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Momeni N, Larijani B, Razmi H, Mohammadi F, Mirzazadeh A, Asghari F. Educational content of professional ethics in postgraduate dental education. J Dent Educ 2022; 87:454-461. [PMID: 36464997 DOI: 10.1002/jdd.13149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 10/14/2022] [Accepted: 11/12/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE Inclusion of proper educational content with respect to professional ethics in dental curricula is an important step to achieve objectives of ethics education especially in postgraduate programs when the time and opportunities for explicit instruction of ethics are limited. This study aimed to find and discuss the topics of ethics and professionalism for dental postgraduate programs. METHODS A modified Delphi survey of experts' opinions with three rounds was conducted to establish a consensus on the need to teach professional ethics topics. The topics were identified through a literature review and according to the opinion of the experts. Items scored as highly important by over 80% of the participants in each round of the survey were considered educational needs. RESULTS A total of 154 ethical issues were identified and classified into 29 topical categories to design the initial questionnaire. A consensus was developed on 24 ethics and professionalism topics for inclusion in the professional ethics curriculum for all dental postgraduate programs. CONCLUSIONS Based on the results of this study, the same educational content in professional ethics is needed for all dental residency programs in all specialties. Most of the topics on which experts reached a consensus to be included in the ethics educational content were related to ethical and professional standards of conduct.
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Affiliation(s)
- Nafiseh Momeni
- Department of Medical Ethics, School of Medicine Tehran University of Medical Sciences Tehran Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute Tehran University of Medical Sciences Tehran Iran
- Medical Ethics and History of Medicine Research Center Tehran University of Medical Sciences Tehran Iran
| | - Hasan Razmi
- Dental Research Center, Dentistry Research Institute Tehran University of Medical Sciences Tehran Iran
- Department of Endodontics, School of Dentistry Tehran University of Medical Sciences Tehran Iran
| | - Farnoosh Mohammadi
- Department of Oral and Maxillofacial Surgery, school of Dentistry Tehran University of Medical Sciences Tehran Iran
| | - Azim Mirzazadeh
- Health Professions Education Research Center, School of Medicine Tehran University of Medical Sciences Tehran Iran
| | - Fariba Asghari
- Medical Ethics and History of Medicine Research Center Tehran University of Medical Sciences Tehran Iran
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An Online Ethics Curriculum for Short-Term Global Health Experiences: Evaluating a Decade of Use. Ann Glob Health 2022; 88:74. [PMID: 36072830 PMCID: PMC9414809 DOI: 10.5334/aogh.3716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 07/28/2022] [Indexed: 11/28/2022] Open
Abstract
Background: Medical students and early career healthcare professionals commonly participate in short-term experiences in global health (STEGH). Objective: The authors evaluate the use of a free-to-access, case-based online curriculum addressing ethical issues trainees should consider prior to engaging in STEGH. Methods: Demographic data and feedback on specific cases were collected from 5,226 respondents accessing the online curriculum between November 1, 2011 and October 31, 2021. Feedback on the curriculum included 5-point Likert scale and open-ended responses. Quantitative data were analyzed using standard descriptive statistics. Qualitative data were independently dual coded and analyzed thematically in NVivo. Findings: The curriculum reached respondents from 106 countries. Undergraduate (36%) and graduate (38%) respondents included those from several different professional specialties. Less than a quarter of all of respondents, less than half with previous global health experience, and one-third with planned future global health experiences had received prior global health ethics training. Overall, the curriculum was highly rated; respondents felt it provided necessary tools to improve their thought processes, confidence, and behavior when encountering ethical issues during STEGH. Areas for curriculum improvement include balancing case specificity with generalizability. Conclusion: This curriculum has met a need for accessible introductory global health ethics education and demonstrates successful use of an online platform in case-based ethics learning.
