the perspective offered by social epistemology.While many of the same issues are addressed, the approach to these issues generates both fresh questions and new insights into old debates. In addition, (...) the broader purview offered by social epistemology opens up opportunities to address new topics such as the role of consensus conferences, epistemic injustice, the value of medical knowledge, continuing medical education, and industry funding. This article situates and summarizes the contributions to this special issue. (shrink)

Bioethics Education in the Anglo-European context developed since 1970 and was incorporated into the undergraduate and postgraduate education, residency training, and continuous education. In the Asia-Pacific region, bioethics education is less structured and often dependent on contextual constraints. This paper provides a cross-sectional analysis, describing institutional experiences in developing bioethics curriculum at two medical schools in Malaysia and Hong Kong. The medical programmes of the two institutions are distinctive in terms curriculum framework, teaching approach, (...) and topic selection, and common challenges include implementation of bioethics courses, students’ resistance to bioethics, and limited teaching capacity, emerged as they evolve. The reported experiences revealed that there is room for improvement regarding how medical schools integrate bioethics education in regions where curriculum development remains at an early stage. At least, a bioethics education requires both top-down support from the faculty to improve teaching and educational quality, as well as from the bottom-up approach to empower students to raise awareness and concerns toward bioethics, and helps students developing reasoning through challenging issues. (shrink)

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

Few studies exist which look at psychological factors associated with physician sexual misconduct. In this study, we explore family dysfunction as a possible risk factor associated with physician sexual misconduct. Six hundred thirteen physicians referred to a continuing medical education (CME) course for sexual misconduct were administered the FACES-II survey, a validated and reliable measure of family dynamics. The survey was part of a self-learning activity. We collected data from February 2000 to February 2009. Participants were predominantly (...) white, middle-aged males who represented the full range of medical specialties. Their results were compared against a sample of 177 physicians. The FACES-II is a self-report test that measures family of origin (the family in which one was raised) dynamics on two dimensions (1) flexibility, ranging from too flexible (chaotic) to not flexible enough (rigid) and (2) cohesion ranging from too close (enmeshed) to not close enough (disengaged). The most common family pattern observed among physicians accused of sexual misconduct was rigid flexibility paired with disengaged cohesion, indicative of unhealthy family functioning. This pattern was significantly different than the pattern observed in the comparison group. Physicians who engage in sexual misconduct are more likely to have family of origin dysfunction. Ethics is developmental and learned in one’s family of origin. Family of origin dynamics may be one risk factor predisposing one to ethical violations. These findings have important implications for screening, education, and treatment across the medical education continuum. (shrink)

Background There is continued need for enhanced medical ethics education across the United States. In an effort to guide medical ethics education reform, we report the first interprofessional survey of a cohort of graduate medical, nursing and allied health professional students that examined perceived student need for more formalized medical ethics education and assessed preferences for teaching methods in a graduate level medical ethics curriculum. Methods In January 2018, following the successful implementation (...) of a peer-led, grassroots medical ethics curriculum, student leaders under faculty guidance conducted a cross-sectional survey with 562 of 1357 responses received among students enrolled in the School of Medicine, College of Nursing, Doctor of Physical Therapy and BS/ MD Professional Scholars programs at The Medical College of Georgia at Augusta University. An in person or web-based questionnaire was designed to measure perceived need for a more in-depth medical ethics curriculum. Results The majority of respondents were female, white and mid-20s in age. Almost half of respondents reported no prior medical ethics exposure or training in their previous educational experience, while 60% of students across all degree programs reported an interest in more medical ethics education and 92% noted that an understanding of medical ethics was important to their future career. Over a quarter of students were interested in pursuing graduate-level training in medical ethics, with case-based discussions, small group peer settings and ethics guest lectures being the most desired teaching methods. Conclusions The future physician, nursing and physical therapist workforce in our medical community demonstrated an unmet need and strong interest for more formal medical ethics education within their current coursework. Grassroots student-driven curricular development and leadership in medical ethics can positively impact medical education. Subsequent integration of interprofessional training in medical ethics may serve as a vital curricular approach to improving the training of ethically competent healthcare professionals and overcoming the current hierarchical clinical silos. (shrink)

Medical cannabis is widely available in the USA and legalisation is likely to expand. Despite the increased accessibility and use of medical cannabis, physicians have significant knowledge gaps regarding evidence of clinical benefits and potential harms. We argue that primary care providers have an ethical obligation to develop competency to provide cannabis to appropriate patients. Furthermore, specific ethical considerations should guide the recommendation of medical cannabis. In many cases, these ethical considerations are extensions of well-established principles of (...) beneficence and nonmaleficence, which indicate that providers should recommend cannabis only for conditions that have the strongest evidence base. Additionally, the contested status of cannabis in American culture raises specific issues related to shared decision-making and patient education, as well as continuing clinical education. (shrink)

