Case-based knowledge and ethics education: improving learning and transfer through emotionally rich cases

Gelingende Ethik-Lehre in der Medizin. Erkenntnisse aus der Lehrforschung

Die Frage nach den Faktoren, die eine wirksame Ethik-Lehre in der Medizin ausmachen, blieb bislang weitgehend unbeantwortet. Vor allem im deutschsprachigen Raum wird hier zu wenig Forschung betrieben. Aufgrund fehlender wissenschaftlich aussagekräftiger Evaluationsstudien lässt sich somit mitunter nur vermuten, wie wirksam bestimmte Lehrformate und -methoden in der Ethik-Lehre tatsächlich sind. Die Auswahl von Lehrformaten und -methoden, die Ethik-Dozierende für das Erreichen eines festgelegten Lernziels einsetzen, wird häufig nicht nach evidenzbasierten Kriterien, sondern auf der Grundlage von guten oder schlechten Lehrerfahrungen sowie von unmittelbarem Feedback der Studierenden getroffen. Im vorliegenden Beitrag werden nach einem kurzen Überblick über Evaluationsverfahren ethischer Kompetenzen Erkenntnisse aus ausgewählten internationalen Wirksamkeitsstudien vorgestellt und auf ihre Relevanz für den Medizinethik-Unterricht diskutiert. Wenngleich die Erkenntnisse aus diesen Evaluations- und Meta-Studien aus anderen, angrenzenden Bereichen wie der Forschungsethik und anderen Lehrkontexten kommen, so können sie doch als Diskussionsanstoß dienen und dazu beitragen, Eckpunkte für die Gestaltung wirksamer Ethik-Lehre in der Medizin im deutschsprachigen Raum zu definieren.

A Multi-level Review of Engineering Ethics Education: Towards a Socio-technical Orientation of Engineering Education for Ethics

This paper aims to review the empirical and theoretical research on engineering ethics education, by focusing on the challenges reported in the literature. The analysis is conducted at four levels of the engineering education system. First, the individual level is dedicated to findings about teaching practices reported by instructors. Second, the institutional level brings together findings about the implementation and presence of ethics within engineering programmes. Third, the level of policy situates findings about engineering ethics education in the context of accreditation. Finally, there is the level of the culture of engineering education. The multi-level analysis allows us to address some of the limitations of higher education research which tends to focus on individual actors such as instructors or remains focused on the levels of policy and practice without examining the deeper levels of paradigm and purpose guiding them. Our approach links some of the challenges of engineering ethics education with wider debates about its guiding paradigms. The main contribution of the paper is to situate the analysis of the theoretical and empirical findings reported in the literature on engineering ethics education in the context of broader discussions about the purpose of engineering education and the aims of reform programmes. We conclude by putting forward a series of recommendations for a socio-technical oriented reform of engineering education for ethics.

Engineering Students as Co-creators in an Ethics of Technology Course

Research on the effectiveness of case studies in teaching engineering ethics in higher education is underdeveloped. To add to our knowledge, we have systematically compared the outcomes of two case approaches to an undergraduate course on the ethics of technology: a detached approach using real-life cases and a challenge-based learning (CBL) approach with students and stakeholders acting as co-creators (CC). We first developed a practical typology of case-study approaches and subsequently tested an evaluation method to assess the students' learning experiences (basic needs and motivation) and outcomes (competence development) and staff interpretations and operationalizations, seeking to answer three questions: (1) Do students in the CBL approach report higher basic needs, motivation and competence development compared to their peers in the detached approach? (2) What is the relationship between student-perceived co-creation and their basic needs, motivation and competence development? And (3) what are the implications of CBL/CC for engineering-ethics teaching and learning? Our mixed methods analysis favored CBL as it best supported teaching and research goals while satisfying the students' basic needs and promoting intrinsic motivation and communication competences. Competence progress in other areas did not differ between approaches, and motivation in terms of identified regulation was lower for CBL, with staff perceiving a higher workload. We propose that our case typology model is useful and that as a method to engage students as co-creators, CBL certainly merits further development and evaluation, as does our effectiveness analysis for engineering ethics instruction in general and for case-study approaches in particular.