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Boer MCD, Zanin A, Latour JM, Brierley J. Paediatric Residents and Fellows Ethics (PERFEct) survey: perceptions of European trainees regarding ethical dilemmas. Eur J Pediatr 2022; 181:561-570. [PMID: 34430986 PMCID: PMC8821074 DOI: 10.1007/s00431-021-04231-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 07/06/2021] [Accepted: 07/31/2021] [Indexed: 11/23/2022]
Abstract
With an increasingly complex healthcare environment, ethics is becoming a more critical part of medical education. We aimed to explore European paediatric trainees' experiences of facing ethical dilemmas and their medical ethics education whilst assessing their perceptions of ethical dilemmas in current and future practice. The Young Sections of the European Academy of Paediatrics and European Society of Paediatric and Neonatal Intensive Care developed an explorative online survey covering demographics, ethical dilemmas faced and ethics training. The survey was made available in nine languages from November 2019 to January 2020 via newsletters and social media. Participants (n = 253) from 22 countries, predominantly female (82%) and residents (70%), with a median age of 29-years, completed the survey. The majority (58%) faced ethical dilemmas monthly or more frequently. Most ethics training was received by ethics lectures in medical school (81%) and on the job (60%). A disagreement between the healthcare team and patient/family was the most frequently faced moral dilemma (45%); the second was withholding/withdrawing life-prolonging measures (33%). The latter was considered the most challenging dilemma to resolve (50%). Respondents reported that ethical issues are not sufficiently addressed during their training and wished for more case-based teaching. Many have been personally affected by moral dilemmas, especially regarding withholding/withdrawing life-prolonging measures, and often felt inadequately supported.Conclusion: Paediatric trainees face many moral issues in daily practice and consider that training about managing current and future ethical dilemmas should be improved, such as by the provision of a core European paediatric ethics curriculum. What is Known: • Paediatric services are becoming more complex with an increase in ethical dilemmas asking for rigorous training in ethics. • Ethics training is often lacking or covered poorly in both pre- and postgraduate medical education curricula. • Existing ethics training for European paediatric trainees is haphazard and lacks standardisation. What is New: • The PaEdiatric Residents and Fellows Ethics (PERFEct) survey provides insight into the European paediatric trainees' views regarding ethical dilemmas in their current and future practice. • European paediatric trainees report a lack of ethics training during paediatric residency and fellowship. • This study provides content suggestions for standardised medical ethics training for paediatric trainees in Europe.
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Affiliation(s)
- M. C. den Boer
- grid.10419.3d0000000089452978Division of Neonatology, Leiden University Medical Center, Albinusdreef 2, Leiden, The Netherlands ,grid.10419.3d0000000089452978Department of Medical Ethics and Health Law, Leiden University Medical Center, Albinusdreef 2, Leiden, The Netherlands
| | - A. Zanin
- grid.5608.b0000 0004 1757 3470Department of Women’s and Children’s Health, University of Padua, Via Giustiniani, 3-35128 Padua, Italy
| | - J. M. Latour
- grid.11201.330000 0001 2219 0747School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, PL4 8AA UK ,grid.440223.30000 0004 1772 5147Nursing Department, Hunan Children’s Hospital, Changsha, China
| | - J. Brierley
- grid.83440.3b0000000121901201Paediatric Bioethics Centre, University College London, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
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Macpherson I, Arregui M, Marchini L, Giner-Tarrida L. Analysis of moral reasoning in dentistry students through case-based learning (CBL). J Dent Educ 2021; 86:416-424. [PMID: 34796479 DOI: 10.1002/jdd.12830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 10/11/2021] [Accepted: 10/31/2021] [Indexed: 11/10/2022]
Abstract
PURPOSE The aim of this study was to develop a tool to analyze the ethical dimensions during dental students' decision making, by using case-based learning (CBL). METHODS Five clinical scenarios involving ethical aspects addressing different moral dilemmas were selected. The cases were then administered to students during a course on ethics, and the students responded using a narrative technique. To analyze the responses, a criterion inspired by Kohlberg's theory of moral development was used. Subsequently, the data were analyzed statistically, and possible associations between the answers and other variables, such as the student's gender and theoretical knowledge of ethics, were evaluated. RESULTS A total of 260 students participated (182 women and 78 men), and 1300 narratives were analyzed. The reliability of the construct, as tested by the Cronbach's alpha and the homogeneity index, was acceptable (0.7). The validity of the construct was also assessed, suggesting a component analysis. The descriptive analysis suggests a certain tendency to solve moral problems by referring to established norms and laws. Furthermore, the correlation anaylysis suggests the interrelation between dimensions linked to patient integrity and respect for the truth, even though this conclusion is not reflected in the component analysis, which only detects a generic component of moral sensitivity. No significant differences by gender were found in the narratives, nor a strong correlation of the responses with theoretical knowledge on ethics. CONCLUSION CBL through the narrative method on ethical dilemmas is an effective tool for assessing dental students' moral competencies and their possible interactions with other variables.