Objective: To identify factors that predict physicians’ intent to comply with the American Medical Association’s ethical guidelines on gifts from the pharmaceutical industry.Methods: A survey was designed and mailed in June 2004 to a random sample of 850 physicians in Florida, USA, excluding physicians with inactive licences, incomplete addresses, addresses in other states and pretest participants. Factor analysis extracted six factors: attitude towards following the guidelines, subjective norms , facilitating conditions , profession-specific precedents , individual-specific precedents and intent. Multivariate (...) regression modelling was conducted.Results: Surveys were received from 213 physicians representing all specialties, with a net response rate of 25.5%. 62% of respondents were aware of the guidelines; 50% had read them. 48% thought that following the guidelines would increase physicians’ credibility and professional image; 68% agreed that it was important to do so. Intent to comply was positively associated with attitude, subjective norms, facilitators and sponsorship of continuing medical education events, while individual-specific precedents had a negative relationship with intent to comply. Predictors of intent were attitude, subjective norms, the interaction term , sponsorship of CME events and individual-specific precedents.Conclusions: Physicians are more likely to follow the AMA guidelines if they have positive attitudes towards the guidelines, greater subjective norms, fewer expectations of CME sponsorship and fewer individual-specific precedents. Physicians believing that important individuals or organisations expect them to comply with the guidelines are more likely to express intent, despite having fewer beliefs that positive outcomes would result through compliance. (shrink)

As a result of the epidemiological situation in Poland that occurred as a consequence of the SARS-CoV-2 pandemic, all classroom study was suspended in March 2020 and schools were required to deliver online education. There number of teachers who create educational resources for medical e-education, also those including interactive elements, is still insufficient. Teachers’ IT skills must be continuously improved and they have to take part in e-learning course design training programmes, taking into account the characteristics of (...) the teaching process in medical sciences and health studies. The existing examples of effective e-classes, particularly for medical training, are important sources of knowledge on how to build e-learning courses for beginners and an inspiration for others in subsequent implementations. This knowledge is needed immediately, and the time available for acquiring it is shorter than previously, as the epidemic does not allow for full-range training schemes. This paper presents such results, collected from the period from March to June 2020 at the Poznan University of Medical Sciences by teachers who had started working on e-learning resources in 2019 and are successfully implementing these in the educational offer made available to their students as part of various curricula. (shrink)

Medical Humanities the journal started life in 2000 as a special edition of the JME. However, the intellectual taproots of the medical humanities as a field of enquiry can be traced to two developments: calls made in the 1920s for the development of multidisciplinary perspectives on the sciences that shed historical light on their assumptions, methods and practices; refusals to assimilate all medical phenomena to a biomedical worldview. Medical humanities the term stems from a desire to (...) situate the significance of medicine as a product of culture. But despite growing usage over half a century the term defies a unifying encapsulation and continues to conjure up a multitude of discourse communities, including scholars working at the interfaces of health and humanities, arts and health, and medical education and bioethics. The field is intellectually capacious and polymorphous, forming and reforming around critical new research questions and teaching tasks spanning disciplines. (shrink)

HIV stigma, a social-medical problem, continues to confound researchers and health professionals, while undermining outcomes. Empathy may reduce stigma; its absence may predict stigma. This research investigates: How does Kafka’s _Metamorphosis_ advance understandings of HIV stigma in medical health education? _Metamorphosis_ amplifies the sociological-relational mechanisms fostering HIV stigma. It offers a multi-disciplinary, responsive space for ethical, humanistic and clinical inquiry to meet: enabling students to consider how social structures shape health inequities, moral, social experience, and their professional (...) identity within. _Metamorphosis_ may ultimately promote medical health humanities’ social mission—allowing literature to unfold such revelations towards greater equity in health. (shrink)

Eduard Seidler sets his discussion of the teaching of medical ethics in the Federal Republic of Germany against an historical background. Immediately after the Second World War the freshness of the memory of the 'Nuremberg Medical Trials' influenced the way in which moral dilemmas were treated in Germany. At the present time no systematic instruction in medical ethics is provided in either undergraduate or postgraduate or continuing medical education. As a result of this, an (...) inquiry was set up in 1977/78. Questionnaires were sent out with a view to collecting information on how subjects referring to medical ethics are treated during medical training. The inquiry showed that no special discipline can claim to be the only competent one for medical ethics, but that everyone has something to contribute. Dr Seidler concludes by stating that basic curricula related to the problems of medical ethics would have to be developed and should be carried on continuously within the training programme. (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)

Medical conferences are organised by professional bodies with a view to providing an opportunity of continuing medical education and improving the practices of medical professionals. Of late these events have degenerated into entertainment extravaganzas and no longer remain pure academic exercises. This article discusses the possible reasons behind the current state of decay and mechanisms to improve the state of affairs.