Applying a Social Constructivist Approach to an Online Course on Ethics of Research

The growing trend of shifting from classroom to distance learning in ethics education programs raises the need to examine ways for adapting best instructional practices to online modes. To address this need, the current study was set to apply a social constructivist approach to an online course in research ethics and to examine its effect on the learning outcomes of science and engineering graduate students. The study applied a pre-test post-test quasi-experimental research design within a framework of a mixed-methods approach. The study compared the learning outcomes of students who participated in a social constructivist online course (N = 175) with those who studied in a conventional online course (N = 170). The data were collected via questionnaires and interviews. The findings indicated that both the conventional and the social constructivist online learners gained knowledge of facts and regulations. Yet, the social constructivist learners were more successful in demonstrating knowledge of practices that are used to establish research ethics, and in understanding the importance of conducting research in a responsible manner. The social constructivist online learners were also more successful in demonstrating awareness of ethical dilemmas, by identifying ethical dilemmas and providing solutions to ethical problems.

A scoping review of the integration of ethics education in undergraduate nursing high-fidelity human simulation-based learning

AIMS AND OBJECTIVES

To systematically assemble, examine and map the extant literature pertaining to the integration of ethics education in high-fidelity simulation-based learning experiences in nursing undergraduate programmes.

BACKGROUND

The value of ethics education for undergraduate nursing students is well established in the literature. Whether high-fidelity human simulation (HFHS) supports the development of ethical reasoning or positively impacts the acquisition of ethical knowledge and reasoning skills in undergraduate nursing students is inconsistently addressed.

DESIGN

A scoping review was conducted using the Arksey and O'Malley framework.

METHOD

CINAHL, ProQuest Nursing & Allied Health Source, ProQuest Dissertations & Theses A&I, MEDLINE, Web of Science, ERIC, Scopus, PsycINFO, and the Joanna Briggs Institute EBP databases were searched for English-language manuscripts published between 2012 and 2020. The PRISMA-ScR was used.

RESULTS

Eight papers that met the inclusion criteria were extracted for this review. Three broad categories were identified: the 'what' in ethics education, the 'how' of ethics education and the 'when' of ethics education in high-fidelity human simulation.

CONCLUSION

The integration of ethics education into simulation-based learning has the potential to positively promote nursing students' ability to develop knowledge of and skills in ethical practice. However, the inclusion of ethics education scenarios in HFHS is a relative new teaching innovation in undergraduate nursing education. As such, there continues to be no consensus on the 'what', 'how' or 'when' of ethics education for best practice in ethics education for undergraduate nursing programmes.

RELEVANCE TO CLINICAL PRACTICE

Quality improvement processes and research studies are needed to determine: the types of ethical dilemmas and debriefing sessions and optimal timing of HFHS ethics simulation in undergraduate nursing education, student support needed for running HFHS, and the learning needs of nurse educators seeking to incorporate ethics within HFHS.

The Effects of Case-Based Teaching in Nursing Skill Education: Cases Do Matter

Nursing skill education plays a very important part for the nursing education. It's necessary to analyze the role of the case-based teaching (CBT) in nursing skill education, to provide insights into the nursing education. The sophomore nursing students who received nursing skill teaching from September 2019 to January 2020 were selected. The students either underwent traditional teaching (control group) or CBT (CBT group) intervention. The objective structure clinical examination (OSCE), autonomous learning ability, questionnaire for effects evaluation of CBT, and student's satisfaction level on CBT were analyzed. A total of 146 participants were included. There were no significant differences in the gender, age and the final exam score as freshman between 2 groups (all P > .05). The OSCE scores and autonomous learning ability in CBT group were significantly higher than that of control group (all P < .05). The most students favored the use of CBT, and most students were satisfied with CBT. CBT is beneficial to improve the nursing skill and comprehensive ability of students, and it's conducive to increase the interest of students, which merits application in nursing education.

Are Emergency Medicine Residents Prepared to Meet the Ethical Challenges of Clinical Practice? Findings from an Exploratory National Survey

BACKGROUND

Although the Accreditation Council for Graduate Medical Education and the American Board of Emergency Medicine require clinical ethics education in residency training, instruction varies widely. We assessed the educational preparedness of trainees in emergency medicine to address ethics challenges common to their field.