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Affiliation(s)
- Ignacio Macpherson
- Department of Humanities, Faculty of Humanities, Universitat Internacional de Catalunya, Sant Cugat del Vallés, Spain
| | - María Arregui
- Department of Dentistry, Faculty of Dentistry, Universitat Internacional de Catalunya, Sant Cugat del Vallés, Spain
| | - Leonardo Marchini
- Department of Preventive and Community Dentistry, College of Dentistry and Dental Clinics, University of Iowa, Iowa City, Iowa, USA
| | - Luís Giner-Tarrida
- Department of Dentistry, Faculty of Dentistry, Universitat Internacional de Catalunya, Sant Cugat del Vallés, Spain
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Deng G, Cai W, Yang M, Lio J, Feng C, Ma X, Liang L. Linking doctor-patient relationship to medical residents' work engagement: The influences of role overload and conflict avoidance. BMC FAMILY PRACTICE 2021; 22:191. [PMID: 34560844 PMCID: PMC8464118 DOI: 10.1186/s12875-021-01541-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 09/03/2021] [Indexed: 11/16/2022]
Abstract
Background Chinese residents’ practical work experiences are different from those described in Western studies. To explore potential mechanisms underlying the effects of doctor-patient relationships on medical residents’ work engagement, verifying a posited mediating effect of role overload, and moderating effect of conflict avoidance, in the Chinese context. Methods Based on the conservation of resources theory, a composite model was constructed. This study’s data were collected from four different Chinese tertiary hospitals; 195 residents undergoing regularization training took this survey. Hierarchical moderated and mediated regression analyses were utilized. Results Doctor-patient relationship were found to be positively related to residents’ work engagement (β=0.31, p≤0.001). Role overload partially mediated the effect of these relationships on work engagement, and the moderating role of conflict avoidance in the relationship between doctor-patient relationship and conflict avoidance was negative. Conclusion Maintaining good doctor-patient relationship can prompt residents to increase their engagement in work in order to meet their patients’ needs. Furthermore, role overload has a particular influence in early career stages. Not only is it necessary for residents to gain a sense of recognition and support while they carry out their job responsibilities, especially while dealing with complex doctor-patient relationship, but it is also important to create work environments that can help residents shape their professional competency.
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Affiliation(s)
- Guangwei Deng
- School of Management, Hefei University of Technology, Hefei, Anhui Province, 230009, P.R. China
| | - Wenjun Cai
- School of Management, University of Science and Technology of China, Hefei, P.R. China
| | - Monica Yang
- Robert B. Willumstad School of Business, Adelphi University, Garden City, USA
| | - Jonathan Lio
- Department of Medicine, University of Chicago, Chicago, USA
| | - Chenpeng Feng
- School of Management, Hefei University of Technology, Hefei, Anhui Province, 230009, P.R. China.