For medical schools, the COVID-19 pandemic necessitated examination and curricular restructuring as well as significant changes to clinical attachments. With the available evidence suggesting that medical students’ mental health status is already poorer than that of the general population, with academic stress being a chief predictor, such changes are likely to have a significant effect on these students. This online, cross-sectional study aimed to determine the impact of COVID-19 on perceived stress levels of medical students, investigate possible (...) contributing and alleviating factors, and produce recommendations for medical schools to implement during future healthcare emergencies. The majority of respondents reported levels of stress ranging from moderate to extreme. Higher levels of stress were significantly associated with female gender and international status. A significant association was also noted between reported stress and the transition to online learning and online assessment formatting, concerns for personal health and for the health of family members. Students who reported higher stress levels were less confident in their government’s management of the crisis. Additionally, students who reported lower stress agreed highly that their medical school had an appropriate response to the crisis, had provided sufficient information regarding the crisis, that they trust their school in handling the continuing of their education and that their school had appropriate plans in place to support the continuing of education. (shrink)

Many senior doctors have had little in the way of formal ethics training, but express considerable interest in extending their education in this area. This paper is the report of an initiative in continuing medical education in which doctors were introduced to narrative ethics. We review the theoretical basis of narrative ethics, and the structure of and response to the two-day workshop.

Background International electives are often considered a valuable learning opportunity for medical students. Yet, as travelling to lower and middle income countries (LMICs) becomes more common, ethical considerations of such practices emerge. We conducted a scoping review to assess the extent to which five ethical themes were addressed in existing literature about electives, with the aim of investigating the ethical impacts of medical student electives on local resources, patients and clinicians in LMICs. Methods We systematically searched PubMed, Global (...) Health and Embase databases using the search terms “(ethics) AND (medical electives)”. Thematic content analysis was undertaken using a combination of deductive and inductive themes. The deductive themes included: exceeding clinical competence, use of limited local resources, respect for patients and local culture, collaboration with local community/colleagues, and one-sided benefits in partnership. In addition, we also allowed for emerging themes within the data, and conducted a narrative synthesis of the results. Results A total of 37 papers discussed ethical issues relating to medical student international electives to LMICs. More publications were written from the medical student perspective (n = 14), than by the host-institution (n = 5), with nearly half written from third-party perspectives (n = 18). Negative impacts on local host students and impact upon patient care were identified as additional ethical considerations. Conclusions Our review demonstrated that while there is a degree of awareness in the existing literature of the potential negative impacts of medical electives to local LMIC students’ access to medical education and patient care, continued work is needed to ensure equitable partnerships. We recommend that these ethical themes should be further explored in pre-departure elective teaching courses and post-elective debriefs to increase medical students’ awareness of the impact of their presence on host communities. (shrink)

Empirical research has proven the influence exerted by the medical industry on physicians’ decision-making. Physicians are the gatekeepers who determine how money is spent within the healthcare system. Hence, they are the target group of powerful lobbies in the field, i.e. the manufacturers of medical devices and the pharmaceutical industry. As clinical research lies in the hands of physicians, they play an exclusive and central role in launching new medical products. There are many ethical problems involved here: (...) physicians may develop a mindset of entitlement; biased decisions may put patients at risk; academic interests and research activities will no longer be free if they are influenced considerably by financial incentives; fair resource allocation may be restricted. An aspect that has been neglected so far is the administrators’ involvement as they not rarely expect physicians to acquire external financial resources from industry as benefits often lie with the institutions. To “protect” physicians from undue sway may be in the best interest of patients in order to guarantee a fair allocation of resources and to prevent the application of technologies (and medications) that would not have been used according to current standards of care. The latter may and obviously does put patients at risk. On the other hand, medico–industrial relations are of great importance. A considerable part of medical progress is driven by private industry. Yet, any co-operation between those who care for patients and industry ultimately has to serve the patient. Hence, strong policies to guide conduct are sorely needed. The following points are held to be pivotal in order to secure ethical conduct: (1) professional codes of ethics; (2) a stronger academic attitude amongst medical staff, (3) rules of transparency for medico−industrial relations including online disclosure and limiting scale of payments, (4) establishing rules (and laws) that ban unethical conduct and mandate vigorous surveillance of adherence to guidelines. (shrink)