METHODS

The survey assessed two outcomes: 1) knowledge of specific ethical challenges and 2) perceived educational preparedness, across five ethics areas: 1) informed consent and decisional-capacity assessment, 2) surrogate decision making, 3) interpretation of advanced directives, 4) withdrawing and/or withholding life support, and 5) presumed consent for emergency treatment. Clinical vignettes, revised through expert panel review and pilot testing, were utilized to evaluate these areas. The final instrument was administered via Web link to emergency medicine residents and recent graduates through adverts within Emergency Medicine Residency Association and Society for Academic Emergency Medicine (SAEM) newsletters and social media platforms. Additionally, targeted e-mails through the Council of Residency Directors in Emergency Medicine, the Clerkship Directors of Emergency Medicine, and the SAEM Ethics Committee listservs encouraged survey distribution. Analyses involved one-way analysis of variance for overall knowledge scores and chi-square tests for categorical outcomes. Multivariable regression models tested associations between respondent characteristics and outcomes.

RESULTS

There were 302 participants of which 34% reported having a dedicated ethics module within their residency curriculum. The mean (±SD) knowledge score was 59.7% (±12.8%); assessing decisional capacity was the most difficult topic for respondents as only 1% both correctly addressed the general issue and identified the correct plan of action. Participants having a dedicated ethics module perceived themselves better prepared, although there was no association between having a dedicated ethics module and knowledge scores.

CONCLUSIONS

Gaps in clinical ethics knowledge appear prevalent among emergency medicine trainees, and few programs have dedicated ethics modules. Greater study is needed to understand and remedy clinical ethics knowledge shortfalls.

Continuous Evaluation in Ethics Education: A Case Study

A great need for systematic evaluation of ethics training programs exists. Those tasked with developing an ethics training program may be quick to dismiss the value of training evaluation in continuous process improvement. In the present effort, we use a case study approach to delineate how to leverage formative and summative evaluation measures to create a high-quality ethics education program. With regard to formative evaluation, information bearing on trainee reactions, qualitative data from the comments of trainees, in addition to empirical findings, can ensure that the training program operates smoothly. Regarding summative evaluation, measures examining trainee cognition, behavior, and organization-level results provide information about how much trainees have changed as a result of taking the ethics training. The implications of effective training program evaluation are discussed.

A Meta-analytic Comparison of Face-to-Face and Online Delivery in Ethics Instruction: The Case for a Hybrid Approach

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.

Single case research methodology: a tool for moral imagination in business ethics

Purpose

Although there are several often-used case research methods for teaching purposes, these cannot be used to conduct scientific research into business ethics, perhaps owing to criticism levelled against it. The precise aim of this work is to expound and argue for its use within the framework of scientific hypothetical-deductive methodology.

Design/methodology/approach

The opportunities offered by this methodological approach, both from an inductive (Eisenhardt, 1989; Dyer and Wilkins, 1991) and a deductive perspective (Yin, 1993; Carson et al., 2000), have been wasted, creating a need for scientific contributions within this area; hence, this study. It was carried on a theoretical approach of the use of single case applied to corporate management based on religion and spirituality inclusion.

Findings

The results obtained indicate that the single-case research method makes it possible to put forward alternative hypotheses to the dominant hypothesis, making contributions to the theory. Concretely, the scientific legitimacy of its use is justified by what it has been called “possibilistic hypothesis” for what it is not necessary to collect a large data or make an empiric research.

Practical implications

In the field of business ethics, these hypotheses (possibilistics) make alternatives stand out that widen the moral responsibility of decision-makers. It implies an open mind for decision-makers and rigorous arguments using just a single case. Reinforce and make them easier based on moral imagination improvement.

Originality/value

The decision process is complex, but in this rich method, the single-case study could permit establishing rigorous and robust decisions easily. The case study is not used widely for management, but this perspective could enrich and increase its use.

Strategies for Teaching Professional Ethics to IT Engineering Degree Students and Evaluating the Result

This paper presents an experience in developing professional ethics by an approach that integrates knowledge, teaching methodologies and assessment coherently. It has been implemented for students in both the Software Engineering and Computer Engineering degree programs of the Technical University of Madrid, in which professional ethics is studied as a part of a required course. Our contribution of this paper is a model for formative assessment that clarifies the learning goals, enhances the results, simplifies the scoring and can be replicated in other contexts. A quasi-experimental study that involves many of the students of the required course has been developed. To test the effectiveness of the teaching process, the analysis of ethical dilemmas and the use of deontological codes have been integrated, and a scoring rubric has been designed. Currently, this model is also being used to develop skills related to social responsibility and sustainability for undergraduate and postgraduate students of diverse academic context.