| | - Xiaopeng Ma
- Department of General Surgery, the First Affiliated Hospital of University of Science and Technology of China, Hefei, P.R. China
| | - Liang Liang
- School of Management, Hefei University of Technology, Hefei, Anhui Province, 230009, P.R. China
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Hong DZ, Goh JL, Ong ZY, Ting JJQ, Wong MK, Wu J, Tan XH, Toh RQE, Chiang CLL, Ng CWH, Ng JCK, Ong YT, Cheong CWS, Tay KT, Tan LHS, Phua GLG, Fong W, Wijaya L, Neo SHS, Lee ASI, Chiam M, Chin AMC, Krishna LKR. Postgraduate ethics training programs: a systematic scoping review. BMC MEDICAL EDUCATION 2021; 21:338. [PMID: 34107935 PMCID: PMC8188952 DOI: 10.1186/s12909-021-02644-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 03/30/2021] [Indexed: 05/17/2023]
Abstract
BACKGROUND Molding competent clinicians capable of applying ethics principles in their practice is a challenging task, compounded by wide variations in the teaching and assessment of ethics in the postgraduate setting. Despite these differences, ethics training programs should recognise that the transition from medical students to healthcare professionals entails a longitudinal process where ethics knowledge, skills and identity continue to build and deepen over time with clinical exposure. A systematic scoping review is proposed to analyse current postgraduate medical ethics training and assessment programs in peer-reviewed literature to guide the development of a local physician training curriculum. METHODS With a constructivist perspective and relativist lens, this systematic scoping review on postgraduate medical ethics training and assessment will adopt the Systematic Evidence Based Approach (SEBA) to create a transparent and reproducible review. RESULTS The first search involving the teaching of ethics yielded 7669 abstracts with 573 full text articles evaluated and 66 articles included. The second search involving the assessment of ethics identified 9919 abstracts with 333 full text articles reviewed and 29 articles included. The themes identified from the two searches were the goals and objectives, content, pedagogy, enabling and limiting factors of teaching ethics and assessment modalities used. Despite inherent disparities in ethics training programs, they provide a platform for learners to apply knowledge, translating it to skill and eventually becoming part of the identity of the learner. Illustrating the longitudinal nature of ethics training, the spiral curriculum seamlessly integrates and fortifies prevailing ethical knowledge acquired in medical school with the layering of new specialty, clinical and research specific content in professional practice. Various assessment methods are employed with special mention of portfolios as a longitudinal assessment modality that showcase the impact of ethics training on the development of professional identity formation (PIF). CONCLUSIONS Our systematic scoping review has elicited key learning points in the teaching and assessment of ethics in the postgraduate setting. However, more research needs to be done on establishing Entrustable Professional Activities (EPA)s in ethics, with further exploration of the use of portfolios and key factors influencing its design, implementation and assessment of PIF and micro-credentialling in ethics practice.
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Affiliation(s)
- Daniel Zhihao Hong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228 Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Jia Ling Goh
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228 Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Zhi Yang Ong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228 Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Jacquelin Jia Qi Ting
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228 Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Mun Kit Wong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228 Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Jiaxuan Wu
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228 Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Xiu Hui Tan
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228 Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Rachelle Qi En Toh
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228 Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Christine Li Ling Chiang
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228 Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Caleb Wei Hao Ng
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228 Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Jared Chuan Kai Ng
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228 Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Yun Ting Ong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228 Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Clarissa Wei Shuen Cheong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228 Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Kuang Teck Tay
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228 Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Laura Hui Shuen Tan
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228 Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Gillian Li Gek Phua
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857 Singapore
| | - Warren Fong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228 Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857 Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, 16 College Road, Block 6 Level 9, Singapore General Hospital, Singapore, 169854 Singapore