The Medical Innovation Bill continues its journey through Parliament. On 23 January 2015, it was debated for the final time in the House of Lords and with one final amendment, the House moved to support the Bill, which then moved to the House of Commons on 26 January. It will be debated again on 27 February 2015. The Bill’s purpose is to encourage responsible innovation in medical treatment. Although this goal is laudable, it is argued that the Bill (...) is unnecessary and has the potential to undermine the very cause it aims to advance. More useful for encouraging responsible innovation is the continued education of health-care professionals on how the law already supports practitioners who look to improve care through responsible innovation. (shrink)

Obtaining a sufficient amount of measurable and reliable results of student surveys has always posed a challenge for university teams tasked with the provision of the quality of education. This is especially visible at faculties where education is based on the classic classroom-based model, which then transfers to clinical units, hospital wards, and specialist laboratories. The highly unpredictable pandemic situation caused by the SARS-CoV-2 virus raises the bar for the evaluation of didactics. Fortunately, the continuous technological progress in (...) the area of Artificial Intelligence makes it possible to design the implementation of tools that would improve the position of systems for the management of courses of studies. The evaluation survey for didactic classes, as one of the last output data obtained during the process, may finally become a fully recognized source of information about the conducted classes and the teachers themselves. On the other hand, it may become a tool for those surveyed to influence the quality of classes, express their opinion, present suggestions and propositions generally pertaining to changes in the process of education. New information technologies not only make it possible to improve the effectiveness of reaching the recipients, but also provide completely new, very reliable methods of acquisition of credible behaviour, used as integration data in solutions based on machine communication. Using Artificial Intelligence coupled with data may make it possible to use intelligent communication for effective management of the process of surveying – a solution that has so far been used in business, in the form of the so-called bots. As a result, this would lead to an ongoing, fully quantitative and qualitative, assessment of classes. (shrink)

Purpose: To determine motives and attitudes towards life-sustaining treatments by clinical and preclinical medical students. Methods: This was a scenario-based questionnaire that presented patients with a limited life expectancy. The survey was distributed among 455 medical students in preclinical and clinical years. Students were asked to rate their willingness to perform LSTs and rank the motives for doing so. The effect of medical education was then investigated after adjustment for age, gender, religion, religiosity, country of origin, (...) and marital status. Results: Preclinical students had a significantly higher willingness to perform LSTs in all cases. This was observed in all treatments offered in cases of a metastatic oncologic patient and an otherwise healthy man after a traumatic brain injury. In the case of an elderly woman on long-term care, preclinical students had higher willingness to supply vasopressors but not perform an intubation, feed with a nasogastric tube, or treat with a continuous positive air-pressure ventilator. Both preclinical and clinical students had high willingness to perform resuscitation on a twelve-year-old boy with a TBI. Differences in motivation factors were also seen. Discussion: Preclinical students had a greater willingness to treat compared to clinical students in all cases and with most medical treatments offered. This is attributed mainly to changes along the medical curriculum. Changes in reasons for supplying LSTs were also documented. (shrink)

Innovation in ethics pedagogy has continued to evolve and incorporate other forms of storytelling aimed at improving student engagement and learning. The use of bioethics narratives in feature-length films, medical television shows, or short clips in the classroom has a well-established history. In parallel, screenplays present an opportunity for an active approach to ethical engagement. We argue that screenplays and screenwriting provide a rich supplement to current medical ethics teaching and serve as a strong form of reflective learning.

To incorporate medical ethics into clinical practice, it must first be understood and valued by health care professionals. The recognition of this principle led to an expanding and continuing educational effort by the ethics committee of the Vancouver General Hospital. This paper reviews this venture, including some pitfalls and failures, as well as successes. Although we began with consultants, it quickly became apparent that education in medical ethics must reach all health care professionals—and medical students (...) as well. Our greatest successes came in the formative years of a medical career (ie, in medical school and residency training programmes), but other efforts were not wasted, particularly among nurses and other health care professionals.Although this is a personal review of the experience in one institution, the lessons learnt in Vancouver are applicable to the further development of medical ethics in the UK. (shrink)

During their educational life, medical students encounter several challenges, the origins and causes of which vary. This paper explores and attempts to scrutinize two of these challenges, before eventually introducing the concept of responsibility. First, this paper describes the general characteristics of medical schools, medical students, and medical education. Second, two different ethical challenges that medical students confront are then delineated: the anxiety of continuously questioning ‘while being trained, do I cause patients to receive (...) suboptimal health care?’ and occasionally feeling obligated, consequently, to breach the ethical boundaries to practice procedures on patients. Finally, the faculty of responsibility and its components are introduced and discussed as a model that can overcome these ethical challenges. (shrink)