Values and ethics: a collection of curricular reforms for a new generation of physicians

Clinical Curriculum Revolution to Integrity and “Attunity”

Reviewing the history of clinical educational curricula reveals enormous change and progress through successive antiquity up-to the current 21th century. Surely, there are stable fundamental criteria which are pillars in designing any curriculum; however there are torrential inevitable reforms which are important in filling the changeable gaps and fulfilling the ecological and temporal aspects. Over the last 20th century, numerous new paradigms for curricula reforms were constructed to adapt ebullient millennium needs, interactive pedagogical approaches and psychological/sociological learning theories. These reforms fostered clinical practice, integrating core competencies and reflection on designing, and achieving clinical curricula depending on outcome-based models such as clinical competences milestones. On the other hand, systematic approach of Kern’s framework adopts curriculum development through six consecutive interlinked and intersected steps which are refined to eight steps later. Moreover, taking contextual factors into account during curricula planning was evolved in other models such as PRISMS model. Despite all these pearly efforts, there are still caveats about inclusive gaps negligence between education process and overall health system. 3P-6Cs toolkit is deemed a recent novel paradigm that enrolls this role of health systems in clinical training during curricula design.

The Development of Cognitive and Affective Skills Through a Sexual and Reproductive Health Medical Education Unit

INTRODUCTION

Although better medical training on sexual and reproductive health (SRH) is an unquestionable global need, and recent research has emphasized the importance of SRH education, few studies have presented alternative teaching models to conventional approaches.

AIM

To examine the structure and evaluation of a curricular unit that uses an active teaching and learning strategy, and to evaluate both the cognitive and affective student learning outcomes.

METHODS

This study used retrospective and cross-sectional analyses of a curricular unit with 8 weekly lessons structured into individual activities before the class, group activities monitored in class, feedback, and the development of medical empathy.

MAIN OUTCOME MEASURE

Student performance was evaluated through summative and formative activities. The process was evaluated quantitatively by a questionnaire containing Likert-type and open-ended questions with speech analysis and with categorical evaluation.

RESULTS

The final average of the analyzed group was 7.95 ± 0.5 on a scale of 10. Likert-type assessment (Cronbach's α = 0.86) revealed strong student adherence and, through responses to open-ended questions, positive evaluations of the proposed SRH teaching model. The Jefferson Scale of Physician Empathy showed a high index of self-reported general empathy (117.3 ± 11), with a significantly higher index for female students (P = .019) than male students; however, this gender difference disappeared after the intervention (P = .086).

CONCLUSIONS

The curriculum model was developed and continuously adjusted based on grounded theory for teaching SRH and included both cognitive and affective stimuli; the results showed favorable student evaluation of the unit, and it proved feasible to implement in the time available. de Oliveira R, Montagna E, Zaia V, et al. The Development of Cognitive and Affective Skills Through a Sexual and Reproductive Health Medical Education Unit. Sex Med 2019;7:326-336.

Does Performance on Evidence-Based Medicine and Urgent Clinical Scenarios Assessments Deteriorate During the Fourth Year of Medical School? Findings From One Institution

PURPOSE

The fourth year of medical school (M4) should prepare students for residency yet remains generally unstructured, with ill-defined goals. The primary aim of this study was to determine whether there were performance changes in evidence-based medicine (EBM) and urgent clinical scenarios (UCS) assessments before and after M4 year.

METHOD

University of Michigan Medical School graduates who matched into internship at Michigan Medicine completed identical assessments on EBM and UCS at the beginning of M4 year and 13 months later during postgraduate year 1 (PGY1) orientation. Individual scores on these assessments were compared using paired t test analysis. The associations of academic performance, residency specialty classification, and initial performance on knowledge changes were analyzed.

RESULTS

During academic years 2014 and 2015, 76 students matched into a Michigan Medicine internship; 52 completed identical EBM stations and 53 completed UCS stations. Learners' performance on the EBM assessment decreased from M4 to PGY1 (mean 93% [SD = 7%] vs. mean 80% [SD = 13%], P < .01), while performance on UCS remained stable (mean 80% [SD = 9%] vs. mean 82% [SD = 8%], P = .22). High M4 performers experienced a greater rate of decline in knowledge level compared with low M4 performers for EBM (-20% vs. -4%, P = .01). Residency specialty and academic performance did not affect performance.

CONCLUSIONS

This study demonstrated degradation of performance in EBM during the fourth year and adds to the growing literature that highlights the need for curricular reform during this year.

Humanism, the Hidden Curriculum, and Educational Reform: A Scoping Review and Thematic Analysis

BACKGROUND

Medical educators have used the hidden curriculum concept for over three decades to make visible the effects of tacit learning, including how culture, structures, and institutions influence professional identity formation. In response to calls to see more humanistic-oriented training in medicine, the authors examined how the hidden curriculum construct has been applied in the English language medical education literature with a particular (and centering) look at its use within literature pertaining to humanism. They also explored the ends to which the hidden curriculum construct has been used in educational reform efforts (at the individual, organizational, and/or systems levels) related to nurturing and/or increasing humanism in health care.

METHOD

The authors conducted a scoping review and thematic analysis that draws from the tradition of critical discourse analysis. They identified 1,887 texts in the literature search, of which 200 met inclusion criteria.

RESULTS

The analysis documents a strong preoccupation with negative effects of the hidden curriculum, particularly the moral erosion of physicians and the perceived undermining of humanistic values in health care. A conflation between professionalism and humanism was noted. Proposals for reform largely target medical students and medical school faculty, with very little consideration for how organizations, institutions, and sociopolitical relations more broadly contribute to problematic behaviors.