| | - Limin Wijaya
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857 Singapore
- Department of Infectious Diseases, Singapore General Hospital, Outram Road, Singapore, 169608 Singapore
| | - Shirlyn Hui Shan Neo
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Alexia Sze Inn Lee
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Annelissa Mien Chew Chin
- Medical Library, National University of Singapore Libraries, Blk MD6, Centre, 14 Medical Dr, #05-01 for Translational Medicine, Singapore, 117599 Singapore
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228 Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
- Palliative Care Institute Liverpool, Cancer Research Centre, University of Liverpool, 200 London Rd, L3 9TA Liverpool, UK
- Centre of Biomedical Ethics, National University of Singapore, 21 Lower Kent Ridge Rd, Singapore, 119077 Singapore
- PalC, The Palliative Care Centre for Excellence in Research and Education, PalC c/o Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436 Singapore
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Chaffkin J, Wasser T. The Impact of Teaching Internal Medicine Residents About Decision-Making Capacity. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2020; 44:340-343. [PMID: 32232729 DOI: 10.1007/s40596-020-01219-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 03/02/2020] [Indexed: 06/10/2023]
Affiliation(s)
| | - Tobias Wasser
- Yale University School of Medicine, New Haven, CT, USA
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Macpherson I, Roqué MV, Segarra I. Moral dilemmas involving anthropological and ethical dimensions in healthcare curriculum. Nurs Ethics 2020; 27:1238-1249. [PMID: 32347190 DOI: 10.1177/0969733020914382] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Currently a variety of novel scenarios have appeared within nursing practice such as confidentiality of a patient victim of abuse, justice in insolvent patients, poorly informed consent delivery, non-satisfactory medicine outputs, or the possibility to reject a recommended treatment. These scenarios presuppose skills that are not usually acquired during the degree. Thus, the implementation of teaching approaches that promote the acquisition of these skills in the nursing curriculum is increasingly relevant. OBJECTIVE The article analyzes an academic model which integrates in the curriculum a series of specific theoretical concepts together with practical skills to acquire the basic ethic assessment competency. RESEARCH DESIGN The project includes designing two subjects, General Anthropology and Ethics-Bioethics, with an applied approach in the nursing curriculum. The sequential structure of the curriculum in both subjects is constituted by three learning domains (theoretical, practical, and communicative) with different educational strategies. ETHICAL CONSIDERATIONS No significant ethical considerations as this is a discussion paper. FINDINGS The model was structured from the anthropology's concepts and decision-making process, applied to real situations. The structure of the three domains theoretical-practical-communicative is present in each session. DISCUSSION It is observed that theoretical domain fosters the capacity for critical analysis and subsequent ability to judge diverse situations. The practical domain reflected two significant difficulties: students' resistance to internalizing moral problems and the tendency to superficial criticism. The communicative domain has frequently shown that the conflicting points are in the principles to be applied. CONCLUSION We conclude that this design achieves its objectives and may provide future nursing professionals with ethical competences especially useful in healthcare practice. The three domains of the presented scheme are associated with the same process used in decision making at individual levels, where the exercise of clinical prudence acquires particular relevance.
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Firn J, Rui C, Vercler C, De Vries R, Shuman A. Identification of core ethical topics for interprofessional education in the intensive care unit: a thematic analysis. J Interprof Care 2019; 34:453-460. [PMID: 31405312 DOI: 10.1080/13561820.2019.1632814] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Medical educators have not identified effective approaches for interprofessional ethics education of clinicians who work in intensive care units (ICUs), in spite of the fact that ICUs have a high incidence of ethical conflicts. As a first step in designing an interprofessional ethics education initiative tailored to the needs of ICU team members, we interviewed 12 professionals from the medical and surgical ICUs of a tertiary care academic medical center to understand what they know about medical ethics. Respondents were interviewed between November 2016 and February 2017. We used the 'think aloud' approach and realist thematic analysis of the sessions to evaluate the extent and content of interprofessional team members' knowledge of medical ethics. We found wide variation in their knowledge of and facility in applying the principles and concepts of biomedical ethics and ways of resolving ethical conflicts. Ethics education tailored to these areas will help equip critical care professionals with the necessary knowledge and skills to discuss and address ethical conflicts encountered in the ICU. Preventive ethics rounds are one approach for providing real-time, embedded interprofessional ethics education in the clinical setting.