Six Challenges for Ethical Conduct in Science

The realities of human agency and decision making pose serious challenges for research ethics. This article explores six major challenges that require more attention in the ethics education of students and scientists and in the research on ethical conduct in science. The first of them is the routinization of action, which makes the detection of ethical issues difficult. The social governance of action creates ethical problems related to power. The heuristic nature of human decision making implies the risk of ethical bias. The moral disengagement mechanisms represent a human tendency to evade personal responsibility. The greatest challenge of all might be the situational variation in people's ethical behaviour. Even minor situational factors have a surprisingly strong influence on our actions. Furthermore, finally, the nature of ethics itself also causes problems: instead of clear answers, we receive a multitude of theories and intuitions that may sometimes be contradictory. All these features of action and ethics represent significant risks for ethical conduct in science. I claim that they have to be managed within the everyday practices of science and addressed explicitly in research ethics education. I analyse them and suggest some ways in which their risks can be alleviated.

Are Ethics Training Programs Improving? A Meta-Analytic Review of Past and Present Ethics Instruction in the Sciences

Given the growing public concern and attention placed on cases of research misconduct, government agencies and research institutions have increased their efforts to develop and improve ethics education programs for scientists. The present study sought to assess the impact of these increased efforts by sampling empirical studies published since the year 2000. Studies published prior to 2000 examined in other meta-analytic work were also included to provide a baseline for assessing gains in ethics training effectiveness over time. In total,this quantitative review consisted of 66 empirical studies, 106 ethics courses, 150 effect sizes, and 10,069 training participants. Overall, the findings indicated that ethics instruction resulted in sizable benefits to participants and has improved considerably within the last decade. A number of specific findings also emerged regarding moderators of instructional effectiveness. Recommendations are discussed for improving the development, delivery, and evaluation of ethics instruction in the sciences.

Connecting Past with Present: A Mixed-Methods Science Ethics Course and its Evaluation

We present a graduate science ethics course that connects cases from the historical record to present realities and practices in the areas of social responsibility, authorship, and human/animal experimentation. This content is delivered with mixed methods, including films, debates, blogging, and practicum; even the instructional team is mixed, including a historian of science and a research scientist. What really unites all of the course's components is the experiential aspect: from acting in historical debates to participating in the current scientific enterprise. The course aims to change the students' culture into one deeply devoted to the science ethics cause. To measure the sought after cultural change, we developed and validated a relevant questionnaire. Results of this questionnaire from students who took the course, demonstrate that the course had the intended effect on them. Furthermore, results of this questionnaire from controls indicate the need for cultural change in that cohort. All these quantitative results are reinforced by qualitative outcomes.

The capacity for ethical decisions: the relationship between working memory and ethical decision making

Although various models of ethical decision making (EDM) have implicitly called upon constructs governed by working memory capacity (WMC), a study examining this relationship specifically has not been conducted. Using a sense making framework of EDM, we examined the relationship between WMC and various sensemaking processes contributing to EDM. Participants completed an online assessment comprised of a demographic survey, intelligence test, various EDM measures, and the Automated Operation Span task to determine WMC. Results indicated that WMC accounted for unique variance above and beyond ethics education, exposure to ethical issues, and intelligence in several sensemaking processes. Additionally, a marginally significant effect of WMC was also found with reference to EDM. Individual differences in WMC appear likely to play an important role in the ethical decision-making process, and future researchers may wish to consider their potential influences.

Feelings and ethics education: the film dear scientists

There is an increasing body of evidence that not only cognition but also emotions shape moral judgment. The conventional teaching of responsible conduct of research, however, does not target emotions; its emphasis is on rational analysis. Here I present a new approach, 'the feelings method,' for incorporating emotions into science ethics education. This method is embodied in Dear Scientists, an innovative film that combines humanities with arts and works at the subconscious level, delivering an intense mix of music and images, contrasted by calm narration. Dear Scientists has struck a chord across the science, humanities, and arts communities-a promising sign.

Case-based ethics instruction: the influence of contextual and individual factors in case content on ethical decision-making

Cases have been employed across multiple disciplines, including ethics education, as effective pedagogical tools. However, the benefit of case-based learning in the ethics domain varies across cases, suggesting that not all cases are equal in terms of pedagogical value. Indeed, case content appears to influence the extent to which cases promote learning and transfer. Consistent with this argument, the current study explored the influences of contextual and personal factors embedded in case content on ethical decision-making. Cases were manipulated to include a clear description of the social context and the goals of the characters involved. Results indicated that social context, specifically the description of an autonomy-supportive environment, facilitated execution of sense making processes and resulted in greater decision ethicality. Implications for designing optimal cases and case-based training programs are discussed.