CONCLUSIONS

The authors argue that there is a need to transcend conceptualizations of the hidden curriculum as antithetical to humanism and offer suggestions for future research that explores the necessity and value of humanism and the hidden curriculum in medical education and training.

Alliance for clinical education perspective paper: recommendations for redesigning the "final year" of medical school

BACKGROUND

Although medical school typically lasts 4 years, little attention has been devoted to the structure of the educational experience that takes place during the final year of medical school.

SUMMARY

In this perspectives paper, we outline goals for the 4th year of medical school to facilitate a transition from undergraduate to graduate medical education. We provide recommendations for capstone courses, subinternship rotations, and specialty-specific schedules, and we conclude with recommendations to medical students and medical schools for how to use the recommendations contained in this document.

CONCLUSIONS

We provide an overview of general competencies and specialty specific recommendations to serve as a foundation for medical schools to develop robust 4th-year curricula and for medical students to plan their 4th-year schedules.

Caring ethics and a Somali reproductive dilemma

The use of traditional ethical methodologies is inadequate in addressing a constructed maternal–fetal rights conflict in a multicultural obstetrical setting. The use of caring ethics and a relational approach is better suited to address multicultural conceptualizations of autonomy and moral distress. The way power differentials, authoritative knowledge, and informed consent are intertwined in this dilemma will be illuminated by contrasting traditional bioethics and a caring ethics approach. Cultural safety is suggested as a way to develop a relational ontology. Using caring ethics and a relational approach can alleviate moral distress in health-care providers, while promoting collaboration and trust between providers and their patients and ultimately decreasing reproductive disparities. This article examines how a relational approach can be applied to a cross-cultural reproductive dilemma.

Medical students hierarchy of values and sense of responsibility

BACKGROUND

Ethical skills and personal values contribute to making students competent and humane physicians. However, there is not much research done on medical students' personal values and sense of responsibility.

PURPOSES

The study was designed to examine differences in personal values and sense of responsibility between medical students and their peers.

METHODS

The students performed demographic survey and reliable tests: Scheler's Value Scale and Responsibility Scale.

RESULTS

Medical students scored higher in responsibility, also in values of hedonism and truth, and scored lower in values of holy, both religion and secularism. They did not differ from the control group in values of vitality, aesthetics, morals, physical fitness as well as strength and stamina.

CONCLUSION

Medical students differ from their peers from other faculties at the level of responsibility and hierarchy of values. They rate higher at such values as hedonism and truth and lower values of holy.

Humanities in undergraduate medical education: a literature review

PURPOSE

Humanities form an integral part of undergraduate medical curricula at numerous medical schools all over the world, and medical journals publish a considerable quantity of articles in this field. The aim of this study was to determine the extent to which the literature on humanities in undergraduate medical education seeks to provide evidence of a long-term impact of this integration of humanities in undergraduate medical education.

METHOD

Medline was searched for publications concerning the humanities in undergraduate medical education appearing from January 2000 to December 2008. All articles were manually sorted by the authors. Two hundred forty-five articles were included in the study. Following a qualitative analysis, the references included were categorized as "pleading the case," "course descriptions and evaluations," "seeking evidence of long-term impact," or "holding the horses."

RESULTS

Two hundred twenty-four articles out of 245 either praised the (potential) effects of humanities on medical education or described existing or planned courses without offering substantial evidence of any long-term impact of these curricular activities on medical proficiency. Only 9 articles provided evidence of attempts to document long-term impacts using diverse test tools, and 10 articles presented relatively reserved attitudes toward humanities in undergraduate medical education.

CONCLUSIONS

Evidence on the positive long-term impacts of integrating humanities into undergraduate medical education is sparse. This may pose a threat to the continued development of humanities-related activities in undergraduate medical education in the context of current demands for evidence to demonstrate educational effectiveness.

The current state of basic medical education in Israel: implications for a new medical school

The recent government decision to establish a new medical school, the fifth in Israel, is an opportune moment to reflect on the state of Basic Medical Education (BME) in the country and globally. It provides a rare opportunity for planning an educational agenda tailored to local needs. This article moves from a description of the context of Israeli health care and the medical education system to a short overview of two existing Israeli medical schools where reforms have recently taken place. This is followed by an assessment of Israeli BME and an effort to use the insights from this assessment to inform the fifth medical school blueprint. The fifth medical school presents an opportunity for further curricular reforms and educational innovations. Reforms and innovations include: fostering self-directed professional development methods; emphasis on teaching in the community; use of appropriate educational technology; an emphasis on patient safety and simulation training; promoting the humanities in medicine; and finally the accountability to the community that the graduates will serve.

Faculty development: yesterday, today and tomorrow

Medical education has evolved to become a discipline in its own right. With demands on medical faculties to be socially responsible and accountable, there is now increasing pressure for the professionalisation of teaching practice. Developing a cadre of professional and competent teachers, educators, researchers and leaders for their new roles and responsibilities in medical education requires faculty development. Faculty development is, however, not an easy task. It requires supportive institutional leadership, appropriate resource allocation and recognition for teaching excellence. This guide is designed to assist those charged with preparing faculty for their many new roles in teaching and education in both medical and allied health science education. It provides a historical perspective of faculty development and draws on the medical, health science and higher education literature to provide a number of frameworks that may be useful for designing tailored faculty development programmes. These frameworks can be used by faculty developers to systematically plan, implement and evaluate their staff development programmes. This guide concludes with some of the major trends and driving forces in medical education that we believe will shape future faculty development.