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Affiliation(s)
- Janice Firn
- Center for Bioethics and Social Sciences (CBSSM), University of Michigan Medical School , Ann Arbor, MI, USA
| | - Crystal Rui
- M4101 Medical Science Building I- C Wing, University of Michigan Medical School , Ann Arbor, MI, USA
| | - Christian Vercler
- Center for Bioethics and Social Sciences (CBSSM), University of Michigan Medical School , Ann Arbor, MI, USA
| | - Raymond De Vries
- Center for Bioethics and Social Sciences (CBSSM), University of Michigan Medical School , Ann Arbor, MI, USA
| | - Andrew Shuman
- Center for Bioethics and Social Sciences (CBSSM), University of Michigan Medical School , Ann Arbor, MI, USA
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Stites SD, Clapp J, Gallagher S, Fiester A. Moving beyond the theoretical: Medical students' desire for practical, role-specific ethics training. AJOB Empir Bioeth 2018; 9:154-163. [PMID: 29727598 DOI: 10.1080/23294515.2018.1472149] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND It has been widely reported that medical trainees experience situations with profound ethical implications during their clinical rotations. To address this, most U.S. medical schools include ethics curricula in their undergraduate programs. However, the contents of these curricula vary substantially. Our pilot study aimed to discover, from the students' perspective, how ethics pedagogy prepares medical students for clerkship and what gaps might remain. METHODS This qualitative study organized focus groups of third- and fourth-year medical students. Participants recounted ethical concerns encountered during clerkship rotations and reflected on how their medical school ethics curriculum informed their responses to these scenarios. Transcripts of the focus-group sessions were analyzed using a grounded theory approach to identify common themes that characterized the students' experiences. RESULTS While students' accounts demonstrated a solid grasp of ethical theory and attunement to ethical concerns presented in the clinic, they also consistently evinced an inability to act on these issues given clerks' particular position in a complex learning hierarchy. Students felt they received too little training in the role-specific application of medical ethics as clinical trainees. We found a desire among trainees for enhanced practical ethics training in preparation for the clerkship phase of medical education. CONCLUSION We recommend several strategies that can begin to address these findings. The use of roleplaying with standardized patients can enable students to practice engagement with ethical issues. Conventional ethics courses can focus more on action-based pedagogy and instruction in conflict management techniques. Finally, clear structures for reporting and seeking advice and support for addressing ethical issues can lessen students' apprehension about acting on ethical concerns.
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Affiliation(s)
- Shana D Stites
- a Department of Medical Ethics and Health Policy , University of Pennsylvania
| | - Justin Clapp
- b Department of Anesthesiology and Critical Care , University of Pennsylvania
| | - Stefanie Gallagher
- a Department of Medical Ethics and Health Policy , University of Pennsylvania
| | - Autumn Fiester
- a Department of Medical Ethics and Health Policy , University of Pennsylvania
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Todd EM, Watts LL, Mulhearn TJ, Torrence BS, Turner MR, Connelly S, Mumford MD. A Meta-analytic Comparison of Face-to-Face and Online Delivery in Ethics Instruction: The Case for a Hybrid Approach. SCIENCE AND ENGINEERING ETHICS 2017; 23:1719-1754. [PMID: 28150177 DOI: 10.1007/s11948-017-9869-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 01/02/2017] [Indexed: 06/06/2023]
Abstract
Despite the growing body of literature on training in the responsible conduct of research, few studies have examined the effectiveness of delivery formats used in ethics courses (i.e., face-to-face, online, hybrid). The present effort sought to address this gap in the literature through a meta-analytic review of 66 empirical studies, representing 106 ethics courses and 10,069 participants. The frequency and effectiveness of 67 instructional and process-based content areas were also assessed for each delivery format. Process-based contents were best delivered face-to-face, whereas contents delivered online were most effective when restricted to compliance-based instructional contents. Overall, hybrid courses were found to be most effective, suggesting that ethics courses are best delivered using a blend of formats and content areas. Implications and recommendations for future development of ethics education courses in the sciences are discussed.
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Affiliation(s)
- E Michelle Todd
- Department of Psychology, The University of Oklahoma, Norman, OK, 73019, USA
- Center for Applied Social Research, 201 Stephenson Parkway, Suite 4100, Norman, OK, 73019, USA
| | - Logan L Watts
- Department of Psychology, The University of Oklahoma, Norman, OK, 73019, USA
- Center for Applied Social Research, 201 Stephenson Parkway, Suite 4100, Norman, OK, 73019, USA
| | - Tyler J Mulhearn
- Department of Psychology, The University of Oklahoma, Norman, OK, 73019, USA
- Center for Applied Social Research, 201 Stephenson Parkway, Suite 4100, Norman, OK, 73019, USA
| | - Brett S Torrence
- Department of Psychology, The University of Oklahoma, Norman, OK, 73019, USA
- Center for Applied Social Research, 201 Stephenson Parkway, Suite 4100, Norman, OK, 73019, USA
| | - Megan R Turner
- Department of Psychology, The University of Oklahoma, Norman, OK, 73019, USA
- Center for Applied Social Research, 201 Stephenson Parkway, Suite 4100, Norman, OK, 73019, USA
| | - Shane Connelly
- Department of Psychology, The University of Oklahoma, Norman, OK, 73019, USA
- Center for Applied Social Research, 201 Stephenson Parkway, Suite 4100, Norman, OK, 73019, USA
| | - Michael D Mumford
- Department of Psychology, The University of Oklahoma, Norman, OK, 73019, USA.
- Center for Applied Social Research, 201 Stephenson Parkway, Suite 4100, Norman, OK, 73019, USA.
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Mulhearn TJ, Steele LM, Watts LL, Medeiros KE, Mumford MD, Connelly S. Review of Instructional Approaches in Ethics Education. SCIENCE AND ENGINEERING ETHICS 2017; 23:883-912. [PMID: 27387564 DOI: 10.1007/s11948-016-9803-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 06/20/2016] [Indexed: 05/11/2023]
Abstract
Increased investment in ethics education has prompted a variety of instructional objectives and frameworks. Yet, no systematic procedure to classify these varying instructional approaches has been attempted. In the present study, a quantitative clustering procedure was conducted to derive a typology of instruction in ethics education. In total, 330 ethics training programs were included in the cluster analysis. The training programs were appraised with respect to four instructional categories including instructional content, processes, delivery methods, and activities. Eight instructional approaches were identified through this clustering procedure, and these instructional approaches showed different levels of effectiveness. Instructional effectiveness was assessed based on one of nine commonly used ethics criteria. With respect to specific training types, Professional Decision Processes Training (d = 0.50) and Field-Specific Compliance Training (d = 0.46) appear to be viable approaches to ethics training based on Cohen's d effect size estimates. By contrast, two commonly used approaches, General Discussion Training (d = 0.31) and Norm Adherence Training (d = 0.37), were found to be considerably less effective. The implications for instruction in ethics training are discussed.
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Affiliation(s)
- Tyler J Mulhearn
- Department of Psychology, Center for Applied Social Research, University of Oklahoma, 201 Stephenson Parkway, Suite 4100, Norman, OK, 73019, USA
| | - Logan M Steele
- Department of Psychology, Center for Applied Social Research, University of Oklahoma, 201 Stephenson Parkway, Suite 4100, Norman, OK, 73019, USA
| | - Logan L Watts
- Department of Psychology, Center for Applied Social Research, University of Oklahoma, 201 Stephenson Parkway, Suite 4100, Norman, OK, 73019, USA
| | - Kelsey E Medeiros
- Department of Psychology, Center for Applied Social Research, University of Oklahoma, 201 Stephenson Parkway, Suite 4100, Norman, OK, 73019, USA
| | - Michael D Mumford
- Department of Psychology, Center for Applied Social Research, University of Oklahoma, 201 Stephenson Parkway, Suite 4100, Norman, OK, 73019, USA.
| | - Shane Connelly
- Department of Psychology, Center for Applied Social Research, University of Oklahoma, 201 Stephenson Parkway, Suite 4100, Norman, OK, 73019, USA
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Kesselheim JC, Najita J, Morley D, Bair E, Joffe S. Ethics knowledge of recent paediatric residency graduates: the role of residency ethics curricula. JOURNAL OF MEDICAL ETHICS 2016; 42:809-814. [PMID: 27884969 DOI: 10.1136/medethics-2016-103625] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 09/08/2016] [Accepted: 09/27/2016] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To evaluate the relationship between recently trained paediatricians' ethics knowledge and exposure to a formal ethics or professionalism curriculum during residency. METHODS We conducted a cross-sectional survey of recently trained paediatricians which included a validated 23-item instrument called the Test of Residents' Ethics Knowledge for Pediatrics. The sample included paediatricians who completed medical school in 2006-2008, whose primary specialty was paediatrics or a paediatric subspecialty, and who completed paediatric residency training in 2010-2011. This sample was stratified based on residency programme variables: presence of a formal curriculum in ethics or professionalism, programme size and American Board of Pediatrics certifying exam passage rate. Paediatricians were randomly selected from each stratum for survey participation. RESULTS Among the 370 responding paediatricians (55%), the mean knowledge score was 17.3 (SD 2.2) out of a possible 23. Presence of a formal curriculum in ethics and/or professionalism was not significantly associated with knowledge. Knowledge was lowest on items about parental requests for a child to undergo genetic testing (2 items, 44% and 85% incorrect), preserving patient confidentiality over email (55% incorrect), decision-making regarding life-sustaining technologies (61% incorrect), and decision-making principles such as assent and parental permission (2 items, 47% and 49% incorrect). CONCLUSIONS This study highlights several areas in which paediatricians' knowledge may be low and that are amenable to targeted educational interventions. These findings should prompt discussion and research among ethicists and educators about how ethics and professionalism curricula can more consistently influence paediatricians' knowledge.
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Affiliation(s)
- Jennifer C Kesselheim
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Julie Najita
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute and Department of Biostatistics Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Debra Morley
- Department of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Elizabeth Bair
- Department of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Steven Joffe
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Fronek P, Kendall MB. The impact of Professional Boundaries for Health Professionals (PBHP) training on knowledge, comfort, experience, and ethical decision-making: a longitudinal randomized controlled trial. Disabil Rehabil 2016; 39:2522-2529. [PMID: 27737566 DOI: 10.1080/09638288.2016.1236152] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE A randomized controlled trial was conducted to evaluate the impact of Professional Boundaries for Health Professionals (PBHP) training program on the knowledge, comfort, experience, and ethical decision-making of multidisciplinary practitioners facing client-practitioner boundary dilemmas. METHODS In all, 36 rehabilitation practitioners from an Australian state-wide spinal cord injuries service were assigned to experimental and control groups. The Boundaries in Practice (BIP) Scale measured outcomes at four points: pre, post, 3 months, and 1 year. The control group received the training after 3 months. Nonparametric Friedman's two-way analysis of variance was used to examine the trajectories over time. RESULTS Analysis was conducted using the data of 10 experimental and 13 control group participants who responded at four data collection points. The experimental group showed significant improvement in knowledge (χ2 = 10.673, p = 0.014) and comfort (χ2 = 9.727, p = 0.021) managing professional boundaries post-training. The control group showed no significant change in knowledge or comfort. No significant change was seen in experience across either experimental (χ2 = 3.609, p = 0.307) or control group (χ2 = 7.800, p = 0.050). Ethical decision-making improved in the control group (χ2 = 13.188, p = 0.004) following training, however remained unchanged in the experimental group. CONCLUSIONS The findings do not definitively support this training approach. Ethical decision-making may improve more substantially within the practice context and organizational culture change. Multifaceted approaches are indicated. Implications for Rehabilitation Ethical dilemmas related to boundaries between clients and practitioners are a frequent occurrence in the rehabilitation setting. In a relatively small sample, the current randomized trial provided inconclusive evidence on the benefit of a 1-day needs-oriented training program to improve knowledge, comfort, and ethical decision-making. Randomized trials of education and training for rehabilitation practitioners are fraught with challenges in the clinical environment of the rehabilitation setting. Multifaceted training approaches, management support and training as well as changes to policy and organizational context in the rehabilitation setting may be needed to more holistically address the issues surrounding professional boundaries in the rehabilitation setting.
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Affiliation(s)
- Patricia Fronek
- a School of Human Services and Social Work, Griffith University, Gold Coast Campus , Southport , QLD , Australia.,b Menzies Health Institute Queensland, Griffith University , Gold Coast , QLD , Australia
| | - Melissa B Kendall
- c Transitional Rehabilitation Program, Queensland Spinal Cord Injuries Service , Princess Alexandra Hospital, Metro South Health , Brisbane , QLD , Australia.,d School of Human Services and Social Work, Griffith University , Logan Campus , Meadowbrook , QLD , Australia
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Steele LM, Mulhearn TJ, Medeiros KE, Watts LL, Connelly S, Mumford MD. How Do We Know What Works? A Review and Critique of Current Practices in Ethics Training Evaluation. Account Res 2016; 23:319-50. [DOI: 10.1080/08989621.2016.1186547] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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